Medicare Improvements for Patients and Providers Act of 2008
How will this change affect Medicare Advantage recipients?
Now that the bill has become law, many Medicare Advantage members are concerned. Although it’s still too early to say exactly how this legislation may impact your clients’ coverage:
• No changes are being made at this time. Your clients’ current coverage remains the same.
• In the future and in some areas of the country, this legislation will likely shift some of the healthcare cost burden from the federal government onto seniors and disabled individuals.
Humana will continue to inform its valued members and agents about any changes before they happen.
H.R. 6331 contains new marketing rules for Medicare Advantage and PDP plans. It also contains several changes that affect Medicare Supplement (Medigap) plans. Most notably, it requires MA plans to establish new sales and marketing practices starting with the 2009 plan year.
Those standards are similar to what America’s Health Insurance Plans (AHIP) and Humana previously recommended, including more stringent standards in areas like cold-calling, cross selling of non-health related products, consumer disclosures, and agent training and certification.
Humana’s position
Humana vigorously opposed this bill because members could see future reductions in benefits, healthcare options, and plan choices, as well as increased out-of-pocket costs, as a direct result of H.R. 6331. With the override vote, Congress eliminated a pending 10.6 percent Medicare payment rate cut for physicians treating Medicare patients that was set to retroactively take effect on July 1.
“While Humana is opposed to cuts in physician payments, we do not believe it’s a fair trade-off to pay for increased payments to physicians by uninsuring vulnerable seniors who cannot afford to lose comprehensive healthcare coverage,” said Heidi Margulis, Humana’s senior vice president of Government Relations.
Humana’s outlook remains positive
Humana has been in the Medicare business for more than 20 years and is well positioned to continue its growth, even with the enactment of H.R. 6331. We anticipated that the PFFS product would eventually be transitioned to network-based products, and we have made considerable progress over the last few years in developing HMOs, local PPOs, and regional PPOs in dozens of new markets.
While the legislation would phase-out Indirect Medical Education (IME) payments, Humana’s network-based MA products are generally not located in areas with large numbers of academic medical centers, which for us, significantly reduces the impact of this phased reduction in MA payments.
Over the next several months, Humana will complete a detailed county-by-county assessment to gauge the impact of the 2010 phase-out of the IME payments across MA product service areas. In addition, we will identify those counties that would be exempt from the PFFS product-contracted network requirement because fewer than two MA network-based plans are offered. This information enables us to gauge the financial impact and potential disruption for our MA customers.
[Excerpt from email to Humana Agents 7/22/2008]
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