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Welcome to Medicare Heads Up, a regular feature intended to deliver state and national Medicare-related headlines that will keep consumers abreast of developments that affect their coverage and costs. This week:
As Medicare Advantage plans continue to grow in popularity and in supplemental benefits, an increasing number of the plans have $0 premiums (Medicare Advantage enrollees still have to pay their Part B premium, even if the Advantage plan is free). The number of insurers offering Medicare Advantage plans with little or no premiums for 2020 has increased to 49 percent of the market, up from 45 percent last year with 1,724 plans listing a monthly premium of $0, and 910 plans under $50.
UnitedHealthcare will be prevented from offering its Care Improvement Plus Medicare Advantage-Prescription Drug plan to new members for 2020, due to failure to meet federal loss ratio laws. The contracted loss ratio regulations, established by the Affordable Care Act, require Medicare Advantage insurers to spend a minimum of 85 percent of revenue (from the government and from enrollees’ premiums) on medical care and quality improvements for enrollees. Care Improvement Plus policies are sold in Florida, Georgia, Kansas, New Hampshire, New Jersey, Ohio, Oklahoma, Texas, and Virginia, and their total membership amounts to less than 1 percent of UnitedHealthcare’s 6 million Medicare Advantage members. The CMS sanctions prohibit 2020 sign-ups of new enrollees in Care Improvement Plus plans, but existing enrollees can keep their coverage for 2020.
In a recent executive order and budget proposal, the Trump administration has called for expanding the use of Medicare Savings Accounts (MSAs) and potentially opening these accounts up to allow enrollees to make contributions – as opposed to the current rules, which only allow the enrollee’s Medicare Advantage insurer to contribute to the account. Similar to their tax-advantaged cousins the Health Savings Accounts (HSAs), which work with high-deductible health plans, MSAs are specifically designed to use with high-deductible Medicare Advantage plans (Part C). The Trump budget would change the contribution rules and allow enrollees to contribute directly, a move seen by critics as a tax shelter benefitting the wealthiest seniors. Currently, only 6,000 Medicare beneficiaries use MSAs.
Humana, BCBS, and UnitedHealthcare gobbled up 59 percent of Medicare Advantage enrollees in 2019. As enrollees in Medicare Advantage have rapidly increased, (doubling in the last 10 years to over 22 million) insurers have raced to get a piece of the lucrative market. Although startups are on the rise, the concentration of market share held by these top three has fueled a fierce competition for in-network facilities and corporate America’s retirees.
In a recent list of proposed efficiency changes, CMS outlined strategies to battle fraud and improve “payment accuracy,” by moving records and billing reviews from humans to AI technology. Due to the vast numbers of documents, only 1 percent of current submissions are reviewed, which allows fraudsters plenty of opportunities to manipulate the publicly funded program. The most recent numbers from 2018, show 5 percent of total Medicare costs ($30.8 billion) were deemed improper payments.
The change to zero-dollar premiums may indicate how valuable Medicare Advantage enrollees are for insurers. The average profit margin for Medicare Advantage plans stood at $1,608 per enrollee between 2016 and 2018 – roughly double the average profit margins for enrollees in individual ($779 per enrollee) or group ($855 per enrollee) plans.
When Medicare launched a behavioral health program to prevent the onset of type 2 diabetes in 2018, the expectations were big: 25 percent of seniors are impacted by diabetic conditions. The results, though, show little engagement, with only 157 participants listed for CMS’ Medicare Diabetes Prevention Program (MDPP); other numbers reported a 2020 range of 200 to 400 participants. MDPP consists of a 16-week core curriculum focused on exercise, nutrition, and behavior. Critics point to poor advertising, little provider involvement, and also the possibility that lifestyle-focused care has yet to gain public traction. Medicare reported $42 billion in extra costs for diabetic beneficiaries in 2016.
A majority of Medicare Advantage plans available for 2020 include dental benefits (88%) and vision coverage (87%), such as eye exams or glasses. Traditional Medicare does not cover most dental or vision care services, leaving all costs to beneficiaries. The issue has found voice in the 2020 Democratic field, with Bernie Sanders proposing Medicare include dental and vision as part of a universal expansion plan.
Jesse Migneault is a journalist and editor who has written about business, government and healthcare – including public and private-payer health insurance. His articles have appeared in HealthPayerIntelligence, the Hartford Courant, Portsmouth Herald, Seacoastonline.com, Foster’s Daily Democrat, and York County Coast Star.
In addition, his work has been cited by health industry stakeholders such as the Eugene S. Farley Health Policy Center, Association of Healthcare Journalists, American Academy of Actuaries, Kaiser Permanente, blueEHR, San Diego Law Review, Medicare Agent News, healthjournalism.org, and Concierge Medicine among others.