Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

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dm200
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Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Sat Sep 29, 2018 10:17 am

Nice to see that some things actually go down in price - relating to health/medical care. :happy

https://www.cms.gov/newsroom/press-rele ... rease-2019

Waiting for details on ours..

orlandoman
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by orlandoman » Sat Sep 29, 2018 10:29 am

My MA PPO plan, has slight increases, like $90 for Urgent/ER care instead of $80. Decreases like $150 deductable for tier 3/4/5 drugs instead of $265 deductable (Tier 1/2 still $0 by mail order). Added $40 per quarter OTC purchases. Premium for MA PPO still $0 per month.

Number of other changes, in my case it will be slight net savings, based on past usage.
"Don't Believe Everything You Think"

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dm200
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Sat Sep 29, 2018 11:01 am

For my state of Virginia:


Medicare in Virginia, 2019

Medicare continues to offer seniors and people with disabilities flexibility and choices while
providing high quality healthcare services. Whether through Original Medicare (Parts A and B),
Medicare Advantage, or the prescription drug benefit (Part D), 1,464,341 beneficiaries in
Virginia continue to have access to the benefits that Medicare offers.
In Virginia in 2019:
• 97 Medicare Advantage plans are available.
• 100 percent of people with Medicare have access to a Medicare Advantage plan.
• $0 is the lowest monthly premium for a Medicare Advantage plan.
• 100 percent of people with a Medicare Advantage plan have access to a plan with a lower
premium than what they paid in 2018.
• 27 stand-alone Medicare prescription drug plans are available. All Medicare beneficiaries
have access to a Medicare prescription drug plan.
• 100 percent of people with a stand-alone Medicare prescription drug plan have access to
a plan with a lower premium than what they paid in 2018.
• 27 percent of people with a stand-alone Medicare prescription drug plan get Extra Help
(also called the low-income subsidy, or LIS).
• $14.50 is the lowest monthly premium for a stand-alone Medicare prescription drug plan.

runner3081
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by runner3081 » Sat Sep 29, 2018 11:33 am

Is it possible that the networks are shrinking for MAPs?

I know that is an issue for people in my area, a couple of major healthcare players don't accept advantage plans.

orlandoman
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by orlandoman » Sat Sep 29, 2018 12:12 pm

runner3081 wrote:
Sat Sep 29, 2018 11:33 am
Is it possible that the networks are shrinking for MAPs?

I know that is an issue for people in my area, a couple of major healthcare players don't accept advantage plans.
If your MA plan is a PPO or if you have a supplement, the doctors you can use have the same requirement ... that they participate in Medicare.

The majority of MA plans are HMO's, which have a required networks. Many of the negative MA plan experiences, in my opinion, are based on MA HMO's, which are not the same as MA PPO's.
"Don't Believe Everything You Think"

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ram
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by ram » Sat Sep 29, 2018 12:25 pm

It is possible that lesser number of physicians will accept medicare patients starting Jan 1, 2019. The whole article needs a subscription but the gist is medicare is decreasing payments to physicians.
https://www.nejm.org/doi/pdf/10.1056/NEJMp1809742
Ram

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dm200
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Sat Sep 29, 2018 1:09 pm

ram wrote:
Sat Sep 29, 2018 12:25 pm
It is possible that lesser number of physicians will accept medicare patients starting Jan 1, 2019. The whole article needs a subscription but the gist is medicare is decreasing payments to physicians.
https://www.nejm.org/doi/pdf/10.1056/NEJMp1809742
Could be. I notice (for 2018 at least) my previous PCP group of physicians participates in the Humana MA plans, but does not accept new Original Medicare patients.

I infer/conclude that Medicare seems to be paying MORE to MA plans for 2019. Maybe an "incentive" for Physicians to participate in MA plans?

