LOWER YOUR MEDICARE SUPPLEMENT PREMIUMS NOW

Medicare clients and friends of Kenton Henry and All Plan Med Quote,

Greetings! Please take a few minutes to read this in its entirety. Whether you have Medicare Supplement through me, or another agent, what I am proposing could save you up to 20%, or more, of what you are currently paying for coverage.  

To those who are current clients – thank you so much for your continued business. We made it through another Prescription Drug Plan Open Enrollment Period which ran, as always, from October 15th through December 7th. During that time (for those who requested assistance) I shopped for your best value in a 2018 Part Medicare Drug Plan. It is my goal to keep my clients in the lowest “total cost” drug plan available to them, and I moved many of you to that plan. Others were in that plan already, and I advised them to stay the course.

It was a very hectic period for everyone in my industry, made more hectic because it overlapped with the Open Enrollment Period for Under Age 65 (Obamacare) health plans. Personally, it was all I could do to meet everyone’s need as well as possible without hiring additional staff. A staff which I would only have to have let go―at the end of the 8 weeks. This, most as soon as I had them adequately trained. For those who have Medicare Supplement policies, I advised you that, once this busy period was over, I would be in a position to re-shop your Supplement plan to see if there is a better value for you. That time has come.

If you have had your Medicare Supplement policy three or more years, you have had a series of premium increases. These usually correspond with your policy anniversary and, hopefully, they have been reasonable. But, the reality is, you may now be paying more than necessary for equivalent or ideal coverage. I say “ideal” because things have changed. Many of you are with Supplement Plan F. This is because, historically, it was considered the best value. In 2016 that changed in that the Center For Medicare Services (CMS) informed the insurance companies they were phasing out plan F and mandated they cease offering it in 2020. At that time, those who have plan F will be “grandfathered“. In other words, they will be allowed to keep theirs. But no new plan F policies will be issued.

With this mandate, the insurance companies re-priced plan G, which is the second most comprehensive plan after plan F. Plan F pays all eligible expenses for a calendar year. The only thing plan G does not pay is the $183 Medicare Part B calendar year out-patient deductible paid by plan F. So―yes―if you have plan G―you will pay the first $183 for out-patient care each year. (This will most likely be for your first doctor’s visit and perhaps a portion of the second). But, guess what? Your annual premium savings is probably going to be as much as twice that deductible. Therefore, plan G makes better financial sense than F.

Couple the yearly inflation of your policy premium by the three-year mark―with the fact you may be in plan F―and I can probably save you substantial premium dollars if we move you to plan G based on new first-year rates. Or― if you have had your plan G three or more years―we can attempt to move you to a lower cost plan G.

Is there a catch? Yes. The catch is―because you are now past your period of “Guarantee Issue” which, in general, ended six months after you turned age 65 and entered Medicare Part B. This means you now have to answer health questions and be approved for new coverage based on your health history. While approval is not as difficult as it used to be for those applying for under age 65 health insurance, you are going to have been in at least moderately good health and had no major illnesses in the last two years or more. I want you to ask yourself if this applies to you. If so, I would like to see if we can move you to a lower cost Medicare Supplement Plan.

Here is an example of the typical health questions you must answer “negative” to be approved – taken from what is currently one of the most competitive Medicare Supplement policies:

OPTION I: at lower rates than OPTION II

  1. Have you been prescribed or taken any prescription medications within the past 12 months? If “YES,” please indicate below.

If “NO,” indicate “None.” Agent – This is to assist in preparing the Applicant to answer questions in sections 3 through 5.

APPLICANT A

Name of Medication, Date Prescribed and Condition

(Example: Vytorin, 10/2009, High Cholesterol)

APPLICANT B

Name of Medication, Date Prescribed and Condition

(Example: Vytorin, 10/2009, High Cholesterol)

  1. Personal History Questions:
  2. Have you ever been diagnosed with diabetes?
  3. Have you ever:
  4. been advised by a physician to have or are you currently waiting for an organ transplant?
  5. been diagnosed with, treated, or advised to receive treatment for Alzheimer’s Disease, dementia,

mental incapacity, organic brain disease or any other cognitive disorder?

  1. been diagnosed with, treated or advised to receive treatment for Lou Gehrig’s disease (ALS),

Huntington’s disease or any terminal medical condition?

  1. been diagnosed with, treated or advised by a licensed member of the medical profession to

receive treatment for Systemic Lupus, Osteoporosis with Fractures, or kidney disease or failure

requiring dialysis?

  1. used insulin to treat or control diabetes?
  2. had any type of Diabetes with Complications including retinopathy, neuropathy, nephropathy,

peripheral vascular disease, heart disease, stroke, transient ischemic attack (TIA), high blood

pressure, or skin ulcers?

