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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 1 of 22

For john258

For your reading enjoyment -

 

March 2014 - The Value of Medicare Advantage Employer Group Waiver Plans (MA-EGWPs) for Employers an...

From the link -

"More than 2.7 million retirees receive health insurance coverage from their employer through a Medicare Advantage Employer Group Waiver Plan (MA-EGWP). Like other MA plans, MA-EGWPs cover all Medicare Part A and Part B bene ts, plus supplemental bene ts such as reduced cost sharing and non-Medicare covered health services. CMS waives certain requirements for MA-EGWPs so that they may limit enrollment to only eligible retirees and family members of a retiree and modify rules to meet an employer’s speci c needs such as a uniform plan design and broad national access to providers.

 

MA-EGWPs are increasingly used by employers and unions to offer comprehensive health coverage for their Medicare-eligible retirees at lower cost than traditional employer retiree coverage. However, recently, policymakers have raised concerns that federal pay- ments to MA-EGWPs exceed those paid to non-EGWP MA plans and have proposed policies that would reduce MA-EGWP payments."

 

Yes, the CMS payment problem for these plans has been going on for a very long time.  MEDPAC has been mentioning the problem in their annual review for several years.  As the CMS link said, they fixed the payment for the Prescription Drug plan (Part D) for these type plans several years ago.  Now they are fixing the MA-EGWP plans.

 

Back to the link -

Avalere found that MA-EGWPs are valued by employers because they:

• Lower employers’ costs and reduce long-term liabilities

• Offer robust coverage that matches or exceeds previous employer coverage

• Include care coordination and disease management programs, providing opportunities to lower costs that are not available in traditional retiree coverage

• Offer plan options that maximize exibilities in coverage for employers and retirees

• Rate high in terms of retiree satisfaction

 

Employers indicated that they are following the discussion on payment changes for these plans and are beginning to factor this into their decisions about long term use of MA-EGWPs. If MA-EGWPs were no longer a cost effective option, employers would likely discontinue offering them to retirees leading to increased costs for employers and signi cant disruption for their retirees. As a result, retirees would likely lose access to care coordination programs, possibly reversing gains in health status and outcome"

 

Now will this change by CMS cause unions/employers to drop them - I don't know.

 

You can read the rest of this Avalere 03/2014 report if you' want - it does give background.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 2 of 22

john258 wrote

 

The way you explained it was not correct and would only further lead a person not to understand it. Please do not give me an item from CMS to back something up. You have to relate items such as you post to the full program to understand what is going on. You have to live and understand what goes on in the real world. There are exceptions to the rules approved all the time. This thread should have never been started as it is based on bad information. Sadly this happens all the time when people read something and do not understand it, then put it up in here as real fact. The end result bad info, and people not familiar with the subject know even less. Let the experts like AARP handle this subject in the classes they give to people, and we will all be better off for it.

-------------------------------------------------------------------

 

Why don't you tell me where I am wrong with how these GROUP Medicare Advantage plans have been paid and how CMS is now modifying this methodology.

 

Seems CMS, the controller of the program, agrees with me.

 

In this case there is no exception to the rule - the change is taking place in all  GROUP Medicare Advantage plans.

 

Personally, I don't think you really understand the difference in these GROUP Medicare Advantage plans and those in the individual MA market.  The explanation which I gave you from CMS describes the difference and why these changes are being made.

 

Yes, those who supply these plans - unions and large enployers - are upset but they have a captive audience (retirees) and thus don't have to compete in the open marketplace of all Medicare Advantage plans.

 

I supplied information about this thread, from a reputable source (CMS ) - 

and this has nothing to do with AARP - they do not have anything to do with GROUP Medicare Advantage plans which come from unions / employers.

 

If you look around here, we discuss a lot of things which aren't related to AARP.

 

May I suggest that you understand the subject of the thread, ask questions or do a little outside reading and research before you just start telling people they don't know what they a talking about - especially when a link is supplied from a very reliable source.


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 3 of 22

afisher

seems you are slightly off topic since the tread concerns GROUP Medicare Advantage plans and not those in the individual Medicare Advantage plan.

 


* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 4 of 22

    The Republicans have had this particular whine since ACA, because it normalized / reduced the federal reimbursement rates to the healthcare insurance companies that sell these policies - aka if people want ME, that may cause the premiums to rise v. insurance companies profits to slightly decrease.  

 

     Republican snowllakes are whining that they shouldn't have to pay more than those who don't have the financial means to buy extra "benefits".   

 

     GOP that want to destroy essential benefits  will be more than happy to see the RW rates go up and the snowflakes here will just have to tough it up....because GOP.    Get sick, die quickly and quietly.  

PRO-LIFE is Affordable Healthcare for ALL .
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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 5 of 22

@GailL1 wrote:

john258

In my reply to rker321, I was explaining to her the reason why CMS is changing the payment methodology to these GROUP Medicare Advantage plans which are Union and employer based retiree Medicare coverage.