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dm200
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Sat Sep 29, 2018 1:29 pm

orlandoman wrote:
Sat Sep 29, 2018 12:12 pm
runner3081 wrote:
Sat Sep 29, 2018 11:33 am
Is it possible that the networks are shrinking for MAPs?
I know that is an issue for people in my area, a couple of major healthcare players don't accept advantage plans.
If your MA plan is a PPO or if you have a supplement, the doctors you can use have the same requirement ... that they participate in Medicare.
The majority of MA plans are HMO's, which have a required networks. Many of the negative MA plan experiences, in my opinion, are based on MA HMO's, which are not the same as MA PPO's.
Yes - that seems to be the case. Although, I know several folks who are very happy with their Humana MA HMO plan. Before being on Medicare, over the decades, we were in all sorts of insurance: regular (pays everything), PPO, HMO (several different types), etc. While slightly less convenient, we never experienced an actual problem with any of the HMOs in getting the care we needed.

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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by Alan S. » Sat Sep 29, 2018 3:41 pm

I am waiting for the HMO pre authorization requirements to go away. This obviously will cause some people to delay treatment, perhaps enough to generate a reduction in the loss ratio that exceeds the added overhead from the gate keeping activities.

Another expected benefit is that this is more of a hassle for sicker people, and if they drop their plan the loss ratio again benefits.


Medigap suffers from adverse selection vs MA, but within MA it may also be a factor comparing the non HMO plans with the HMO plans. And that may also be keeping the MA HMO premiums in check.

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dm200
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Sat Sep 29, 2018 4:24 pm

Alan S. wrote:
Sat Sep 29, 2018 3:41 pm
I am waiting for the HMO pre authorization requirements to go away. This obviously will cause some people to delay treatment, perhaps enough to generate a reduction in the loss ratio that exceeds the added overhead from the gate keeping activities.
Another expected benefit is that this is more of a hassle for sicker people, and if they drop their plan the loss ratio again benefits.
Medigap suffers from adverse selection vs MA, but within MA it may also be a factor comparing the non HMO plans with the HMO plans. And that may also be keeping the MA HMO premiums in check.
Even if not clear from the plan documents, there are several ways that the HMO "referral" works in practice. By the "letter" of the wording, you might conclude that each and every Specialist visit must be "authorized" ahead of time.

However, in practice (in my current HMO), once I get the initial referral - I do not need to get another one - as long as the specialist continues my situation. So, for example, 7 1/2 years ago, I needed an initial referral to both Ophthalmology and Endocrinology. I got that - and saw each specialist. Never needed another referral - even though I am now on my 3rd Ophthalmologist and second Endocrinologist. So, for me, the HMO "referral" requirement is close to zero impact.

Neither have I experienced a "delay". My wife, for example, saw here PCP earlier this year at 10 am - and got an immediate referral to see a general surgeon two hours later. Hard to beat two hours!

It works both ways, but sometimes what a layperson thinks needs a specialist referral may not be needed at all OR we might otherwise go to the wrong specialist.

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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by 2015 » Sat Sep 29, 2018 10:40 pm

Alan S. wrote:
Sat Sep 29, 2018 3:41 pm
I am waiting for the HMO pre authorization requirements to go away. This obviously will cause some people to delay treatment, perhaps enough to generate a reduction in the loss ratio that exceeds the added overhead from the gate keeping activities.

...
This is perhaps one of the biggest misconceptions regarding HMO plans that I've run into. I've been in many different HMO plans from many different carriers over the last 20 something years first as a result of changing employers then as a result of changing to the ACA upon retirement. Not a single time did I experience any sort of "delay" or issue with a referral. Never once did I encounter any sort of "gate keeping" activities or barriers to treatment of any kind. My family members on Medicare with Kaiser and with other MA plans report the same experience.

