Medicare Advantage

Medicare Advantage Plans Shift Their Financial Risk To Doctors

Oct 9, 2018
iStock

STUART, Fla. — Dr. Christopher Rao jumped out of his office chair. He’d just learned an elderly patient at high risk of falling was resisting his advice to go to an inpatient rehabilitation facility following a hip fracture.

He strode into the exam room where Priscilla Finamore was crying about having to leave her home and husband, Freddy.

“Look, I would feel the same way if I was you and did not want to go to a nursing home, to a strange place,” Rao told her in September, holding her hand. “But the reality is, if you slip at home even a little, it could end up in a bad, bad way.”

After a few minutes of coaxing, Finamore, 89, relented and agreed to go into rehab.

Keeping patients healthy and out of the hospital is a goal for any physician. For Rao, a family doctor in this retiree-rich city 100 miles north of Miami, it’s also a wise financial strategy.

medicare.gov

Open enrollment for Medicare begins October 15 and this year there are lots of changes that will create more health care options for seniors.

A new study finds that health care spending is reduced by about 10 percent when patients using Medicare Advantage and Medicaid managed care plans  are connected to social services to help with things like housing, medical transportation, healthy food programs, and assistance with utility bills.

A trio of health clinics for cash-strapped seniors is opening in Jacksonville this summer.

The primary-care clinics are set to serve as many as 9,000 people.

When Sol Shipotow enrolled in a new Medicare Advantage health plan earlier this year, he expected to keep the doctor who treats his serious eye condition.

"That turned out not to be so," said Shipotow, 83, who lives in Bensalem, Pa.

Shipotow said he had to scramble to get back onto a health plan that he could afford and that his longtime eye specialist would accept. "You have to really understand your policy," he said. "I thought it was the same coverage."

Sen. Grassley Demands Scrutiny Of Medicare Advantage Plans

Apr 19, 2017
Bill Clark/CQ Roll Call

Sen. Chuck Grassley (R-Iowa) wants federal health officials to tighten scrutiny of private Medicare Advantage health plans amid ongoing concern that insurers overbill the government by billions of dollars every year.

A federal judge has ruled against the proposed acquisition of the health insurance company Humana by its larger rival, Aetna.

The decision is a victory for former President Obama's Justice Department, which sued Aetna last year to block the $34 billion merger, NPR's Yuki Noguchi reported.

The suit alleged that the merger would hurt competition in the health care market, leading to higher prices for consumers and fewer services for Medicare patients.

Six years ago, federal health officials were confident they could save taxpayers hundreds of millions of dollars annually by auditing private Medicare Advantage insurance plans that allegedly overcharged the government for medical services.

An initial round of audits found that Medicare had potentially overpaid five of the health plans $128 million in 2007 alone, according to confidential government documents released recently in response to a public records request and lawsuit.

More than three dozen just-released audits reveal how some private Medicare plans overcharged the government for the majority of elderly patients they treated, often by overstating the severity of certain medical conditions, such as diabetes and depression.

Some Seniors Surprised To Be Automatically Enrolled In Medicare Advantage Plans

Jul 27, 2016
Kaiser Health News

Only days after Judy Hanttula came home from the hospital after surgery last November, her doctor’s office called with bad news: Records showed that instead of traditional Medicare, she had a private Medicare Advantage plan, and her doctor and hospital were not in its network.

WellCare

WellCare Health Plans has made an offer for the Medicare Advantage insurance plans that Aetna plans to shed, according to Reuters.

Private Medicare Advantage plans treating the elderly have overbilled the government by billions of dollars, but rarely been forced to repay the money or face other consequences for their actions, according to a congressional audit released Monday.

Florida Regulators OK Anthem-Cigna Insurance Deal

Apr 4, 2016
Associated Press

State insurance regulators have approved Anthem's purchase of Cigna's Florida companies as part of a broader merger of the major health insurers.

Don’t Renew Medicare Plan Without Shopping Around

Oct 15, 2015

Ten years after a prescription drug benefit was added to Medicare, 39 million older or disabled Americans have coverage to help pay for their medicine, including most of the 17 million with private insurance policies known as Medicare Advantage, an alternative to traditional Medicare.

Senior citizens are switching from privately run insurance plans to traditional Medicare when they face serious, long-term health conditions, a study shows.

Researchers at Brown University found that 17 percent of Medicare Advantage patients who entered nursing homes for long-term care chose to switch to traditional Medicare the following year. Only 3 percent of similar patients in Medicare made the decision to go to a private Medicare Advantage plan.

Humana.com

A recent federal court decision in Miami may help health care providers who are suing plans that have slashed Medicare Advantage payments, Modern Healthcare reports.

Florida Accountable Care Services

The former owners of the now-defunct Physician United Plan have dropped a lawsuit that accused the accountants who worked for the Medicare Advantage plan of hiding its financial woes from state regulators, the Ocala Star-Banner reports.

