Post on 26-Dec-2015
The Future of MedicareAnd How Private Plans are Affected
Dwane McFerrin, VP Medicare Solutions Senior Market Sales, Inc.
© 2011, National Association of Health Underwriters • www.nahu.org
Source: CSG Actuarial, LLC, Future of Medicare Supplement. www.medicaresupp.org/2012/program/501b.pdf, November 2012.
© 2011, National Association of Health Underwriters • www.nahu.org
Source: Kaiser Family Foundation, Medigap: Spotlight on Enrollment, Premiums and Recent Trends, Medicare Policy. www.kff.org/medicare/8412.cfm, April 2013.
Sales Trends Vary Greatly by State
© 2011, National Association of Health Underwriters • www.nahu.org
Reimbursement Cuts impact on MA
Congressional Budget Office Projections
Source: The Insurance Barn, Medicare Advantage’s Future Is Bad But Not As Bad As Rumors Would Have You Believe. www.theinsurancebarn.wordpress.com, November 2012.
© 2011, National Association of Health Underwriters • www.nahu.org
Projected Federal Spending on Medicare and Medicaid (% GDP)
It is the rate of spending per individual that will have the most impact rather than the quantity/demographics of an aging population.
“Excess cost growth” refers to the extent to which the increase in healthcare spending for an average individual exceeds the growth in per capita GDP.
“Interaction…” refers to the effects of excess cost growth and the aging of the population, which results in greater growth in spending than would result from either factor separately.
“Aging of population” refers to demographic shifts, such as increasing average population age and life expectancy.
Source: Congressional Budget Office via Wikimedia Commons File: Medicare and Medicaid GDP Chart.svg. <http://commons.wikimedia.org/wiki/File:Medicare_and_Medicaid_GDP_Chart.svg> 12 September 2009.
© 2011, National Association of Health Underwriters • www.nahu.org
Source: Congressional Budget Office via Fix Health Care Policy. Presidential Debate Prep: Understanding Obamacare’s $716 Billion in Cuts to Medicare. 19 October 2012. <http://fixhealthcarepolicy.com/tag/medicare-advantage-cuts>
* Disproportionate Share Hospital, meaning payments that go to hospitals that serve a large number o flow-income patients.
© 2011, National Association of Health Underwriters • www.nahu.org
Medicare Budget Cuts No One Likes
President Obama’s Proposed 2014 Budget
• President open to reform, combining Part A and B to a single deductible*
• Proposed 15% surcharge on new buyers of Med Supp Plan F• Republicans and Democrats with misgivings**
– Pat Roberts R-KS “Lizzie Borden whack” at critical access hospitals
– Democratic Senators Cantwell – WA, Nelson – FL and Menendez – NJ object to cuts in graduate medical education
– Max Baucus D-MT expressed concern about cuts to nursing homes
Persuading lawmakers of a grand bargain cutting entitlements and raising
revenue will be difficult; Distrust of IRS a major political issueSource: * http://nyti.ms/161LB6C 3/28/2013**Mary Agnes Carey, Kaiser Health News 4/18/2013
© 2011, National Association of Health Underwriters • www.nahu.org
Deficit Reduction Proposals
Medicare Impact
• Senators Coburn R-OK and Lieberman I-CT (former) “Raise eligibility for Medicare by 2 months every year”* thereby increasing eligibility from 65 to 67 gradually
• The Medicare Payment Advisory Commission (MedPAC) has discussed a 20 percent surcharge on Plan F
• H.Con.Res.25 Means Testing for Medicare Parts B and D and freeze thresholds until 25% of beneficiaries are paying income-related premiums**
• Bowles-Simpson Commission proposed in 2010 to combine Part A and B into a $550 deductible and 20% coinsurance rate with $7,500 out-of-pocket maximum
*Source: http://1.usa.gov/14Mk4uP 4/18/2013** Kaiser Family Foundation, Medicare and the Federal Budget http://bit.ly/ZbKJMN 4/2013
© 2011, National Association of Health Underwriters • www.nahu.org
CMS Regulations for MA
• Quality Stars reimbursement
• 5 stars = year-round selling
• Low-Performing Plans – Letters to beneficiaries– Method for agents to get
paid
• CMS threatening to term carriers performing at 2.5 stars
• Expansion plans limited• Medicare Advantage
Disenrollment Period
Carrot and Stick Approach
© 2011, National Association of Health Underwriters • www.nahu.org
Major Issues facing Medicare
A Complex Environment
• COBRA• Observation status• Open Enrollment Period begins 10-1 and 10-15• Accountable Care Organizations• Navigators and healthcare exchanges/marketplaces• Medicare Advantage consolidation• Fraud estimated to cost $60-$90 billion annually*• Disclosing provider costs
Source: 5/14/2013 SF Chronicle article by Kelli Kennedy “89 charged in Medicare fraud busts in 8 cities”
© 2011, National Association of Health Underwriters • www.nahu.org
Medicare Advantage Consolidation
Recent MA Acquisitions/Mergers
• Humana/Arcadian• UnitedHealthcare/Care Improvement Plus• Aetna/Coventry• Cigna/HealthSpring
© 2011, National Association of Health Underwriters • www.nahu.org
Medicare Supplement Carriers
Newer Entrants
• AFLAC• Equitable Life & Casualty• Manhattan Life• Everence Insurance Company• Omaha Insurance Company
Carriers making Acquisitions
© 2011, National Association of Health Underwriters • www.nahu.org
Part D Environment
A Competitive Market
• Coverage Gap is narrowing and for the first time, 2014 deductibles and thresholds will go down
• Fierce competition for zero deductible plans• Fierce competition for low premium aging-in buyers• More brand name drugs moving to generic status• Referral programs becoming popular• Pharmacies/Retailers becoming more active• Quoting by vendor for Medicare.gov now commercially
available
© 2011, National Association of Health Underwriters • www.nahu.org
The Senior Segment is the Fastest Growing Demographic
Source: CRS computations based on data in the U.S. January 21, 2011 based on the Census Bureau’s December 2010 data release. These data do not include results from the 2010 census.
© 2011, National Association of Health Underwriters • www.nahu.org
The Senior Segment will Account for 20% of the U.S. Population by 2050
Source: CRS computations based on data in the U.S. January 21, 2011 based on the Census Bureau’s December 2010 data release. These data do not include results from the 2010 census.
© 2011, National Association of Health Underwriters • www.nahu.org
Sources of Supplemental CoverageAmong Medicare Beneficiaries, 2009
Medigap24%
Medicare Advantage only 14%
Medicaidonly 14%
Employer-Sponsored only 25%
Other Public/Private
Coverage only1%
Multiple Sources of Coverage (without
Medigap)10%
No Supplemental Coverage12%
Source: Kaiser Family Foundation, Medigap: Spotlight on Enrollment, Premiums and Recent Trends, Medicare Policy. www.kff.org/medicare/8412.cfm, April 2013.
Total Medicare Beneficiaries, 2009 = 47.2 Million
© 2011, National Association of Health Underwriters • www.nahu.org
So What Does it all Mean?
Change is Guaranteed Due to:• Healthcare costs• Demographic changes• Federal deficit• Regulations already underway
Private Insurance will Play a Key Role Due to:• Consumer preferences• Demographic changes• Accountable Care Organizations/cost cutting• Legislation will likely be phased in
© 2011, National Association of Health Underwriters • www.nahu.org
How does an Agent Survive in a Changing Environment?
• Study the changes• Educate your clients• Embrace technology• Support NAHU and industry organizations• Know your value proposition
– Your clients want Call, Click, Mail or Meet™