Groups Says that Divestitures Don’t Keep Medicare Advantage Competitive

Requiring companies to divest does not maintain competition amid health insurance mergers, according to an issue brief by the Center for American Progress. (Competition authorities frequently require merging parties to divest a number of brands or operations in order to clear a proposed merger.) The Center says that divestitures don’t restore competition with Medicare Advantage plans. Also, seniors pay higher premiums for divested plans. By 2015, acquiring partners exited more than half of the affected counties. Only two of the 15 divested plans are offered, and premiums increased an average of 44% for more than half of the divested plans. Researchers at the Center say that divestitures in the proposed Aetna-Humana merger won’t be successful in maintaining competition and protecting seniors. In fact, the proposed Aetna-Humana merger would greatly reduce market competition for Medicare Advantage beneficiaries. In markets where Medicare Advantage beneficiaries have a choice of insurers, Aetna’s average annual premiums were lowered by as much as $302 and Humana’s annual premiums were lowered by as much as $43. Under the merger, premiums could increase beyond these amounts because of the greater market power of the combined company.

Seniors Gain Greater Consumer LTCI Protections

Governor Brown signed Senate Bill 575 into law. It requires long-term care insurers to provide annual notifications of the availability of non-forfeiture benefits and contingent benefits to the insured and the insured’s designated backup contact. The bill was authored by Senator Carol Liu and sponsored by Insurance Commissioner Dave Jones. “Without notification, individuals and their families can easily lose track of…benefits and may end up paying for care or missing out on benefits that are available to them,” Jones said. Consumers may stop making premium payments because they can no longer afford them. Although the long-term care benefits may still be available to the consumer even after they stop making payments, the benefits may not be utilized by the consumer until years after the policy has lapsed, which is why consumers may forget the benefits are available.

New Law Increases Financial Protections for Seniors Investing in Annuities

New Law Increases Financial Protections for Seniors Investing in Annuities

New consumer protections were ushered in when Governor Brown signed Senate Bill 426 (Leyva) into law. Under the new law, the death benefit for fixed deferred annuities must be at least equal to the annuity amount or the accumulation value for those annuities issued to consumers 65 or older. The law also prohibits companies from charging a surrender penalty on the death benefit payment. Commissioner Dave Jones said, “While many companies do not pay out a death benefit that is less than the premium paid, some insurers do apply surrender penalties reducing the death benefit below the total premiums, which is the reason for this important legislation. I thank Senator Leyva for partnering with me on this change in law.”  Taking effect on January 1, 2016, SB 426 earned strong bipartisan support in the Legislature and was supported by the California Advocates for Nursing Home Reform, California Health Advocates, Congress of California Seniors and the Elder Financial Protection Network. Commissioner Jones encourages seniors to learn more about their options by visiting the Senior Information Center on the California Department of insurance web site atinsurance.ca.gov.

How Telehealth Could Save Big Money for in Medicare

Telehealth can help achieve savings in the Medicare program, according to an actuarial study by Alliance for Connected Care. The study found that 83% of telehealth visits require no additional follow-up care. Replacing in-person acute care services with a telehealth could save the Medicare program $45 per visit. “Reimbursing for telehealth will not increase Medicare expenditures; it will provide an easy alternative for beneficiaries to get quality health care. Telehealth can often replace an in-person visit to the emergency room or urgent care center and resolve the issue so no further care is needed,” said Dale Yamamoto of Red Quill Consulting.

Some Medicare Advantage plans have started offering telehealth services. Most seniors in fee-for-service Medicare lack access to telehealth services because of the restrictions in the Affordable Care Act. Generally, covered telehealth services must be provided in rural areas as determined by the Dept. of Health and Human Services (HHS). The Alliance says that telehealth can play a critical role in meeting the primary care needs of the incoming influx of Baby Boomers. For more information, visit Alliance for Connected Care.

Part B premiums stay the same for 3rd straight year

Most seniors will pay the same monthly premium for Medicare Part B next year that they did this year: $104.90. Deductibles for hospital coverage under Part A are rising by $44. The Washington Post (tiered subscription model)/The Associated Press (10/9)

AMAC Applauds the SAVE Medicare Home Healthcare Act

The Association of Mature American Citizens (AMAC) is applauding the Securing Access Via Excellence (SAVE) Medicare Home Health Act, which was introduced in the House. It provides relief to American seniors who are at risk due to Medicare cuts of 14% to home health services. The Act achieves the same level of Medicare savings as the Obamacare cuts by creating a program to reduce hospital readmissions through incentives for positive patient outcomes. The goals is to allow mature Americans to remain in their homes. AMAC says that Obamacare’s Medicare home health cut will force thousands of small businesses to close, costing nearly 500,000 home health professionals to lose their jobs. AMAC says these cuts affect the Medicare population’s most vulnerable demographic — older, sicker and poorer mature Americans.  Some will be forced to seek care in an institutional setting, driving up patient and Medicare costs and putting patients at risk for poorer health outcomes. For more information, visitwww.amac.us/medicarecuts.

