Medicare Advantage plan sponsors weigh reimbursement increase

The region’s two biggest Medicare Advantage plan sponsors say they are reviewing government reimbursement rates for next year before making any decision about member benefits.

The Centers for Medicare and Medicaid Services recently issued the fiscal 2015 rates for Medicare Advantage and prescription drug benefit programs that plan sponsors say are essentially flat when compared with the current year. Since enactment of the Affordable Care Act in 2010, Medicare Advantage premiums have fallen by 10 percent while enrollment increased by 38 percent to an all-time high of more than 15 million beneficiaries nationwide.

Highmark, UPMC Health Plan, Aetna/Coventry and Gateway Health are the region’s biggest Medicare Advantage plans. Nationwide, plan sponsors will see a reimbursement increase 0.4 percent for 2015, which compares with a cut of 1.9 percent that had been forecast.

“It’s in line with what we baked into our 2015 internal budget,” said Austin Ifedirah, vice president of Medicare and Strategic Planning at Gateway Health, which has 45,000 special-needs plan members. “It’s better than what the government announced in the advanced notice.

“We’re hoping to keep things as steady as we can, but it’s challenging in this environment.”

Tim Lightner, vice president of product and marketing at Highmark, said the insurer was also reviewing the government reimbursement rates before making any decisions about member benefits. Highmark has 207,890 Medicare Advantage members in the region, making the insurer the biggest provider of the coverage in western Pennsylvania.

Eugene Scanzera, vice president of Medicare at UPMC Health Plan, said the government’s rate increase will help maintain plans’ benefit package, which the insurer was reviewing. It was too soon to say what the impact of the new rates will be, he said.

“It’s preserving choice and that’s a good thing,” Scanzera said about the rate increase. “It will preserve a lot of the options that beneficiaries have come to rely on.”
UPMC has 123,514 Medicare Advantage members, making the insurer the second-biggest plan sponsor in the region. Aetna/Coventry, which has 77,594 members, said the government’s rate increase was actually a decrease, considering inflationary and other cost increases.

“Despite the Centers for Medicare and Medicaid Services’ actions, Medicare Advantage plans will still face rate decreases for 2015,” the company said in a prepared statement. “Aetna continues to evaluate the impact to our Medicare Advantage and Part D products, but is committed to taking steps to ensure that our plans continue to provide beneficiaries with the great value and service they have come to expect.”

Nearly 30 percent of Medicare beneficiaries nationwide are enrolled in a Medicare Advantage plan, but the rate is nearly 60 percent in Allegheny County, which has among the highest penetration rates for the coverage in the country.

HME Billing Service
Provider of Professional
HME Billing Services

HME Billing News Feed:

DME Billing Services MedBill Twitter
DME Billing Service News
DME Billing Services MedBill Twitter

Retrieved From: