HIGH SCHOOL CLASS OF ’72! – MEDICARE IS HERE FOR YOU!

By Don Kenton Henry – editor, broker

Fellow classmates of the High School Class of 1972! Congratulations! It’s been thirty-six years since we graduated and went on to build careers and raise families. During this time we dutifully paid into Social Security and paid Medicare taxes. Most of us will be turning age 65 during the next year if we have not already done so. As such, we will be “aging into Medicare”. Never, in my life, have I looked forward to getting older,―until now. Because―as such―I will be eligible for Medicare and finally have an alternative to the Under Age 65 Affordable Care Act (ACA) marketplace for health insurance purposes. As a Medicare-related, private insurance specialist,―knowing all my plan options―along with knowing which plans I will enroll in―I am elated to finally being able to take advantage of the following benefits not currently available to any of us not currently on Medicare:

I know I will I be able to go to any doctor or hospital that sees Medicare patients. Additionally, I will be out of nothing―or virtually nothing―for my Medicare eligible medical expenses, per se, throughout the calendar year! (By “per se”, I mean aside from the out-patient prescription drug costs I will pay at the pharmacy counter.)

Even those of you who have had the benefit of employer-based group health insurance through throughout your working career ― have to had to meet a significant deductible before insurance benefits apply to your major medical expenses. In recent years, that has probably been at least $1,000 and, probably, more. Then you have been responsible for additional costs (coinsurance) thereafter!  Compare that to your share of a maximum of $183 per calendar year, should you go with the plan option I will most likely recommend for you!

Regarding Part D prescription drug plans ― you will have approximately three dozen to choose from. Each of these covers some drugs but does not cover others. And vice versa. The plan that is best for your spouse or neighbor is not necessarily the best plan for you. Our objective is to: (1) cover all your prescription drugs and (2) do so at your lowest possible total cost for both the plan and your prescription drugs for the calendar year. “Total Cost” is the sum of your plan premium, any applicable deductible, and your copays or coinsurance for your Rx drugs.

*If you would like me to identify your lowest cost Part D Medicare Prescription Drug Plan for 2019 email me, at Allplanhealthinsurance.com, a list of your current drug regimen and dosages. I will do so in the order received and forward the results via email.  

CHANGES TO MEDICARE PART D DRUG PLANS IN 2019:

  1. A) Stage 1, the Medicare Part D “Yearly Deductible Stage” is going to require a Medicare recipient member meet as much as a $415 deductible, up from $405. This does not mean a drug plan will increase your deductible, or even charge one in the first place. It simply means the Center For Medicare Services has informed the drug plans they may charge as much as that amount.
  2. B) Stage 2, the “Initial Coverage Stage” is going to $3,820. This is the limit your, and the plan’s, drug cost must reach before you enter the “Coverage Gap”.
  3. C) Your liability for your drug costs has been diminishing each year since 2011. This year, you will pay 25% of the cost of brand-name drugs, plus a dispensing fee, and 37% of the price for generic drugs.
  4. D) When your year to date personal drug costs reach $5,100 you enter the “Catastrophic Coverage Stage”. Therein, you will pay $3.40 of a drug that is treated like a generic and $8.50 or 5% of the cost of the drugwhichever is higher for all other drugs.

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MEDICARE PART B 2019

There has been no announcement on whether Medicare Part B’s calendar year outpatient deductible of $183 will be changing.

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CONSIDERING MEDICARE SUPPLEMENT VS MEDICARE ADVANTAGE to cover those medical expenses not paid by Medicare? Refer to today’s FEATURED ARTICLE 1 on “Denials of Care” below then call me for my opinion on one vs the other.

Should pharmacists be subject to a “gag” clause preventing them from telling you a lower cost for your drug is available at the pharmacy counter? See FEATURED ARTICLE 2, below:

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THOUGHT FOR THE DAY:

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Turning age 65 in April, I am right in this with you. I share a kinship, not only with my personal HS classmates, but everyone of my generation. I began my career out of college as social worker and then―believe it or not―a pharmaceutical sales person. I understand the perspective on brand name vs generic drugs, both from the drug companies’ and the consumer’s standpoint. (If you’d like to me to share this with you, off the record, please call me.)   I still like to help people and I get great satisfaction from ensuring I keep my client’s drug and medical costs to a minimum.

To assist you in this, I represent virtually every “A” rated (AM Best Rating) Medicare Supplement Plan and most of the Medicare Advantage and Part D Prescription plans I feel worthy of your consideration for 2019. I bring thirty-two years of experience in the industry to provide you an objective comparison of your options, simplify the enrollment process, and ensure you maintain the right plans for yourself, thereafter. I charge no fee for my services. I am compensated directly by the insurance company whose product you elect to utilize, and then―if, and only if―you elect to acquire that product through me. The key to you is―you are charged no more for that product than if went through the door of that insurance company to acquire it on your own. Additionally, when you call, text or email me, you know you are communicating with someone who knows your history and has a vested interest in keeping your business. Which means keeping you happy. This as opposed to a different faceless person at the other end of a toll-free number.

SoClass of ’72! Open enrollment begins October 15th for Medicare plans (and November 1st for your Under Age 65 family members in need of health insurance for 2019). Please call, text, email, or visit my websites for information and assistance. I’m certain our life experiences and objectives are much the same and I know peace of mind when it comes to our healthcare and costs is integral to our quality of life

Kenton Henry – Agent, broker, editor                                                                          Office: 281.367.6565                                                                                                  Text My Cell @ 713.907.7984                                                                                          Email: Allplanhealthinsurance.com@gmail.com                                  http://Allplanhealthinsurance.com                                  http://TheWoodlandsTXHealthInsurance.com          https://HealthandMedicareInsurance.com

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*FEATURED ARTICLE 1

BLOOMBERG

Private Medicare Plans Faulted by Watchdog Over Denials of Care

By  John Tozzi

September 26, 2018, 11:01 PM CDT

A new federal watchdog report warns that privately run Medicare health plans used by millions of older Americans may be improperly denying patients medical care.

Federal auditors have found “widespread and persistent problems related to denials of care and payment in Medicare Advantage,” the privately administered plans that insure more than 20 million people, according to the report from the Health and Human Services Office of Inspector General.

Medicare Advantage plans collect a fixed fee from the government for taking care of patients 65 or older who qualify for traditional Medicare coverage. The fixed per-patient rates the government pays may give plans “an incentive to deny preauthorization of services for beneficiaries, and payments to providers, in order to increase profits,” the report said.

Medicare Advantage plans have become popular with consumers because they combine traditional Medicare benefits with additional coverage, such as vision, dental care, and prescription drugs.

The program paid $210 billion to Medicare Advantage plans last year. Companies including UnitedHealth Group Inc.Humana Inc., and Aetna Inc.are the largest sellers of the coverage. Enrollment in Medicare Advantage has roughly doubled in the past decade, and one-third of Medicare patients are now covered by the private plans.

In 2016, Medicare Advantage plans denied 4 percent of requests to approve treatment before it was provided, known as prior authorization, and 8 percent of requests for payment after treatment, according to the report.

Only 1 percent of patients disputed the insurers’ denials, but in those cases, the decisions were overturned three-quarters of the time, according to the report.

Improper denials “may contribute to physical harm for beneficiaries if they’re not getting access to services that they need,” said Rosemary Rawlins, the inspector general’s team leader on the report. Patients and doctors can also be harmed financially if not reimbursed for appropriate care, she said.

If plans aren’t providing the care they’re contracted to, it risks wasting taxpayers’ money. The government “has already paid to cover beneficiaries’ health care,” Rawlins said. Not every denial is an indication that patients are being blocked from needed treatment, however.

“You wouldn’t expect the denial rate to be zero,” Rawlins said. “Part of managing care is denying care that’s not needed.”

There’s a lot of variation in how often Medicare Advantage plan denials were overturned. In 2016, seven Medicare Advantage contracts had almost all of their denials reversed on appeal — more than 98 percent. Another 69 contracts had denial rates above 90 percent. The report doesn’t name specific companies or plans. Individual insurers can have more than one Medicare Advantage contract with the government.

Problems with denials of care aren’t isolated to a few plans, however. The Centers for Medicare and Medicaid Services, or CMS, audits different organizations each year, “but consistently find problems related to denials of care and payment,” Rawlins said.

The CMS audits are one of many factors that affect health plans’ star ratings, which are intended to help Medicare patients shop for plans based on quality. But starting in 2019, as the result of a change by CMS, the audits will no longer be a factor in the ratings, “which diminishes the usefulness of the star ratings system as a tool for beneficiaries,” the report said.

The inspector general recommended that CMS increase its oversight of Medicare Advantage plans and give patients better information about violations. The agency concurred with the findings.

A CMS spokesperson said in an email that the agency is committed to “strong oversight and enforcement of the Medicare Advantage program to ensure that plans are delivering care to Medicare beneficiaries” as required.

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FEATURED ARTICLE 2

WASHINGTON EXAMINER

Senate unanimously passes bill banning pharmacy ‘gag clauses’ in Medicare

by Kimberly Leonard

 September 05, 2018 03:03 PM

The Senate unanimously passed a bill Wednesday that would ban Medicare insurers from enforcing “gag clauses” that forbid pharmacies from telling customers about cheaper ways to buy drugs.

The Know the Lowest Price Act is intended to help patients covered under Medicare to find out if their prescription would cost less if they were to pay for it out of pocket rather than through their insurance plan.

“Passing this bill and eliminating gag clauses gives patients more power to lower their healthcare costs,” Sen. Bill Cassidy, R-La., who helped introduce the plan, said in a statement. “It makes prices transparent so patients can save money with less expensive prescriptions.”

The new rules explicitly apply to Medicare Part D, which pays for prescription drugs, and to Medicare Advantage, a healthcare plan managed by private insurers. Medicare is the program covering adults 65 and older and people with disabilities.

In the complexity of the system that involves pharmaceutical companies, drug reimbursements, middlemen known as pharmacy benefits managers, and health insurance companies, patients can sometimes end up paying more while others in the chain pay less. Private health insurers and pharmacy benefits managers use “gag clauses” in their contracts to prohibit pharmacists from informing customers that they can save money if they don’t go through their health plans.

Another bill passed in committee, known as the Patient Right to Know Drug Prices Act, would provide the same protections for people who have private health insurance coverage. The Trump administration has called for Congress to undo the gag clauses and pass other measures to help reduce what patients pay for drugs.

Medicare Part B Premiums Projected To Go Up For 2017 ― Insurance Companies Participating In Obamacare Going Down

By Kenton Henry, editor

A double whammy is expected to impact the medical insurance market for 2017. There is bad news for the consumer on both the Medicare and the Under Age 65 ends of the medical insurance spectrum.

One positive note ― more than 60 million Medicare recipients are projected to receive a cost of living adjustment in their Social Security Benefit! But if you’re part of this group … don’t spend all your new found increase in one place. It’s projected to be a minuscule 0.2 percent! What the government giveth . . .  (well, you can see this coming!) The flip side is, their monthly Part B premiums would go to $107.60 in 2017 ― a $2.70 increase.

On the other hand, 30% of recipients, which includes those new to Medicare in 2017; those who do not have their Part B premiums deducted from their Social Security Income Account in 2016; and those with higher incomes may see increases in premium to $149.00 for the lowest tax bracket; from $166.30 ― to $204.40 per month for the next; and from $380.20 to $467.20 in the highest bracket. Whether these projections―which amount to as much as a 22% increase for the highest income earners―are realized will not be known until October.

Part B premiums are extremely relevant when one has the option of remaining on one’s (or one’s spouse’s) company group health insurance beyond age 65 and into retirement and is weighing the cost of such against the cost of transitioning fully to Medicare Part A and B.

For guidance in this consideration please feel free to consult with the author / editor. *(see featured article from the Wall Street Journal below)

And for those still not age 65, or otherwise eligible for Medicare―and not covered by an employer’s group health insurance plan―your options for coverage are scheduled to diminish along with competition in the individual and family Affordable Care Act (ACA) compliant insurance market. If realized, the  proposed mergers between Anthem and Cigna and between Aetna and Humana would reduce your options. This on top of Unitedhealthcare’s (America’s largest insurer) announcement it is pulling out of 90% of its current markets in 2017. Furthermore, BlueCross BlueShield Association announced they may also decline or diminish  participation in the marketplace. Lastly (until our next episode), to cast further doubts on what options will remain for the consumer, both Aetna and Humana have announced they may pull out of the majority of their individual and family markets regardless of whether their proposed merger is approved. Humana issued a statement just last week to the effect they would be limiting coverage to 156 counties this month compared the 1,351 they participate in currently. **(please refer to feature article on Humana below)

For these reasons, and because the majority of my individual and family clients have been forced to migrate to Health Maintenance Organization plans (where their providers and treatment are rationed) I have been advising those who are business owners to transition to group health insurance where they not only have more options relative to benefits but can still benefit from Preferred Provider Organization (PPO) coverage. With the PPO plans, they have the final say on their providers and, thereby, better control the quality of their treatment. Small Business (less than 50 employees) owners should take note that if they enroll during the Small Business Open Enrollment Period (November 15th ― December 15th) they will not have to meet the 75% full-time employee participation rate or the 50% of employee premium contribution requirement. The only requirement is that a minimum of 2 full time, W-2 employees be covered on the plan. This is an excellent opportunity for small, closely held companies who want to improve their family’s health insurance but cannot afford coverage for all employees.

Again, please feel free to contact our office for further insight and guidance on this issue.

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Feature Article #1

WALL STREET JOURNAL

By Anne Tergesen

Updated June 22, 2016 5:12 p.m. ET    

Nearly a third of all Medicare beneficiaries face a steep increase in their premiums next year, the result of a policy that in certain circumstances requires some beneficiaries, including higher earners, to shoulder the burden of rising costs.

The government health-care plan’s trustees projected in a report Wednesday that premiums would rise by as much as 22% for wealthier beneficiaries of Medicare Part B, which covers doctor visits and other types of outpatient care.

The projected increase results from an intersection of the rules governing Medicare and Social Security, said Tricia Neuman, senior vice president and an expert on Medicare at the Kaiser Family Foundation.

Under the Social Security Act’s “hold harmless” provision, Medicare can’t pass along premium increases greater than what most participants would receive through Social Security’s annual cost-of-living adjustment. That adjustment is expected to be just 0.2% in 2017 thanks to low inflation. As a result, Medicare couldn’t pass along any premium increase greater than the dollar increase in Social Security payments to the estimated 70% of beneficiaries who will qualify for hold harmless treatment in 2017, Ms. Neuman said.

Instead, Medicare must spread much of the projected increase in its costs across the remaining 30%. Those who are paying the standard $121.80 a month for Medicare Part B this year would be charged $149 a month in 2017 if the trustees’ predictions come to pass.

Higher earners would pay more. The trustees project individuals earning between $85,001 and $107,000 and couples earning between $170,001 and $214,000 would have their 2016 monthly premiums rise from $170.50 a person this year to about $204.40 in 2017. For those earning more than $214,000, or $428,000 for couples, the projected increase is to about $467.20 a month, from $389.00 in 2016.

This isn’t the first time there has been such a disparity in Part B premiums between Medicare recipients.

Last year, Congress staved off a 52% premium increase for Medicare beneficiaries not covered by the hold harmless provision via a deal in the budget agreement that raised premiums by 16% for them instead. Those covered by the hold harmless provision, in contrast, pay $104.90 a month—the same amount they paid in 2014 due to the fact that there was no Social Security cost-of-living increase in 2016.

The projected increase in Part B premiums affects several other groups of Medicare beneficiaries, including those who receive Medicare but have deferred or aren’t eligible for Social Security benefits. It also would apply to those who are new to Medicare in 2017 and lower-income Medicare beneficiaries whose premiums are paid by state Medicaid programs.

In the latter case, the increase would be paid by Medicaid, Ms. Neuman said.

Paul Van de Water, senior fellow at the nonprofit Center on Budget and Policy Priorities, said the final Social Security cost-of-living adjustment won’t be known until October. If inflation rises by more than the trustees expect between now and then, it could “reduce the spike in the premium” for those who aren’t held harmless, he said.

Acting Administrator for the Centers for Medicare and Medicaid Services Andy Slavitt said at a news conference Wednesday, “We will continue to monitor the data and explore administrative options as needed.”

The Medicare trustees are projecting that the base Medicare Part B premium will reset for everyone at $124.40 a month in 2018, because they expect higher Social Security cost-of-living increases.

Medicare covered 55 million people last year, according to the trustees’ report. Part B covered nearly 51 million. In 2017 Medicare is expected to have 58.7 million total participants and 53.5 million in Part B.

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Feature Article # 2

Humana beats 2Q forecasts, details ACA-related scale back

Tom Murphy, AP Health Writer

Published 9:09 am, Wednesday, August 3, 2016

Humana beat second-quarter earnings expectations and reaffirmed its forecast for 2016, even as the health insurer set aside an additional $208 million to cover expenses in its individual, commercial coverage.

The company also said Wednesday it was scaling back that individual business for next year and would only offer it in 156 counties, compared to 1,351 this year. The insurer also said it will sell coverage on Affordable Care Act individual exchanges in 11 states next year, down from 15 this year.

Humana, based in Louisville, Kentucky, provides individual coverage for nearly 500,000 people through the exchanges. It covers an additional 200,000 individual customers off the exchanges, a small slice of its total medical membership of 14.2 million.

Other major insurers like UnitedHealth Group and Anthem also have recently detailed struggles with coverage they sell on the ACA’s state-based exchanges, which have helped millions of consumers gain insurance since they opened for enrollment in the fall of 2013. Aetna, which is trying to buy Humana, said Tuesday that it cancelled its exchange expansion plans for 2017 and was taking a hard look at the markets in which it is currently participating.

Insurers have been struggling with higher-than-expected claims on the exchanges and lower-than-expected support from government programs, among other issues.

Humana also is one of the nation’s largest providers of Medicare Advantage plans, which are privately run versions of the government’s Medicare program for people over age 65 or disabled. The company said Wednesday that its core businesses remained strong in the second quarter.

Overall, Humana earnings plunged 28 percent to $311 million compared to last year’s quarter, when it booked a $267 million gain from a business sale.

Earnings, adjusted for non-recurring costs and amortization costs, came to $2.30 per share.

Analysts expected, on average, earnings of $2.22 per share, according to Zacks Investment Research.

The health insurer posted revenue of $14.01 billion in the period, which topped the average Wall Street forecast for $13.63 billion.

The company also said Wednesday that it still expects full-year earnings to total at least $9.25 per share.

Shares of Humana edged up 52 cents to $170.09 Wednesday morning while broader indexes were flat.

Humana shares have decreased 5 percent since the beginning of the year, while the Standard & Poor’s 500 index has climbed 5.5 percent.

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BULLETIN: Second Round of Obamacare Breaks From The Gate Starting Now!

HEALTH INSURANCE PREMIUMS 2015

(Announcement by D. Kenton Henry and HealthandMedicareInsurance.com)

Who will end up the winner ― you ― the insured, the insurance companies or Uncle Sam?

As a health insurance broker of 27 years, I and my peers have waiting with baited breath all year to see two things:

First ― will enrollments in 2015 health insurance plans, which begin at midnight tonight, the 15th of November, go more smoothly than last year’s embarrassing debacle that was the glitch plagued Healthcare.gov website which floundered in the death throes of end-stage technology through the entire first year “open-enrollment” period?

Secondly ― what are 2015 premiums and benefits going to look like? By the time you read this, you are about to know. I hope you will be happy with the options available to you, however, I hate to say, I cannot guarantee that. Rumor has it that premiums will be going up at varying rates relative to each of the fifty states. In Texas they are projected to rise an average of 14%  above 2014 rates depending on your age. If this is the case and you have coverage you feel is adequate―along with the option of keeping it―that is exactly what you should do. But if you are like a great number of my clients, who have been told your current plan will terminate 12.31.2014,  your only options are to forego coverage and pay the penalty (excuse me “shared responsibility tax”) when you file your 2015 tax return. Or purchase one of the new compliant plans.

I cannot control the options you will have but I can present, simplify and guide you to your best value in 2015 health insurance coverage. My quoting link will not only determine if you qualify for and calculate the amount of your subsidy (utilizing the same algorithm employed by Healthcare.gov) but, in the event you do qualify, will allow you to seamlessly take advantage of the subsidy and apply for your health plan selection for the reduced (net) premium. It will illustrate all your options from every carrier both on and off the federal exchange.

I am certain that after reviewing your options you will have numerous questions. I encourage you to email or call me with them. I will answer them and once you have decided upon your best value, I can make the enrollment process go as smoothly and comfortably as possible. I intend to work all through the weekend and make myself available to be best of my ability.

It is currently 10 p.m. CST on the 14th. After midnight click on this link to begin exploring your options and know I greatly anticipate working with you and making this transition period in the health insurance consumer market go as smoothly as possible for you.

Sincerely,

Kenton Henry

Broker, Agent, Editor

Email: Quote@allplaninsurance.com

Phone: 281.367.6565

Toll Free: 800.856.6556

CLICK HERE FOR 2015 HEALTH INSURANCE OPTIONS: https://allplanhealthinsurance.insxcloud.com/my-quote/individual-info

*Please return to this page and give us your opinion of your options.

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FEATURE ARTICLES:

NEW YORK TIMES

14 November 2014

Cost of Coverage Under Affordable Care Act to Increase in 2015

By ROBERT PEAR, REED ABELSON and AGUSTIN ARMENDARIZNOV. 14, 2014

“Consumers should shop around,” said Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal insurance exchange serving three dozen states. “With new options available this year, they’re likely to find a better deal.” She asserted that the data showed that “the Affordable Care Act is working.”

But Republicans quickly pounced on the data as evidence of the opposite.

“Last year, many who liked their plan were surprised to learn they couldn’t keep it,” said Senator Orrin G. Hatch of Utah, who is in line to become chairman of the Senate Finance Committee. “This year, many who like their plan will likely have to pay more to keep it.”

The new data means that many of the seven million people who have bought insurance through federal and state exchanges will have to change to different health plans if they want to avoid paying more — an inconvenience for consumers just becoming accustomed to their coverage.

A new Gallup Poll suggests that seven in 10 Americans with insurance bought through the exchanges rate the coverage and the care as excellent or good, and most were planning to keep it.

In employer-sponsored health plans, employees tend to stay with the same insurer from year to year. But for consumers in the public insurance exchanges, that will often be a mistake, experts said.

Nashville illustrates the need for people with marketplace coverage to look closely at the alternatives available in 2015.

Marilyn B. Tavenner, administrator of the Centers for Medicare and Medicaid Services, which runs the federal health exchange. Credit Doug Mills/The New York Times

A 40-year-old in Nashville, with the cheapest midlevel, or silver plan, will pay $220 a month next year, compared to $181 a month this year, for the same plan.

The least expensive plan is offered by another insurer, Community Health Alliance, one of the so-called co-op plans created under the federal law. It offers coverage for a monthly premium of $194.

But the lower premium means that consumers will have to pay a much larger annual deductible, $4,000, rather than $2,000. A policyholder who becomes seriously ill or has a costly chronic condition could pay hundreds of dollars in out-of-pocket expenses.

In addition, different health plans often have different networks of doctors and hospitals and cover different drugs, meaning that consumers who change plans may have to pay more for the same medicines.

Another problem for consumers is that if the price for a low-cost benchmark plan in the area has dropped, the amount of federal subsidies provided by the law could be less, meaning that consumers may have to pay more unless they switch.

The data, released by the Centers for Medicare and Medicaid Services, indicates that price increases will be modest for many people willing to change plans. In a typical county, the price will rise 5 percent for the cheapest silver plan and 4 percent for the second cheapest.

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NEW YORK TIMES

Estimate of Healthcare Enrollment Leaves Room to Grow

10 November 2014

WASHINGTON — The Obama administration on Monday offered a surprisingly modest estimate of the number of people who would sign up for health insurance in the second round of open enrollment, which begins on Saturday.

Sylvia Mathews Burwell, the secretary of health and human services, said she was working on the assumption that a total of 9.1 million people would have such coverage at the end of next year.

By contrast, the Congressional Budget Office had estimated that 13 million people would be enrolled next year, with the total rising to 24 million in 2016. In the past, the White House has used the budget office numbers as a benchmark for success under the Affordable Care Act.

This estimate appeared to be part of an effort by federal officials to lower public expectations, so the goal would be easier to meet and to surpass. In addition, the new number could indicate that administration officials believe it will be difficult to find and enroll many of the uninsured while retaining those who signed up in the last year.

“The number we are going to aim for this year is 9.1 million,” Ms. Burwell said on Monday during remarks at the Center for American Progress, a liberal research and advocacy group.

Ms. Burwell’s estimate was at the lower end of the range suggested by health policy experts in her department. In a report issued earlier Monday, the experts estimated that, at the end of next year, 9 million to 9.9 million people would have coverage purchased through insurance exchanges, or marketplaces.

Representative Marsha Blackburn, Republican of Tennessee, said the administration was “trying to manage expectations and rewrite its definition of success ahead of the second open-enrollment period.” Administration officials said they were just being realistic, in the light of experience with other health programs.

President Obama announced in April that eight million people had signed up for health insurance under the Affordable Care Act. Officials said Monday that enrollment had declined to 7.1 million after some people failed to pay their share of premiums and others were found to be ineligible because of unresolved questions about their citizenship or immigration status.

The Department of Health and Human Services estimated that enrollment, including renewals and new customers, would reach 10 million to 11 million by the end of the three-month sign-up period, which closes on Feb. 15.

However, if Ms. Burwell is right, the number would shrink to 9.1 million people at the end of next year. That would still be a 28 percent increase over the number believed to have marketplace coverage today.

Ms. Burwell’s estimate came as a surprise to insurance counselors, agents and brokers working with the Obama administration.

Anne Filipic, the president of Enroll America, a nonprofit group trying to expand coverage, said the goal of 9.1 million “seems reasonable.” She praised the administration for taking what she described as “a pragmatic, analytic approach” to setting a numeric goal.

Federal health officials said they had ended coverage for 112,000 people who could not demonstrate that they were United States citizens or legal immigrants entitled to insurance under the health care law.

In addition, they said, 120,000 households will lose some or all of the insurance subsidies they have been receiving because they could not adequately document their income. These households will face higher premiums.

In making their estimates, federal health officials said, they assumed that 83 percent of the people with marketplace coverage — 5.9 million of the 7.1 million people in “qualified health plans” — would renew their coverage.

The intense political debate swirling around the Affordable Care Act does not make the job of enrolling people any easier, officials said.

Republicans like Tom Cotton in Arkansas and Joni Ernst in Iowa won Senate races in which they emphasized opposition to the health care law, as did successful Republican House candidates like Mia Love in Utah and Ryan Zinke in Montana.

Senator John Barrasso of Wyoming, the chairman of the Senate Republican Policy Committee, said that people were skeptical of the law and “aren’t signing up because they realize it’s not a good deal for them.”

The Supreme Court said on Friday that it would consider a case challenging subsidies paid to more than four million people who obtained insurance through the federal marketplace.

Ms. Burwell said Monday that she did not see the legal challenge as a serious threat to the Affordable Care Act. “As we go into open enrollment,” she said, “nothing has changed.”

Federal health officials said they believed that marketplace enrollment would grow more slowly than projected by the Congressional Budget Office, which sees the total holding steady at 25 million from 2017 to 2024.

Administration officials noted that uninsured people could also get coverage by enrolling in Medicaid or by finding jobs with health benefits.

In a brief analysis of coverage trends, the Department of Health and Human Services said Monday that “most of the new marketplace enrollment for 2015 is likely to come from the ranks of the uninsured,” rather than from people who previously bought insurance on their own outside the exchanges.

Cost of Obamacare Borne On The Back Of Seniors

SENIORS ANGRY 1

To say that President Obama is not an enthusiastic backer of the two Medicare programs that offer seniors private insurance options would be something of an understatement.

Over the years, Obama has repeatedly derided Medicare Advantage — the program that lets seniors enroll in subsidized, private insurance. He once called it “wasteful,” and said it amounted to “giveaways that boost insurance company profits but don’t make (seniors) any healthier.”

Obama has been equally harsh when it comes to Medicare Part D — the prescription drug benefit President Bush signed into law that relies on privately run plans.

In his 2006 book, “The Audacity of Hope,” Obama blasted the program, saying it “somehow managed to combine the worst aspects of the public and private sectors.” As president, he said it gave overly generous “taxpayer subsidies to prescription drug companies.”