Credit Florida's Second Judicial Circuit

Florida Healthcare Plus, a Medicare HMO with 10,000 members, was declared insolvent Wednesday and turned over to state authorities.

In such cases, state and federal officials help patients move into other health plans or to traditional Medicare. More information is expected on that today or Friday.

The state Division of Financial Services took over the Coral Gables-based plan immediately after the order was issued Wednesday by Circuit Court Judge George S. Reynolds in Tallahassee. DFS is expected to sell off the company’s assets Jan. 1.

Longboat Key News

Sarasota Memorial Hospital will continue to be “in-network” for UnitedHealthcare Medicare Advantage and employer-based policyholders under a new contract, the Sarasota Herald-Tribune reports. 

Millions of Medicare Advantage customers are fast approaching a deadline for a task they’d rather avoid: Researching and then settling on coverage plans for 2015.

The annual enrollment window for the privately run versions of the government’s Medicare program for the elderly and disabled people closes on Sunday. This is the main opportunity most customers have each year to adjust their health coverage, and it may be worth paying extra attention to the details.

(Editor's Note: It's Medicare enrollment season, now through Dec. 7, and beneficiaries are trying to decide on a plan. Health News Florida’s Carol Gentry, who has covered Medicare for many years, is seeing the federal program from a new point of view: as a beneficiary. Her first commentary, which aired Oct. 9, was "Medicare's Complexity Can Be Scary." The second one, "Which Medicare Path Do I Take?" is below).

Medicare Advantage plans that draw a lot of their enrollment from the poor side of town say they're at a disadvantage on the government's five-star ratings scale, which commands respect and governs pay.

One company pressing the issue is WellCare Health Plans, based in Tampa. Its Medicare Advantage plans are rated at 3 or 3 1/2 stars, below the 4-star minimum required for plans to qualify for bonus payments. Plans' premium and bonus payments are kept confidential, but other media report that the bonuses amount to a few hundred dollars per member.

Ultimate Health Plans, a scrappy little company north of Tampa, is offering Medicare HMO deals that  sound too good to be true: no premium, no deductible, free gym membership and even cash back. 

What's not to like? Ask the Florida Office of Insurance Regulation, which suspects the company lacks sufficient funds to pay claims for its 3,000 members. OIR issued a suspension order Oct. 2, but it was  placed on hold when Ultimate invoked its right to a hearing. It can take months, sometimes years, for the hearing process to unfold.

Many Florida shoppers at Medicare.gov will find Day Break and Sunrise among their lowest-priced HMO options. But if they call to enroll in either one, they’re out of luck.

Florida Healthcare Plus, a small Coral Gables company that sponsors the two Medicare Advantage plans, is under state and federal suspension, unable to sign up new members during the current open-enrollment season for Medicare, Oct. 15-Dec. 7. Being frozen at this time of year can be a death sentence for such plans.

More than 3,000 new physicians are joining the Health First Health Plans network under an expanded agreement with Florida Hospital, Florida Today reports.

Adding the major Central Florida hospital chain means seniors with Health First Medicare Advantage plans will have access to physicians and procedures such as kidney and lung transplants.

Just in time for Medicare's open enrollment season, a Florida-based HMO has won the federal government's coveted  five-star rating, a rare honor that brings more than bragging rights. Such plans receive the freedom to enroll new members all year long. 

The winner, CarePlus Health Plans Inc., is a subsidiary of Humana Inc., Florida's largest Medicare vendor. Humana did well in the quality ratings, too,  but was outscored by the little plan it bought in 2005.

.S. Department of Health and Human Services

As of Nov. 1, I will be on Medicare, which means I have to enroll this month. I should have plenty of company, since open enrollment for 2015 begins Oct. 15.

As a reporter and editor on the health-care beat, I’ve been explaining Medicare to the public since 1976. So people assume that I understand it thoroughly.  

But writing about Medicare is one thing; living it is another. For advice, I called Barbara Katz, a former reporter and lawyer who recently moved to Longboat Key from another state.  She enrolled in Medicare and a supplemental plan six years ago.

Medicare Open Enrollment is Fast Approaching -- Here's What We Know So Far

Oct 1, 2014

Medicare beneficiaries who want to make changes to their prescription drug plans or Medicare Advantage coverage can do so starting Oct. 15 during the Medicare's program’s annual open enrollment period. There will be somewhat fewer plans to pick from this year, but in general people will have plenty of options, experts say.

Sunday is the final day seniors covered by a now-defunct Medicare Advantage plan can select a different policy.

The state’s Department of Financial Services took over operation of the Physician’s United Plan in early June, when it was more than $13 million in debt and unable to pay many creditors.

  

Many Medicare Advantage Plans, including Coral Gables-based Simply Healthcare, have begun looking for ways to cut costs, and for some that means directly dropping doctors from their networks, the South Florida Sun Sentinel reports.

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