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HHS Announces that Medicare Advantage Enrollment Is Expected to Increase by 11 Percent

By Brandon Moseley
Alabama Political Reporter

Thursday, the United States Health and Human Services Department (HHS) announced in a written statement that enrollment in the Medicare Advantage (MA) program is projected to increase by 11 percent during the next year and that premiums will remain steady.

HHS Secretary Kathleen Sebelius said, “Thanks to the Affordable Care Act, the Medicare Advantage and Prescription Drug programs have been strengthened and continue to improve for beneficiaries. Since the law was enacted in 2010, average premiums have gone down, enrollment has gone up, and new benefits and lower drug costs continue to help millions of seniors and people with disabilities.” Sebelius said that since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have dropped by 10% and enrollment has risen by 28%.

Secretary Sebelius credited new powers given to the Centers for Medicare & Medicaid Services (CMS) by the Patient Protection and Affordable Care Act (popularly known as Obamacare) with protecting beneficiaries from significant increases in costs or cuts in benefits. Sebelius added that acccess to supplemental benefits has remained steady and that beneficiaries’ average out-of-pocket spending has remained constant.

According to the report, the average MA premium in 2013 will increase by only $1.47 from last year, coming to $32.59 a month. Last year however seniors preferred the lowest cost plans. If they continue to pick the lowest cost plans over higher cost higher benefit plans in 2013, like they did in 2012 the average premium is expected to increase by just 57 cents. According to HHS 99.6% of American seniors live within the service area of at least one Medicare Advantage program. In Alabama, Blue Cross/Blue Shield, United Healthcare, Humana, Viva (a subsidiary of UAB), Windsor, and HealthSprings all offer Medicare Advantage Plans; but not every plan is sold in every county and different counties may pay different prices for the same plan depending on local doctor and hospital participation.

The HHS also announced that the average basic Medicare prescription drug plan (Medicare PDP) premium was projected to just be $30 in 2013, holding steady from last year. Coverage for both brand name and generic drugs in the Part D donut hole coverage gap will increase in 2013. In 2013, people with Medicare will receive approximately 53% off the cost of brand name drugs, and coverage for 21 percent of the cost of generic drugs, in the donut hole. The donut hole was built in to the Medicare senior drug benefit to discourage overuse of prescription drugs by seniors. For 2013 the donut hole will be from $2970 to $4750. Persons with modest means can qualify for the Low Income Subsidy program (LIS) or Alabama Medicaid where there is no donut hole.

Multiple Prescription Drug Plans are available in Alabama although different counties have access to different plans. Stand alone Medicare prescription drug plans are sold by Blue Cross/Blue Shield, United Healthcare, Humana, Silverscript, First One (a subsidiary of Coventry which was recently purchased by Aetna), Aetna, Express Scripts, Cigna, Windsor, Community CCRx (recently purchased by Silverscript), Wellcare, UniCare, United American, Envision, and Health Net as well as other companies.

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This year the annual enrollment period for Medicare beneficiaries to enroll in or change their Medicare Advantage or Prescription Drug Plan begins on October 15th and ends on December 7th. Plans, providers, drug formularies, and LIS subsidy qualification levels change every calendar year so it is important for Medicare beneficiaries to annually check to see if their plan is still the best plan for them.

Original Medicare shares costs with the beneficiaries. For a senior with only original Medicare the inpatient deductible per 60 day benefit period is $11156. The per day copayment for days 61-90 in the hospital is $289. For lifetime reserve days (days 91-150) it is $578 per day. The copayment for Medicare approved skilled nursing care (days 21-100) is $144.50 per day. The annual Medicare Part B deductible is $140 and Medicare pays only 80% of the Part B costs after the deductible is met. Some Medicare providers can charge up to 15% over the Medicare approved amounts. Medicare beneficiaries are responsible for any and all of those excess charges in addition to their 20% copayment. These are the 2012 numbers and there likely will be some changes in 2013.

Unlike most insurers there is no maximum out of pocket cost in basic Medicare. For this reason, most Medicare beneficiaries purchase a Medicare supplement from a private insurance company or they enroll in a Medicare Advantage Plan. Original Medicare and a Medicare supplement are accepted by a far larger network of doctors and hospitals than Medicare Advantage Plans (which are often limited to certain geographic areas). Blue Cross/Blue Shield, United Healthcare, United American, United of Omaha, Gerber, Assured, Humana, Great Plains, and other companies market Medicare supplements in the state of Alabama.

For purposes of full disclosure the writer is a licensed health insurance agent specializing in senior health.

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Brandon Moseley is a former reporter at the Alabama Political Reporter.

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