Medicare Advantage PFFS 2010 and Beyond

[Graham]

Just had Cigna in the office last week going over their 2010 plans and rates for the MA PFFS product. It actually looks pretty good with 270+ $0 premium counties and some nice benefit improvements. There seems to be some real misconceptions out there about what is happening to PFFS after 2010 even on my part until last week. It does not really go away after 2010 just changes to a PFFS networked product. It was pretty interesting...

 

[jdeasy]

Just had Cigna in the office last week going over their 2010 plans and rates for the MA PFFS product. It actually looks pretty good with 270+ $0 premium counties and some nice benefit improvements. There seems to be some real misconceptions out there about what is happening to PFFS after 2010 even on my part until last week. It does not really go away after 2010 just changes to a PFFS networked product. It was pretty interesting...

Can you tell me the difference between a PFFS with a network and PPO?

 

[policy doctor]

I was wondering the same...lol

 

[LoriRutl]

Can you tell me the difference between a PFFS with a network and PPO?

Humana is calling it a "modified PFFS". I don't know what the difference is. Sounds like a PPO to me.

 

[jdeasy]

Humana is calling it a "modified PFFS". I don't know what the difference is. Sounds like a PPO to me.

It is a PPO. The only time is won't be a PPO is in a county where there is only one PFFS. Those counties don't have to have a network. Is there any county in the US with only one MA provider?

If there is, they will leave the building.

 

[LoriRutl]

It is a PPO. The only time is won't be a PPO is in a county where there is only one PFFS. Those counties don't have to have a network. Is there any county in the US with only one MA provider?

If there is, they will leave the building.

Not in my state.

 

[jdeasy]

Not in my state.

There are a few counties here in Ky whre the only PFFS plans are Coventry, Wellcare, Pyramid and Humana. Coventry and Wellcare are done at the end of this year. That will leave Pyramid and Humana for next year. I can't see that Pyramid will develop networks in 2010 for those counties. So, when they exit, Humana will be free to have a PFFS in those counties since they will be alone. They will be able to charge whatever they want.

They charge $148/mo now in some of those counties for their PFFS MAPD.

 

[LoriRutl]

There are a few counties here in Ky whre the only PFFS plans are Coventry, Wellcare, Pyramid and Humana. Coventry and Wellcare are done at the end of this year. That will leave Pyramid and Humana for next year. I can't see that Pyramid will develop networks in 2010 for those counties. So, when they exit, Humana will be free to have a PFFS in those counties since they will be alone. They will be able to charge whatever they want.

They charge $148/mo now in some of those counties for their PFFS MAPD.

Wow. Our PFFS in Oregon is $49/month. Expected to go to $56 next year. I did check into our PFFS in MD. It is $199 there.

 

[stormtracker]

Can you tell me the difference between a PFFS with a network and PPO?

PFFS with a network is once removed from the ancient HMO. PPO is twice removed. Obama Care is to be third removed.

 

[Graham]

From what I understand essentially there'd be no additional cost for using a provider out of the network--that is, a customer could use any Medicare provider willing to see him/her on a case-by-case, visit-by-visit basis.