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Medicare Advantage
Featured Health Business Daily Story Oct. 14, 2009
Medicare Advantage Plans Make Only Incremental Benefit Design Changes for 2010
Reprinted from MEDICARE ADVANTAGE
NEWS, biweekly news and analysis on the Medicare (and Medicaid) managed
care programs.
By Judy Packer-Tursman, Editor, (tursman@comcast.net)
Regional and local Medicare Advantage (MA) plans across the nation say that they are by-and-large making incremental instead of wholesale benefit design changes for 2010, although some report substantial premium hikes for certain products. Many plans also report minimal changes to MA prescription drug plan (MA-PD) and stand-alone Prescription Drug Plan (PDP) benefits for 2010.
“I feel this is somewhat of a transitional year, at least in the markets we serve,” says Sherry Stanislaw, SCAN Health Plan’s senior vice president of operations and marketing. “I don’t think you’ll see major adjustments based on the decrease in CMS revenue [to MA plans for 2010],” she adds, “but I think you’ll see incremental increases in member out-of-pocket cost sharing” — at least in the Southern California market served by SCAN.
According to recent interviews by MAN with plan executives:
- SCAN is expanding from seven counties in Southern California into Contra Costa, San Francisco, Santa Clara and San Joaquin counties in Northern California for 2010, the not-for-profit company says. SCAN announced Sept. 29 that it had entered into a partnership with OmniIPA Medical Group in San Joaquin that shifted the 2,100-some members of the medical group’s Medcore Health Plan, an MA product, into SCAN. In all, SCAN now has about 113,000 MA members, including Medcore’s membership. “Our goal for 2010 was to hold premiums steady and not eliminate benefits, but some copays are going up,” Stanislaw says.
“We’re not making a whole lot of changes on Part D. We’re continuing to cover generics through the gap….That’s a key part of our design,” Stanislaw says. “Our limits are pretty much keeping the same, but there are incremental changes to [Part D] copays,” including a shift from $28 to $30 on the member copay for some brand-name drugs. “Other than that, we’re holding steady,” she says.
SCAN also made incremental increases to MA member copayments for some medical services in 2010, Stanislaw says. For example, she says that the $50 member copay in some counties for five days of hospitalization will go up to $100 as of Jan. 1.
- Pittsburgh-based UPMC Health Plan’s MA-only HMO is zero premium for 2009 and will remain so for 2010. But the insurer is nearly doubling the monthly premium for its standard MA-PD HMO, from the current $28 to $53 as of Jan. 1, says Cathy Batteer, UPMC’s vice president of Medicare. The premium for UPMC’s MA-PD with an enhanced benefit package will increase to $141 from $109. All premium and benefit changes for next year are related to revenue reductions by CMS, she says.
UPMC is adding a second PPO for 2010 with a zero-premium drug benefit but a $2,000 deductible that excludes primary care services, including immunizations and screenings. (Its “regular” MA PPO’s monthly premium is climbing from $166 to $212.) “With the new high-deductible plan, we’ll have three HMOs and two PPOs in this [MA] market, and we’ll have a pretty good distinction between them,” Batteer said.
UPMC is eliminating its group MA private-fee-for-service (PFFS) business for 2010, Batteer says. “We’re in the midst of doing renewals for 2010, and those [group] accounts are being offered a PPO product.…PFFS worked for us, it got us into adjoining geographies [in Ohio and West Virginia], and we subsequently got licenses there for HMO and PPO products.” She says UPMC is “more comfortable” with network-based MA products.
Similar to 2009, UPMC has no coverage in the “doughnut hole” gap for its standard Part D product in 2010, she says. The enhanced MA PPO (not the high-deductible plan) is the only plan that will continue to offer generic coverage through the gap as of Jan. 1; such coverage was dropped by its enhanced HMO option for 2009. UPMC has fewer than 1,000 members in its PDP, which hasn’t been a company focus, she says, adding, “We’ll continue to offer it, but we don’t expect it to grow.”
UPMC hasn’t added or exited any service areas for 2010, Batteer says. Current MA enrollment is about 65,300 in UPMC’s HMO, PPO and PFFS plans; another 17,000 members are in its MA Special Needs Plan (SNP) for people dually eligible for Medicare and Medicaid.
- UCare reports minor premium increases — and minor premium decreases — for its 2010 MA products. Benefit changes in its MA plans were “kept to a minimum” and 2010 Part D benefits are basically identical to 2009, although the insurer instituted step therapy for a handful of prescription drugs starting Jan. 1, UCare spokeswoman Ghita Worcester says. Supplemental dental, vision and hearing benefits are unchanged for 2010, she adds, and remain part of the standard benefit for UCare’s Classic plan.
UCare’s current MA-PD enrollment is 65,000 members in its combined Minnesota and Wisconsin service areas, Worcester says, noting that UCare did not add or drop any counties for 2010. UCare did not eliminate any plans in 2010 due to low enrollment, according to Worcester, but the not-for-profit insurer eliminated its chronic-care SNP “due to changes from CMS.”
Currently, UCare’s chronic-care SNP covers members with any of seven chronic conditions, Worcester explains. She concedes that the SNP has few enrollees, but asserts that other factors, including CMS’s new rules on which conditions are eligible for chronic-condition designation, as well as bidding regulations, led to UCare’s determination that it was no longer viable to keep offering the plan.
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