Medicare Advantage plans could see payment reductions topping 5 percent, considering they are also facing cuts from the health care reform and from steep federal budget cuts known as sequestration that are slated to start in March (Associated Press, 2013). Medicare Advantage plans are a key source of growth for insurers. It allows Medicare to offer basic coverage topped with vision or dental coverage, or offer premiums lower than standard Medicare Rates (Associated Press, 2013). The Advantage plans help cuts costs and negotiate reimbursement with providers to help keep costs down.
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide the citizen with all their Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and arent paid for under Original Medicare (Medicare.gov, n.d.).
Under each plan there are different coverages. For example under a PPO you pay less for use of doctors, hospitals, and other health care providers that belong in your plans network. If you choose to go elsewhere youll pay a larger premium. With an HMO, you cant get your health care from any doctor, other health care provider or hospital. You must get your care and services from providers in that network (Medicare.gov, n.d.).
Per Medicare News Watch, the annual estimated out-of-pocket costs for Medicare Advantage Plan members in 2013, including applicable copayments, deductibles, and premiums will vary from state to state. This website ranks all plans within the state and gives you an average on how much youll play per plan whether your health is good, fair or poor. For Massachusetts, a citizen can pay anywhere from $727-6712 on average per year depending on their health status.
In the West Palm Beach area of Florida, it will costs between $106-4178 a year (Hmos4seniors.com, 2013). Considering a good majority of these patients dont have much expendable income its hard to think that these prices may increase and that there will be fewer options as well. I personally know elderly and disabled on these types of plans and they have expressed that any increases will be a hardship on all of them. The health status is defined per the chart below (Hmos4seniors.com, 2013): Health Status: GOOD
Requiring occ. routine care| Health Status: FAIR
Requiring episodic care for non-chronic conditions| Health Status: POOR Requiring chronic disease
care and management|
Low annual utilization- 4 Doctor office visits (in-network)
1 Urgent care visit (out-of-area)
0 Inpatient admissions
0 Home health visits
6 Prescriptions (30 day supply)
1 Vision, hearing exams
1 Dental prevention visit| Moderate annual utilization- 12 Doctor office visits (in-network)
1 Emergency room visit
1 Inpatient admission (5 days)
4 Home health visits
24 Prescriptions (2 per month)
1 Vision, hearing exam
1 Dental prevention visit| High annual utilization- 24 Doctor office visits (in-network)
2 Emergency room visits
3 Inpatient admissions (15 days)
12 Home health visits
72 Prescriptions (6 per month)
1 Vision, hearing exam
1 Dental prevention visit|
Hmos4seniors.com (2013). MedicareNewsWatch.com Medicare Advantage Plan Cost Comparisons in Major Cities throughout the United States. [online] Retrieved from: http://www.hmos4seniors.com/costcomparisons.html [Accessed: 25 Feb 2013]. Medicare.gov (n.d.). Medicare Advantage Plans | Medicare.gov. [online] Retrieved from: http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html [Accessed: 25 Feb 2013]. Associated Press (2013). Health insurer stocks slip over possible Medicare Advantage payment cuts. The Washington Post, 19th February.