For enrollment in a Medicare Advantage plan for the first time or when switching plans, members have several options. These Part C replacement plans are approved by Medicare but are sponsored by private insurance companies. They cover most of the same items outlined in Original Medicare’s Part B and Part A provisions. With this type of plan, the federal government gives money to the private insurance companies for every covered Medicare member, and the payments are adjusted based on the health status of members. The following top insurance providers offer Medicare Advantage plans:
Major adjustments can happen each year, and it is important for plan members to learn about them. When it comes to local and state-based modifications of Medicare Advantage plans, these vary widely and may even vary from one zip code to another within a city. Eligible adults should request information about new rules to help them pick the right first plan or switch to a plan that better meets their individual needs. The following paragraphs cover recent modifications that will affect all plans across the country.
Insurer payment rates will rise by an average of 0.25 percent. However, overall costs may still be closer to the proposed rate when other policy changes are considered. When plan coding differences are added to that equation, the average Medicare Advantage payment rate will rise by about 3.05 percent. This number is still less than the predicted overall cost earlier.
For a Medicare Advantage policy, the payment rate depends on whether providers use fee-for-service Medicare calculations, beneficiary risk score shifts or other current trends. If a member has one or more chronic conditions, that individual has a higher risk score. When a plan covers such a Medicare-eligible individual, that plan receives a higher payment from the government. The purpose of risk scores is to give plans good incentive to cover Medicare beneficiaries regardless of their health conditions. However, this program experienced some backlash stemming from accusations of foul play with calculating risk scores.
Another change is an introduction of employer-sponsored policy cuts. Originally, these cuts were supposed to take place but will be stretched out over the span of 2 years instead. The CMS suggested termination of the bidding process for unions and employers offering Medicare Advantage plans in early 2016. Their proposal also suggested giving these plans lump-sum payments via bids on a county level. They expect this policy to be completely in force by 2018.
Health plans and insurers were both upset over the proposed policy due to fears of the adjustments possibly forcing them to drop their Medicare Advantage policies. If this happened, more than 3 million people would lose coverage. However, insurers failed to mention the profitability of those plans. According to research, the average 2012 gross profit margin of Advantage plans was 7.2 percent. In comparison, individual plans only had an average profit margin of 4.4 percent. With this new program and its gradual shift, plans and employers will have time to brace for modifications and adjust according. Also, this big change will save the program billions of dollars.
This data is associated with risk score. The CMS plans to scale back its collection and use of such data. However, it did release a timeline with the expected time frame for using the data. Scores will eventually be based completely on encounter data, which is associated with claims instead of traditional fee-for-service structures. There will be an even split for, and all scores will use encounter data by 2020. Using this data contributes to lower payments.
For plans with higher enrollment of dual-eligible seniors, there will be higher payments. This includes seniors who are eligible for both Medicaid and Medicare due to low income. For plans with a presence in Puerto Rico, this change is especially beneficial.
CignaCorp’s Medicare plan was bailed out by CMS to prevent major cuts that would have affected bonus payments. This also resulted in the decision to not alter star ratings of other plans facing sanctions due to poor compliance.
Seniors who are looking for anything from no monthly premium to generous coverage can find a variety of plans from the leading providers. These are some of the top benefits of the major Medicare Advantage plan providers:
When you are ready to shop for the best plan, use our side-by-side comparison tool to view the available Advantage plans in your state. Medicare Advantage plans vary by location. If you just moved, a plan with the same name in your new location may not offer the same benefits as your last plan. With our fast and free search tool, you can view all of the available plans in your state and what they offer.