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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Sun Sep 30, 2018 8:50 am

2015 wrote:
Sat Sep 29, 2018 10:40 pm
Alan S. wrote:
Sat Sep 29, 2018 3:41 pm
I am waiting for the HMO pre authorization requirements to go away. This obviously will cause some people to delay treatment, perhaps enough to generate a reduction in the loss ratio that exceeds the added overhead from the gate keeping activities.
...
This is perhaps one of the biggest misconceptions regarding HMO plans that I've run into. I've been in many different HMO plans from many different carriers over the last 20 something years first as a result of changing employers then as a result of changing to the ACA upon retirement. Not a single time did I experience any sort of "delay" or issue with a referral. Never once did I encounter any sort of "gate keeping" activities or barriers to treatment of any kind. My family members on Medicare with Kaiser and with other MA plans report the same experience.
Yes - My experience as well over the years with many types of HMOs (including Kaiser) AND with Kaiser Medicare now. Especially now, with Kaiser, the referral from the PCP often makes things faster because the PCP can book your appointment with the appropriate specialist on the computer system while you are there.

It is certainly not obvious that the HMO referral requirement will delay medically needed treatment or tests.

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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by Broken Man 1999 » Sun Sep 30, 2018 9:32 am

2015 wrote:
Sat Sep 29, 2018 10:40 pm
Alan S. wrote:
Sat Sep 29, 2018 3:41 pm
I am waiting for the HMO pre authorization requirements to go away. This obviously will cause some people to delay treatment, perhaps enough to generate a reduction in the loss ratio that exceeds the added overhead from the gate keeping activities.

...
This is perhaps one of the biggest misconceptions regarding HMO plans that I've run into. I've been in many different HMO plans from many different carriers over the last 20 something years first as a result of changing employers then as a result of changing to the ACA upon retirement. Not a single time did I experience any sort of "delay" or issue with a referral. Never once did I encounter any sort of "gate keeping" activities or barriers to treatment of any kind. My family members on Medicare with Kaiser and with other MA plans report the same experience.
Our experiences as well.

We started using HMOs in the 70ties, BC (before children). Wife and I were very healthy, so we always signed up with whatever plan covered the children's pediatricians. Through all the years we have never been challenged by any type gatekeeper, and other than picking up the referral (surely no one still uses a paper referral any longer :oops: ) never encountered any delay in needing a specialist. Our children had the usual issues: broken bones, stiches, sprains, ear tubes, infections, viruses, immunizations... the list goes on.

I am not saying gatekeeping isn't present, but we have never experienced it unless it was extremely subtle. Believe me, if DW thought anyone was not moving fast enough for one of our dimpled darlings, I would have heard about it. She was a SAHM until the youngest started preschool, so all the doctor activities were on her shift.

Once the children were gone, we have pretty much been in PPOs, as offered by MegaCorp. Using a PPO eliminates the need for referrals, but we still use our PCPs for recommendations of specialists. Their opinions are valuable to us.

Broken Man 1999
“If I cannot drink Bourbon and smoke cigars in Heaven than I shall not go. " -Mark Twain

2015
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by 2015 » Sun Sep 30, 2018 9:56 am

dm200 wrote:
Sun Sep 30, 2018 8:50 am
2015 wrote:
Sat Sep 29, 2018 10:40 pm
Alan S. wrote:
Sat Sep 29, 2018 3:41 pm
I am waiting for the HMO pre authorization requirements to go away. This obviously will cause some people to delay treatment, perhaps enough to generate a reduction in the loss ratio that exceeds the added overhead from the gate keeping activities.
...
This is perhaps one of the biggest misconceptions regarding HMO plans that I've run into. I've been in many different HMO plans from many different carriers over the last 20 something years first as a result of changing employers then as a result of changing to the ACA upon retirement. Not a single time did I experience any sort of "delay" or issue with a referral. Never once did I encounter any sort of "gate keeping" activities or barriers to treatment of any kind. My family members on Medicare with Kaiser and with other MA plans report the same experience.
..

It is certainly not obvious that the HMO referral requirement will delay medically needed treatment or tests.
I'll go one step further. What is obvious to me is the number of rights I have under the HMO in terms of any medical decisions made. Based on the lengthy publications I receive from my HMO's (despite electing paperless!), each has contained extensive explanations of my rights to appeal decisions more than once, with so many days for each carrier to respond. These appeals are all quite time sensitive with the quick turnaround days provided for carrier responses, and next steps clearly laid out each with response requirements.