Both programs, it turns out, have been wildly popular with seniors and, by most measures, big successes. But Obama nevertheless appears determined to undermine them with sharp cuts in payments and sweeping new regulations.

Started back in 1997 — and initially called Medicare+Choice — the Medicare Advantage program pays private insurers a set amount per enrollee to provide comprehensive benefits and anything else they can afford to offer.

The idea was that private insurers could better co-ordinate care and manage health costs than the old fee-for-service Medicare, and so provide more comprehensive benefits.

While enrollment in these private plans was flat for the first several years, it has skyrocketed since 2005, to the point where almost one in three seniors are covered by a private health plan. As long as it is affordable, this editor considers Medicare Supplement the ideal way for a Medicare recipient to be covered for medical expenses. Not because selection of Supplement Plan F or G will cover all or virtually all of your expenses but because ALL Medicare Supplement options allow you to visit any doctor, hospital or medical provider that sees Medicare Patient. This as opposed to Medicare Advantage Plans most of which have evolved to significantly limiting your choice of providers. This being said, Medicare Advantage has been a savior to those who simply cannot afford Medicare Supplement. And contrary to Obama’s claim, seniors selecting Medicare Advantage tend to get better quality health care than those in traditional Medicare.

Critics, however, point to studies showing that the government pays Medicare Advantage more per enrollee than it would cost if these seniors had enrolled in the old Medicare program.

Obama tried to remedy this by cutting Medicare funding by $716 billion over the next ten years with payments to Medicare Advantage totaling $200 billion. The purpose of which is to help pay for ObamaCare (while providing “bonus” payments to plans that score high on a quality rating). An official analysis from Medicare’s actuary concluded, however, that such cuts would drive millions seniors out of their Advantage plans and back into the government-run program.

Recognizing political risks of these payment cuts, the administration put them off until AFTER the presidential elections, shoveling $8 billion into a bogus “demonstration project” that offset almost all the scheduled Medicare Advantage cuts implemented in 2012.

Question: What are your thoughts about President Obama’s cuts to the Medicare Advantage and Part D Prescription Drug Programs?

Admin. – Kenton Henry

http://TheWoodlandsTXHealthInsurance.com

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FEATURE ARTICLE:

THE HILL

February 25, 2014, 10:58 am

GOP leaders to HHS: Call off Medicare changes

By Elise Viebeck

Republican Senate leaders criticized the Obama administration Tuesday for proposed changes to Medicare Advantage (MA) and Part D they say would weaken the two programs.

Led by Minority Leader Mitch McConnell (R-Ky.), the lawmakers called on Health and Human Services (HHS) Secretary Kathleen Sebelius to suspend proposed cuts to Medicare Advantage and reforms in Part D that would allow regulators to participate in negotiations between insurance companies and pharmacies for the first time.

“Unlike ObamaCare, the Medicare prescription drug benefit is wildly popular and it has cost less than initial projections,” the letter stated.

“At a time when HHS is struggling on basic implementation tasks on many fronts, we cannot understand the logic behind the department’s interest in further undermining one of the few success stories under its purview.”

The administration argues that cuts in Medicare Advantage would reduce waste within the program and bring its per-patient funding in line with traditional Medicare, which currently receives less money on average.

In Part D, federal health officials say regulators need new authority to ensure the market for prescription drugs works well for seniors.

The proposed rules would also open drug plans’ preferred networks to a wider range of pharmacies, limit plan bids within a region and remove “protected class” designations for certain types of drugs.

But Republicans say the changes will harm Medicare Advantage beneficiaries and potentially raise premiums on Part D plans or force seniors out of their current coverage.

Both issues are rearing their heads in the midterm elections, as the GOP seeks to broaden its healthcare attacks to include more than ObamaCare.

Tuesday’s letter to Sebelius was signed by McConnell, GOP Whip John Cornyn (Texas), GOP Conference Chairman John Thune (S.D.), GOP Policy Committee Chairman John Barrasso (Wyo.), Conference Vice Chair Roy Blunt (Mo.) and National Republican Senatorial Committee Chairman Jerry Moran (Kan.).

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