Good news for Medicare Advantage plans in Arizona! In what Kaiser Health News called a “surprising move”, the Obama administration “will extend special bonus payments meant to reward top-performing Medicare Advantage plans to those that score only average ratings”.
With most Advantage plans in Arizona rated as average (3 stars), our plans will get additional money even as Medicare reduces payments to the insurance companies that run the plans.
Part of the health care reform law requires Medicare to reduce payments to all Medicare Advantage plans by about 15% over three years starting in 2012. At the same time, the law provides for bonus payments to Advantage plans that are highly rated, or earning 4 or 5 stars based on a range of quality measures.
In Arizona, only Cigna in Maricopa County gets 4 stars or more. In Tucson, the major Advantage plans (Secure Horizons, Health Net and Humana) get 3 stars.
I have written previously that the three-star ratings of Advantage plans in southern Arizona would not bode well for the 45% of Medicare beneficiaries in Pima County who are enrolled in these plans. With payment cuts to Medicare Advantage looming, would all plans have to start charging premiums in 2012? Would co-pays for doctor visits and hospital stays be increased? Would free gym memberships be dropped?
The Kaiser Health News article says the move to reward 3 star-rated Advantage plans is a way to prevent areas like southern Arizona from having a market shock in 2012 where Advantage plans drop out of the market and large numbers of seniors are forced to change plans or return to Medicare. This happened in the late-90′s when payments to private Medicare plans were cut drastically from one year to the next and companies like Blue Cross Blue Shield dropped out of the the Medicare HMO business.
So, while Medicare is going to cut payments to Medicare Advantage plans, the plans are being encouraged to improve their ratings so they will get bonus payments. One of my clients, who is enrolled with Humana, said she was surprised to get a phone call from Humana asking her why she hadn’t gotten her annual physical. The Humana representative encouraged her to use the preventive screening benefits provided in her Medicare Advantage plan. This is a sign that Humana is trying to improve its rating.
The summary rating gives an overall score on the health plan’s quality and performance on 33 different topics in 5 categories:
- Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
- Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
- Ratings of health plan responsiveness and care. Includes ratings of member satisfaction with the plan.
- Health plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan.
- Health plan telephone customer service. Includes how well the plan handles calls from members.