2014 Medicare Advantage changes — content updated May 7, 2014

1st quarter 2014 Medicare Advantage plan enrollment change figures are in….

CMS publishes Medicare Advantage plan membership numbers monthly.  I like to check which plans are gaining membership, what plans are losing, and which are maintaining ‘status quo’.  The April report contains the prior month’s information (paid members only).  Comparing the enrollment information found in the April report to the January report (has the prior year December data) you can see which plans had changes during the prior year’s Medicare Annual Enrollment Period (October 15th through December 7th), any ‘disenrollment’s’, and new member additions for January through March.

I believe this information tells us which Idaho Medicare Advantage plans have become more popular and which are losing favor with the market.   Remember, MA/MAPD plans change annually and people can switch to lower cost plans between October 15th and December 7th each year.

What the Ada County (largest Idaho Medicare market) figures tell me is HMO plans gained membership (Idaho Medicare Insurance Choices helped this number as we feel this is an attractive choice and recommend this plan type when needs/budget match up), PPO plans had a net loss, and PFFS plans had a slight net gain.

A couple of interesting points (to us) are: one appears there was a migration from PPO plans to HMO plans and PFFS plans gained membership.  I understand the PPO plan’s loss but don’t understand this last point.  To me, this may mean people may not understand their Medigap policies and carrier differences.

The Federal Government’s direction is to lower their reimbursement rates to insurance companies offering Medicare Advantage plans.  Read this report if you want to learn more.  In 2013 (and before) the government was spending about 10% more to support Medicare Advantage plans when compared to Original Medicare (people with Part A and Part B and do not have Medicare Part C).   The lower reimbursement rate Medicare provides to insurance companies offering Medicare Advantage plans may mean plan members will be paying more for their health insurance beginning in 2014.  When comparing Idaho Medicare Advantage plan details between 2013 and 2014, we noticed some plans had increased out of pocket costs to plan members.  These differences include monthly premiums, copays, and/or the member’s share of their prescription medication drugs.

If you have an interest in Medicare Advantage plans (or Medigap) as your way to supplement Original Medicare, we can help.  After we understand your needs and retirement budget for health care, we will present at least 2 plans, explain the differences, answer your questions and help you enroll in the plan you feel is best for you. Learn more about us, then call. We can help.


2014 Medicare Advantage Changes – Content below updated October 29, 2013

HMO Plans are catching our attention

While working with people interested in Medicare Advantage plans, we have noticed some interesting changes in HMO’s that should be shared.  The Point of Service (HMO-POS) version of HMO’s may be the start of a revitalization of this plan category. Some of the biggest objections with HMO’s have been:

Members have to pay 100% of all costs when services are used outside of the plan’s network

Members have to get permission from their primary care physician to see a specialist

The designers of the Point of Service version of HMO’s have more flexibility to meet the needs of prospective plan members as well as their own business goals.  For example, the above mentioned main objections to HMO’s may not be in the POS version of this plan.  These plans (HMO-POS) are not all the same, but the right plan may be an excellent alternative to your other choices (and your current plan).  HMO-POS plans may not be available in all markets.

We have bracketed all Idaho Medicare Advantage plans into 3-categories; the zero/low premium plans, the mid-priced premium plans, and the high priced premium plans.  Plans in each of these categories have noticeable differences in their compositions and members share out of pocket cost (for specific services).  Also, we strongly feel if the monthly premium of any plan is above $90, the beneficiary may be better off enrolled in a Medigap plan.  If you would like help sorting through your choices, contact us.  After we learn your needs, concerns and budget, we will start our analysis of your choices.  You will be presented with at least two options; we will explain the differences, and if you feel you would be better off with one of these choices, we will help you enroll in your preference.


2014 Medicare Advantage Changes – Content below updated October 11, 2013


Its official: 2014 Medicare Advantage Changes

Below is a copy of the HHS September 19,2013 Press release on 2014 Medicare Advantage Changes.  Read the original here.   This article notes the projected average premium increase for Medicare Advantage plans is $1.64 over 2013. If your plan’s premium has changed by an uncomfortable margin above the national average, it might be time for you to consider other plans.  Contact us if you would like help evaluating your options.