Continuity of Care for Vulnerable Seniors

On April 1, the first dual eligibles (adults insured through Medicare and Medi-Cal) in eight counties were enrolled in a combined Medi-Cal and Medicare managed care program called “Cal MediConnect.” Cal MediConnect holds the promise of improving the coordination of their care across a complex array of medical and social support services. However, concerns remain whether the transition will result in disruptions in care, according to a UCLA Health Policy study. The authors say that continuity of care is familiar and responsive. It involves long-standing relationships with providers and involves family members, social service providers, and others. The authors recommend that the state’s definitions and assurances of care continuity be expanded to reflect consumers’ broader health and social care needs. Quality care evaluations should involve the preferences and goals of consumers. For more information, visit http://healthpolicy.ucla.edu.

Drug Costs For Seniors Vary Widely Among Medicare Part D Plans

A HealthPocket report demonstrates a compelling reason to comparison shop for Medicare Part D plans. Costs vary widely among prescription drug plans across the United States. Choosing a well-known insurance brands is no guarantee of getting low drug costs, said Kev Coleman, head of Research & Data for HealthPocket. Consumers should consider premiums and cost sharing when evaluating their Medicare Part D options. They should also consider drug restrictions, which could greatly affect their satisfaction with a drug plan.

HealthPocket examined formularies for all 2014 Medicare Part D insurance plans sold in the United States. They estimated what a beneficiary would pay for premiums and prescriptions for each of the top 50 drugs sold in the U.S. and for each Medicare Part D plan. AARP’s MedicareRx Preferred plan in Arizona had the lowest costs while the Health Alliance Medicare Prescription PlanBasic in Illinois had the highest costs. In fact, it was 155% more expensive than the AARP plan. The Humana Enhanced plan had the lowest cost in 26 states and covered 48 of the top 50 drugs. The Aetna Medicare Rx Premier plan had the highest cost in 37 states and covered 41 of the top 50 drugs. Medicare requires Part D insurance policies to cover at least two drugs in most medication categories, but which drugs are covered within each category is left to the discretion of the insurance company. Moreover the same drug covered by two different Medicare Part D plans can charge different amounts, and these differences can significantly affect the economic value of the Part D plan for beneficiaries. For more information, visit HealthPocket.com.

Some seniors find Medicare Advantage choices confusing

Many seniors find it daunting to choose a Medicare Advantage plan, and as a result often end up with one that might not meet all their needs, according to the Kaiser Family Foundation. In response to reports of confusion among seniors, the federal government began rating plans based on customer service, access to health care providers and other factors, but enrollment in five-star plans increased at a slower pace than in three-star plans, said Joshua Raskin of Barclays Capital. Kaiser Health News/Capsules blog (5/14)

Seniors and Persons with Disabilities Are Happy With Managed Care

Beginning in 2011, seniors and persons with disabilities (SPDs) in 16 counties with Medi-Cal fee-for-service had to choose a managed care plan or be assigned to one. Seventy to 80% say that the health services in managed care plans are just as good or better than those from fee-for-service caregivers, according to a survey by University of California, Berkeley. Those who had the most difficult transitions were SPDs who are in the worst health and those with functional and cognitive impairments. People were more likely to experience challenges if they rated their health as poor; had activity and mobility limitations; had difficulty reading health care materials; or were African American, Latino, or older than 65. For more information, visit www.chcf.org.

Last Updated 05/05/2021

Arch Apple Financial Services | Individual & Family Health Plans, Affordable Care California, Group Medical Insurance, California Health Insurance Exchange Marketplace, Medicare Supplements, HMO & PPO Health Care Plans, Long Term Care & Disability Insurance, Life Insurance, Dental Insurance, Vision Insurance, Employee Benefits, Affordable Care Act Assistance, Health Benefits Exchange, Buy Health Insurance, Health Care Reform Plans, Insurance Agency, Westminster, Costa Mesa, Huntington Beach, Fountain Valley, Irvine, Santa Ana, Tustin, Aliso Viejo, Laguna Hills, Laguna Beach, Laguna Woods, Long Beach, Orange, Tustin Foothills, Seal Beach, Anaheim, Newport Beach, Yorba Linda, Placentia, Brea, La Habra, Orange County CA

12312 Pentagon Street - Garden Grove, CA 92841-3327 - Tel: 714.638.0853 - 800.731.2590
Email:
Jay@ArchApple.com
Copyright @ 2015 - Website Design and Search Engine Optimization by Blitz Mogul