One also has to be very careful when making a complaint, as they will immediately open a case, start investigating, and start responding. I made this mistake when reporting a minor annoyance to my mother's carrier not knowing they were treating seriously and taking it as a complaint!

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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Sun Sep 30, 2018 10:48 am

Broken Man 1999 wrote:
Sun Sep 30, 2018 9:32 am
2015 wrote:
Sat Sep 29, 2018 10:40 pm
Alan S. wrote:
Sat Sep 29, 2018 3:41 pm
I am waiting for the HMO pre authorization requirements to go away. This obviously will cause some people to delay treatment, perhaps enough to generate a reduction in the loss ratio that exceeds the added overhead from the gate keeping activities.
...
This is perhaps one of the biggest misconceptions regarding HMO plans that I've run into. I've been in many different HMO plans from many different carriers over the last 20 something years first as a result of changing employers then as a result of changing to the ACA upon retirement. Not a single time did I experience any sort of "delay" or issue with a referral. Never once did I encounter any sort of "gate keeping" activities or barriers to treatment of any kind. My family members on Medicare with Kaiser and with other MA plans report the same experience.
Our experiences as well.
We started using HMOs in the 70ties, BC (before children). Wife and I were very healthy, so we always signed up with whatever plan covered the children's pediatricians. Through all the years we have never been challenged by any type gatekeeper, and other than picking up the referral (surely no one still uses a paper referral any longer :oops: ) never encountered any delay in needing a specialist. Our children had the usual issues: broken bones, stiches, sprains, ear tubes, infections, viruses, immunizations... the list goes on.
I am not saying gatekeeping isn't present, but we have never experienced it unless it was extremely subtle. Believe me, if DW thought anyone was not moving fast enough for one of our dimpled darlings, I would have heard about it. She was a SAHM until the youngest started preschool, so all the doctor activities were on her shift.
Once the children were gone, we have pretty much been in PPOs, as offered by MegaCorp. Using a PPO eliminates the need for referrals, but we still use our PCPs for recommendations of specialists. Their opinions are valuable to us.
Broken Man 1999
Some kinds of "gatekeeping" can be a good thing for the patient - both medically and financially. You might not really need to see a specialist OR (on your own) you might pick the wrong kind of specialist. As many here express, I am very puzzled about dissatisfaction with HMO referral requirements in practice.

Even with a PPO, it is (in my opinion) often best to consult your PCP about many kinds of issues - even if you could see a specialist.

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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Tue Oct 02, 2018 9:21 am

Received my Medicare and You in the mail yesterday, as well as our plan information and changes for 2019. Premium goes up a little, but a few copays go down and the drug program is a little better. They also added ($23/mo more) an optional feature for dental, eyeglasses and hearing aids. Turns out it has remained a "Cost" plan and did not switch to an "Advantage" plan - "Cost" and "Advantage" are very similar - but with a "Cost" plan, we could use Original medicare from any provider that accepts it -- No plans to use that feature, though. :happy

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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by Ron » Tue Oct 02, 2018 9:39 am

FWIW, my son's Annual Notice of Changes for his Blue Journey Classic (PPO) shows the monthly premium going from $62 this year, to $65 in 2019.

All deductibles, out-of-pocket, and doctor's office visits copay's remain the same.

- Ron

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dm200
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Re: Medicare Advantage premiums continue to decline while plan choices and benefits increase in 2019

Post by dm200 » Tue Oct 02, 2018 10:08 am

Ron wrote:
Tue Oct 02, 2018 9:39 am
FWIW, my son's Annual Notice of Changes for his Blue Journey Classic (PPO) shows the monthly premium going from $62 this year, to $65 in 2019.
All deductibles, out-of-pocket, and doctor's office visits copay's remain the same.
- Ron
Nice to see some of our health/medical costs "stabilizing" :)

Hope it continues.

As we see, though, with other posts - some folks are seeing continuing upward pressure on such costs.

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