 

In my discussion I am only referring to this payment methodology although the changes could affect the actual GROUP beneficiaries by raising their premiums or a modification of any extra benefit ( those benefits which they might receive over and above those which have to be supplied for their Medicare benefit).

 

FROM CMS

Background on Medicare Employer Retiree Plans

Medicare Employee Retiree Plans exclusively serve employer/union groups and are either offered through negotiated arrangements between the Medicare Advantage Organization and employer and/or union groups or offered by the employer and/or union directly. As of 2015, approximately 19 percent of Medicare Advantage beneficiaries were enrolled in these plans.

 

Because of the manner in which Medicare Employer Retiree Plans are structured and marketed, they do not have the same competitive pressure as typical Medicare Advantage plans to submit low bids. The Medicare Payment Advisory Commission (MedPAC) has calculated that, in 2012, margins were substantially higher for Medicare Employer Retiree Plans (7.2%) than for other plans (4.4%). Due to related concerns in the Part D context, CMS discontinued bidding under Part D for Medicare Employer Retiree Plans in 2008 and began paying each Part D Medicare Employer Retiree Plan an administratively-set amount that is based on an average of Part D plan bids in the individual market. This policy extends that approach to Part C.

 

CMS Release 04/04/2016 Medicare Advantage Payments to Medicare Employer Retiree Plans

 

This is is what byrondennis was speaking about in his initial post that started this thread.


The way you explained it was not correct and would only further lead a person not to understand it. Please do not give me an item from CMS to back something up. You have to relate items such as you post to the full program to understand what is going on. You have to live and understand what goes on in the real world. There are exceptions to the rules approved all the time. This thread should have never been started as it is based on bad information. Sadly this happens all the time when people read something and do not understand it, then put it up in here as real fact. The end result bad info, and people not familiar with the subject know even less. Let the experts like AARP handle this subject in the classes they give to people, and we will all be better off for it.

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 6 of 22

Like I said ByronDennis, next time I would appreciate less charts and more simple information that I can understand as a person that is not familiar with the subject. We all know how "knowledgeable"  you are on this subject no need to convince us.

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 7 of 22

john258

In my reply to rker321, I was explaining to her the reason why CMS is changing the payment methodology to these GROUP Medicare Advantage plans which are Union and employer based retiree Medicare coverage.

 

In my discussion I am only referring to this payment methodology although the changes could affect the actual GROUP beneficiaries by raising their premiums or a modification of any extra benefit ( those benefits which they might receive over and above those which have to be supplied for their Medicare benefit).

 

FROM CMS

Background on Medicare Employer Retiree Plans

Medicare Employee Retiree Plans exclusively serve employer/union groups and are either offered through negotiated arrangements between the Medicare Advantage Organization and employer and/or union groups or offered by the employer and/or union directly. As of 2015, approximately 19 percent of Medicare Advantage beneficiaries were enrolled in these plans.

 

Because of the manner in which Medicare Employer Retiree Plans are structured and marketed, they do not have the same competitive pressure as typical Medicare Advantage plans to submit low bids. The Medicare Payment Advisory Commission (MedPAC) has calculated that, in 2012, margins were substantially higher for Medicare Employer Retiree Plans (7.2%) than for other plans (4.4%). Due to related concerns in the Part D context, CMS discontinued bidding under Part D for Medicare Employer Retiree Plans in 2008 and began paying each Part D Medicare Employer Retiree Plan an administratively-set amount that is based on an average of Part D plan bids in the individual market. This policy extends that approach to Part C.

 

CMS Release 04/04/2016 Medicare Advantage Payments to Medicare Employer Retiree Plans

 

This is is what byrondennis was speaking about in his initial post that started this thread.


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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 8 of 22

@GailL1 wrote:

rker321

Perhaps I can shed  a little light on this although I didn't start the thread.

 

We hear from the left, mostly, that the Medicare program pays more to Medicare Advantage plans than what they spend in the traditional program per beneficiary.

Since inception of Medicare Part C, in the 90's, there have been several reasons for this.  To name a few -

1.  To prevent adverse selection of beneficiaries.  That is to say, to keep relatively healthy beneficiaries from choosing a MA plan only to switch to traditional Medicare when they get sick and need lots of care.

2.  To encourage MA insurers to stay in certain marketplaces, specifically in some rural areas where there are fewer providers and health care cost are higher.

 

You see government has limited ways to encourage certain behavior, money enticement being the greatest.

 

In trying to explain byrondennis's original post, another reason why some insurers were paid more was because some Union and employer retiree plans were mixed into this mix of MA insurers, known as groups plans.  So even though these group plans had somewhat of a captive market, they were figuring their plans just like those in the individual MA marketplace and were given these advantages of payments.

 

Most of these type group plans are concentrated in certain heavy unionized state.  Michigan being one of several.  You can reference my KFF link which I posted in this thread if you need a more detailed explanation.

 

This bonus money to these group plans has been known for several years.  MEDPAC has included this in their review of Medicare cost containment for several years.  So it seems that many politicians on the left wanted to cut the amount that was paid per beneficiary to the INDIVIDUAL MA marketplace insurers, they resisted any cost modifications to these GROUP MA plans because of pressure from their union/employer base.

 

In 2016, CMS decided to change how these group plans were paid at much displeasure from these unions and employers with retiree MA GROUP coverage.

These payments per beneficiary whether in the group or individual MA marketplace help to keep down the premiums paid by the beneficiary.  The changes to these group plans are to take place this year (2017) and in (2018).

 

Now how this change in payment model will affect retirees in these group MA plans, I don't know for sure - their premiums could rise or some extra (outside of specific Medicare benefit coverage) benefits might be modified or dropped - but this should place these plans on a more even stance with those MA plans in the individual MA marketplace.

 

I have tried to explain this to my understanding as simply as I can, just hitting the highlights, without links which you requested.

 

 


Here are some comments on your answer.

1. All parts of medicare provide the same basic coverage. MA usually has a closed provider network or preferred provider network. The only reason a person would switch is if a specialist they need is not in their MA network. MA can and do get a rating pool that can be way different from the average Medi Care pool. If MA looses money they cancel that class of plan for next year. If they make money they keep it, and that is the main factor not switching by members.

2. MA are mainly in a city type area. In true rural areas you will not find them. The extra payment to MA was so they could make money. At the start some MA provided nothing more than what regular medi care provided. The MA provided claim service and or provider network only. I was in one like that for about 2 years. They were stopped from doing this by Medi Care. MA can add what ever extra services they want. One you see a lot is free Gym membership, as most of the providers have this service for their other insureds.

3. I am not sure what you are talking about on Byrons post. Most employer employee or Union plans have Medi Care be come the front carrier at age 65 of the person. I went through this. The other plan becomes back up. I am in that type now. Yes it does work. My back up wants people to choose a MA plan if they have one in the area, and the employee cost for that coverage is reduced. Yes they can and do offer choices as there are networks. I have and have always have drug coverage with full coverage (no gap). It is now under medicare but when the gap is reached payment is made by the employer through their normal employee drug coverage. As I have said from day one the best way to handle    ones coverage is to refer them to a local expert who knows their plan and area. There is not one plan for all, and never will be.

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 9 of 22

@byrondennis wrote:

@mickstuder wrote:


I need to apologize in advance for being a Tad off topic - But Just Curious..............................I'm not Bright enough to understand most of the major points in this Post - But

 

Are you speaking - "in the First Person" - either Singular or Plural when you write?

 

1. "are only for cutting the public Part C Medicare Advantage plans poor people like me can buy."

 

2. "the sweet deal union members get that the rest of us poor people are not eligible for."

 

3. "roughly divided between those for we real people and those the left has rigged in its favor."

 

 Again, Just Curious - because I read somewhere that the Average Household Income if you combine all the cities & towns on Cape Cod is - $85,000

 

AND

 

The Average Household Income for all cities & towns in Massachusetts is $68,000 and in fact according to my modest research there are only 6 States out of all 50 where the average household income is higher then Massachusetts

 

Where I come those incomes are not considered POOR

 

And these numbers are from 2010..........................

  


Huh? "Me" is first person singular and "we" is first person plural. Is that your question?

 

Your Cape Cod (and Massachusetts) averages look way wrong but since you provide no source (like almost everyone on this comment board), it's kind of hard to tell you why. Most important are they indexed to cost of living?

 

You're off by 50% or so according to the local Patch (see https://patch.com/massachusetts/beaconhill/heres-what-new-census-data-says-household-incomes-massach...) but I would not put much faith in that information either. Tens of thousands of very rich legal residents of Cape Cod live 6 months a year in Florida and Arizona or somewhere else warm (or go there for three months). Take them out of the average (and out of other demographic measurements like people per square mile, etc.) and you find the rest of us on Cape Cod to be relatively rural and poor... It's not Appalachia mind you... you find that in the Berkshires of Massachusetts when those New York City people go back to Manahattan in September.


Actually I was asking if you consider yourself - poor?

 

 

( " China if You're Listening - Get Trumps Tax Returns " )

" )
" - Anonymous

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 10 of 22

Thank you Gail, your explanation was very clear.

Now for Byrondennis, he should understand that all his knowledge goes to waste when he puts posts that only he or experts on this subject can understand.
He should respect his audience, and provide whatever information in a format that will be understood in this message board. His erudition is quite unnecessary. if it  is expressed correctly.

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