Medicare Watch

Medicare Private Health Plan Options Remain Robust and Include New Consumer Protections

In 2011, premiums for Medicare private health plans, also known as Medicare Advantage (MA) plans, will remain stable and decrease one percent on average, according to information released by the Centers for Medicare & Medicaid Services (CMS) on Tuesday, September 21. CMS officials said that this year, the agency more closely scrutinized plan bids using new authority granted to CMS in the Affordable Care Act, and implemented new requirements in regulations released last April to assure that out-of-pocket costs were kept down. For example, as a result of the regulations, MA plans must include as part of the benefit package a Mandatory Out-of-Pocket Limit (MOOP), after which plans must cover the full costs of Medicare-covered services through the end of the year. The MOOP for 2011 is $6,700, but plans may offer an optional lower MOOP. CMS has also simplified the process of choosing a plan by consolidating duplicative plans offered by the same sponsor. Individuals in plans that CMS determined to be duplicative will be automatically enrolled in new plans that offer essentially equivalent benefits and are administered by the same plan sponsor.

While there had been concern before Tuesday’s release about the availability of plans, the data predict that 99.7 percent of all people with MA plans in 2010 will have access to MA plans in 2011.

Read Medicare Rights Center President Joe Baker’s statement about the MA landscape in 2011.

Read CMS’s press release on the Medicare Advantage landscape in 2011.

Read state profiles of MA and Part D plan availability in 2011.

Read the MA and Part D plan landscapes, including premium information, in 2011.

Health Reform Turns 6 Months

Health reform is six months old today. There has already been significant progress in implementing the Affordable Care Act (ACA) since it was signed into law on March 23. Over one million people who entered the Medicare prescription drug coverage gap this year have already received a $250 rebate check. In May, the Centers for Medicare & Medicaid Services (CMS) released guidance to prescription drug plans on how they are to administer the 50 percent discount on brand-name drugs during 2011, a major step toward closing the coverage gap by 2020. Also this summer, CMS released a proposed rule that eliminates cost-sharing for certain preventive services and provides coverage of a new annual wellness visit to develop and update personalized prevention plans and monitor Medicare patients’ health.

In addition, the government has taken immediate action, using its new authority granted in the ACA, to crack down on fraud, waste and abuse in Medicare. Today CMS published a proposed rule in the Federal Register that includes stricter screening requirements for providers who participate in Medicare, and will require certain providers in groups that represent the highest risk for fraud to undergo background checks. The purpose of these provisions is to stop fraud before it happens rather then “pay and chase” fraudulent providers to recoup Medicare funds.

While much has been accomplished, there is more work in the coming months and years. To learn more about health reform and future changes read Medicare Rights Center’s health reform materials.

Read CMS’s guidance to prescription drug plans on the gap discount.

Read Vice President Joe Biden’s announcement on the 50 percent discount.

Read about CMS’s proposed rule on preventive services published June 2010.

Read CMS’s proposed rule on fraud published today.

Medicare Reminder

While the vast majority of people with Medicare get their health coverage from Original Medicare, some people get their benefits from a Medicare private health plan, sometimes called a “Medicare Advantage” plan.

These private health plans contract with Medicare and are paid a fixed amount to provide Medicare benefits. The most common types are HMOs, PPOs and PFFS plans.

You still have Medicare if you join a Medicare private health plan. In most cases, you must still pay your Part B monthly premium (and your Part A premium, if you have one). The plan must provide all Part A and Part B services but can do so with different rules, costs and restrictions, which can affect how and when you can get care.

Learn more about Medicare private health plans and what you will pay in a private plan at www.MedicareInteractive.org.

Spotlight

The Kaiser Family Foundation launched this week a new online tool to explain and analyze health reform. Called the “Health Reform Source,” the tool features video clips, a daily news feed and an interactive timeline of reform. New features will be added as the law is implemented.

Visit the Health Reform Source.

Watch a video on health reform basics.