FOR IMMEDIATE RELEASE September 19, 2013 Contact: HHS Press Office 202-690-6343

More, higher quality options for seniors in Medicare Advantage

More beneficiaries are choosing higher quality Medicare Advantage (MA) plans, and for the fourth straight year enrollment is projected to increase, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today. The average MA premium in 2014 is projected to increase by only $1.64 from last year, coming to $32.60.  Access to the MA program will remain strong, with 99.1 percent of beneficiaries having access to a plan.  The average number of plan choices will remain about the same in 2014 and access to supplemental benefits remains stable.  Since passage of the Affordable Care Act, average MA premiums are down by 9.8 percent. MA quality continues to improve as over one-third of MA contracts will receive four or more stars, which is an increase from 28 percent in 2013.  Over half of MA enrollees are enrolled in plans with four or more stars, a significant increase from 37 percent of enrollees last year.  The Centers for Medicare & Medicaid Services (CMS) calculates star ratings from 1 to 5 (with 5 being the best) based on quality and performance for MA and Medicare prescription drug plans to help beneficiaries, their families, and caregivers compare plans. “As a result of the Affordable Care Act, Medicare Advantage and Prescription Drug Plans remain strong and continue to provide improved benefits and low premiums for beneficiaries,” said Secretary Sebelius.  “And as a reminder, it is business as usual when it comes to their Medicare benefits: people with Medicare do not need to enroll in the new Health Insurance Marketplaces.” Earlier this year, CMS announced that the average estimated basic Medicare prescription drug premium plan in 2014 is projected to be $31 per month, holding steady for four years in a row.  100 percent of people with Part D will have access to a plan with lower premium than what they paid in 2013.  More than 6.6 million people with Medicare have saved over $7 billion on prescription drugs as a result of the Affordable Care Act, an average of $1,061 per beneficiary. The Affordable Care Act closes the “donut hole” over time.  This news comes on the heels of historically low levels of growth in Medicare spending.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, substantially more slowly than the per capita rate of growth in the economy. The Annual Open Enrollment period for health and drug plans begins on October 15 and ends December 7.  Each year plans costs and covered benefits can change, and Medicare beneficiaries should look at their Medicare coverage choices and decide what options best meet their needs.  For more information on Medicare Open Enrollment and to compare benefits and prices of 2014 Medicare health and drug plans, please visit: http://www.cms.gov/Center/Special-Topic/Open-Enrollment-Center.html.  


2014 Medicare Advantage Changes – Mid April Update on How the proposed 2014 Medicare Advantage changes could affect you

After receiving many comments on its draft call letter issued in February 2013, CMS published its Contract Year 2014 Final Call letter on April 1, 2013.  Much of the concern expressed by AHIP, the insurance carriers, pharmacy benefit managers, and other parties involved in the Medicare Advantage business, CMS made noticeable adjustments to their earlier proposal for 2014 Medicare Advantage changes.  Major concern centered around how much monthly premiums would go up for beneficiaries (you and me) of Medicare Advantage and Prescription Drug Plans, the amount of the financial cuts providers would have to take, and several other areas.  CMS yielded in most areas and focused their attention on furthering their efforts to make Medicare and the processes to run this business more efficient. Our costs will go up for beneficiaries, but by far less than earlier anticipated.  Some of this is still taking shape and Congress must do their share to make all of this happen.  We will know more of the details later in 2014.  You can read the actual CMS April 1, 2014 announcement here.  This thread will be updated when CMS announces specific Medicare changes for 2014. If you have the interest in following the daily synopsis of Medicare issues and political dialogue, read the discussion here.


2013 Mid-February proposed 2014 Medicare Advantage changes 

In mid-February of 2013 the government’s Centers for Medicare and Medicaid Services announced several proposed rule changes for Medicare programs that could affect your monthly premiums, out of pocket costs for health care services received, and a reduction in benefits available in your MA and Part D plan. Changes are now subject to a comment period and the final rules will be published on April 1, CMS said. Medicare Advantage changes 2014 are coming and now is the time to plan for those changes. The president of America’s Health Insurance Plans (AHIP), Ms. Karen Ignagni, said “These changes will disrupt coverage for Medicare Advantage beneficiaries at a time when evidence clearly demonstrates that Medicare Advantage provides higher-quality care than the fee-for-service part of Medicare”.  AHIP went on to have an independent actuarial firm, Oliver Wyman, analyze the effect of the proposed changes on the insurers as well as the beneficiaries (those enrolled in Medicare Advantage plans).  Their report is available here. The Medicare Supplement (Medigap) market seems to have dodged a significant challenge  when CMS announced in May of 2013 their intent to not implement cost sharing for Medigap Plan’s C and F in 2014.

2014 Medicare Advantage Changes – Specific Plan Details for 2014 Available Early October 2013

If you already have a Medicare Advantage or Prescription Drug Plan

We encourage you to pay close attention to the details in your Annual Notice of Change (ANOC).  You should have this document in early October.  Notice how your out of pocket costs will change for 2014.  Remember, all plans to not make the same changes to their plan(s) in the same way; if your neighbor has a plan from a different vendor and they use the same exact medical services you do in 2014, there is a very good chance your out of pocket costs will be different.  October 15th to December 7th is a very good time to compare your existing plan to other alternatives available to you.

If you have Original Medicare and are now consider enrolling in Medicare Advantage or a Medigap Plan

Medicare’s Annual Election Period is an excellent time for people in Original Medicare to add a Prescription Drug Plan, a Medigap plan, or a Medicare Advantage Plan.  If you are not sure what the advantages to you would be to do so, contact us.  After we learn your goals, concerns and budget for health insurance, we can make suggestions that should be helpful.

If you have a Medigap Plan and want to switch to Medicare Advantage

Medicare’s Annual Election Period is an excellent time for people who want to move to a Medicare Advantage plan.  If you want help selecting a plan that matches up with your needs, addresses your concerns, and meets your budget, we can help.

If you are joining Medicare in October, November, or December

If you plan to join a Medicare Advantage program during this time period, the plan you enroll in may not be the same on January 1, 2014.  We encourage you to work with an independent agent that specializes in Medicare and handles all plans available in the area where you live.  They can help you make the right choices.

Not sure what to do?

Call us; we will listen, review your options and then recommend at least two plans that will meet your needs.  We represent 100% of the MA plans available to Idaho residents.  We present the facts, you decide what you want to do and we will help you enroll in the plan you choose.

If you are not sure if you should have a Medigap policy, visit Medigap vs Medicare Advantage discussion found here.  It will help you decide.


This page was last modified on Jul 30, 2014 @ 2:46 PM