In our June 26th Coventry Connection Advocacy Alert, we notified you that the U.S. House of Representatives approved a bill (H.R. 6331) that includes $13.8 billion in Medicare Advantage funding cuts over five years. In most areas of the country:
The bill would eliminate the “deeming” authority for Medicare Advantage Private Fee-for-Service (PFFS) plans that makes it possible to offer coverage to beneficiaries who live in service areas with few health care providers.
The bill would reduce Medicare Advantage payment rates in every state by the removal of funds attributed to Indirect Medical Education (IME), and
Other provisions would affect numerous Medicare Advantage administrative and regulatory issues.
In the Senate, on June 26th, the bill failed by one vote to reach the 60-vote majority needed to move the bill forward. However, Congress is planning to bring this legislation up again after the July 4th recess and the Senate will act first. Congress still needs to address the impending physician payment cuts and many are looking to Medicare Advantage beneficiaries to pay for the fix. Members of Congress need to understand the impact these cuts will have on seniors.
WHAT ACTION DO YOU NEED TO TAKE NOW?
We are asking our agents and their clients (beneficiaries) to call their Senators and ask them to NOT support Medicare Advantage funding cuts (such as those in HR 6331).
Below is a toll-free number you can call to be connected to your Senator’s Washington, DC office. You will be asked to key in your zip code, brief directions will be recited, and then you will be connected to your Senator’s office.
(888) 270-6140
You may also contact your Senator or Representative via the U.S. Congressional Switchboard Operator at (202) 224-3121.
TALKING POINTS AND ADDITIONAL INFORMATION FOR YOUR CALL:
H.R. 6331 will have a negative impact on seniors
The House of Representatives rushed through legislation that would require Medicare Advantage beneficiaries to pay for the physician fix without considering the impact these cuts would have on seniors.
Seniors will be shocked when they learn that they could face limited choices, reduced benefits, and higher premiums and out-of-pocket costs if these cuts become law.
Nearly every Medicare Advantage beneficiary in America will be affected by the IME cuts (which would reduce MA payment rates in every state).
Eighty (80) percent of Medicare Advantage beneficiaries would be impacted if the restrictions on Medicare Advantage Private-Fee-For-Service (PFFS) plans were enacted. These plans are a valuable coverage option for Medicare beneficiaries, especially in areas with a limited number of providers.
Seniors in Medicare Advantage would bear the burden of the vast majority of the budget cuts in this legislation (MA cuts represent 94 percent of the bill’s overall direct budget cuts).
Seniors oppose cuts to Medicare Advantage and believe they would be harmful to beneficiaries
Most seniors - regardless of whether they are enrolled in traditional Medicare or Medicare Advantage - oppose cutting the Medicare Advantage program to fund the Medicare physician payment fix.
These seniors also believe cuts to Medicare Advantage will have a negative effect on MA beneficiaries.
Congress should address the physician payment cuts in a way that doesn’t harm seniors
This legislation must not require seniors enrolled in Medicare Advantage to pay for the physician fix.
Congress should reauthorize Special Needs Plans without imposing new requirements or restrictions that would reduce beneficiary access to these innovative plans.
Medicare Advantage is an important coverage option for Medicare beneficiaries
More than 10 million Medicare beneficiaries currently rely on Medicare Advantage to meet their health care needs.
Medicare Advantage plans offer a wide range of benefits, services, and innovations that are not available to beneficiaries in the Original Medicare fee for service (FFS) program, including reductions in out-of-pocket costs; $0-premium comprehensive drug coverage; vision, hearing, and dental benefits; wellness programs; and disease management and care coordination programs.
Medicare Advantage enrollees save an average of $90 per month - through improved benefits and lower out-of-pocket costs - compared to what they would pay in the Original Medicare FFS program.
MA plans are especially important for beneficiaries who have low incomes but may not qualify for Medicaid and who otherwise may not have access to the care management and disease-specific programs available in Medicare Advantage.
More Detail on PFFS and Deeming
As described above, a major concern is that the bill would eliminate “deeming” authority in PFFS. As written, the loss of this deeming authority would eliminate this plan option affecting 80% of Medicare Advantage seniors.
H.R. 6331 imposes additional restrictions on PFFS plans. Federal law requires MA plans to maintain adequate networks of providers - for example, doctors and hospitals - to ensure that all covered benefits and services are available and accessible. PFFS plans can meet access requirements through “deemed” providers. Under this authority, PFFS plans must pay providers rates at least equal to those paid under original Medicare. This authority has been especially important in areas where it is difficult for network-based plans to persuade sufficient numbers and types of providers to contract with them in order to meet access requirements, and for employer groups that provide coverage for retirees living in areas across the country.
Starting in 2011, the bill would limit the use of the deeming authority by requiring PFFS plans in the individual market to have written contracts with networks of providers, with a few exceptions. PFFS plans for employer groups would have to have these contracts wherever they enroll beneficiaries with no exceptions. Without the deeming authority, PFFS plans would face the same challenges of network formation that limited the availability of MA options in many areas in the past and beneficiaries will lose access to these plans and the value they provide.
Enrollees in PFFS plans in these areas would likely face the disruption of either changing plans or return to traditional Medicare. Those who choose to return to FFS would lose the additional benefits, services and disease management that PFFS plans provide. On average, MA enrollees receive about $90 per month in additional benefits. The additional value is demonstrated in the comprehensive coverage that many PFFS plans offer.
LINK TO CHARTS AND ADDITIONAL STATE-SPECIFIC INFORMATION
Attached below is a link to AHIP’s website and additional information. There are state specific charts on the impact of eliminating “deeming” authority in PFFS plans, as well as the implications of removal of IME funding.