  1. been in a diabetic coma or had or been advised to have an amputation due to disease or disorder?
  2. been diagnosed with, treated or advised to receive treatment for Cirrhosis, Emphysema, Chronic

Obstructive Pulmonary Disease (COPD) or other chronic pulmonary disorders?

  1. been diagnosed as having or told by a medical doctor that you have AIDS, HIV, or ARC disorders?
  1. been diagnosed, treated or advised to receive treatment for any neurological disease or disorder

such as Myasthenia Gravis, Multiple or Lateral Sclerosis, or Parkinson’s disease?

  1. Within the past 2 years have you:
  2. been advised to or do you currently use a wheelchair?
  3. been advised to enter or do you reside in a nursing home, assisted living facility, long term

care facility, received hospice, attended an adult day care facility, required home health care, or

been bedridden?

  1. been admitted to a hospital 3 or more times or are you currently admitted to a hospital?
  2. been diagnosed, treated or advised to receive treatment for cancer (other than basal cell carcinoma)?
  3. been diagnosed, treated or advised to receive treatment for alcoholism or drug abuse, mental or

nervous disorder requiring psychiatric care?

  1. been diagnosed, treated or advised to receive treatment for heart attack, coronary or carotid artery

disease (not including high blood pressure), peripheral vascular disease, congestive heart failure

or enlarged heart, stroke, transient ischemic attacks (TIA) or heart rhythm disorders?

  1. been diagnosed, treated or advised to receive treatment for degenerative bone disease impacting

multiple joints, crippling/disabling or rheumatoid arthritis or been advised to have a joint

replacement?

  1. been advised to have surgery, medical tests, treatment or therapy that has not yet been performed

or undergone testing by a medical professional for which the results have not yet been received?

  1. Have you been advised by a physician that surgery may be required within the next 12 months for

cataracts or have you used or been advised to use oxygen equipment, respirator or a catheter?

If any question in 3, 4 and 5 is answered “YES,” please STOP. The Applicant is NOT eligible for underwritten Medicare Supplement.

Take note of that last line. If you answered “yes” to any of these questions you are not going to be approved for the lowest cost plan of your choice. However, this does not mean I cannot get you approved with a new plan. I have a second company whose underwriting requirements are significantly more lenient. There are far fewer health questions to be answered, and no information regarding prescription drug use is requested. Mostly, this company is concerned with whether you have been hospitalized in the last 90 days and have you suffered any major health issues in the last 2 years. If you can answer “negative” to these, you will be approved at their lowest cost. Answer in the affirmative and you may still be approved but at a higher premium. Either of these premiums may or may not be lower than your current premium.  This company’s health questions appear next. Only consider them if you feel you would not qualify for Option I:

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OPTION II: BUT AT RATES HIGHER THAN OPTION I (BUT WHICH MAY STILL BE LOWER THAN YOUR CURRENT PREMIUM)

4A. Within the past 2 years, did a medical professional provide treatment or advice to

you for any problems with your kidneys?

Yes No Not Sure

4B. Within the past 2 years, did a medical professional tell you that you may need any of

the following?

  • hospital admittance as an inpatient
  • joint replacement
  • organ transplant
  • surgery for cancer
  • back or spine surgery
  • heart or vascular surgery

Yes No Not Sure

If you answered YES or NOT SURE to any question in Section 4, we will contact you for further information.

5A. Within the past 90 days, were you hospitalized as an inpatient (not including

overnight outpatient observation)? Yes No Not Sure

5B. Are you currently being treated or living in any type of nursing facility other than an

assisted living facility? Yes No Not Sure

5C. Has a medical professional told you that you have End-Stage Renal (Kidney) Disease

or that you require dialysis? Yes No Not Sure

Answering YES to any question in Section 5 will result in a denial of coverage.

If your health status changes in the future, allowing you to answer NO to all of the

questions in this section, please submit a new application at that time.

If you answered NOT SURE to any question in Section 5, we will contact you

for further information.

*This company has LEVEL 1 RATES (lower) for clients who answer “No” to the health questions. And LEVEL 2 RATES (higher) for those who have not provided a response which would result in a declination but

did answer “Yes” to any question in Section 6. This last scenario would result in you being approved but at a higher rate which may be higher or lower than what you are currently paying for Medicare Supplement insurance.

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Based on all this, if you feel optimistic, here is what I would like you to do:

To save the time required to pull your file (for current clients), please provide me the following in response to this email:

 

1) Your name

2) Your residential zip code

3) Your birth date

4) your tobacco usage

5) Your current Medicare Supplement Company and plan letter designation, e.g., F or G

6) For which new plan would like to seek approval? The lowest cost (harder to be approved) plan or the higher cost plan with less stringent approval criteria?

7) What is your current Medicare Supplement Premium?

Upon receipt, I will quote both options. The first will be for your lowest cost plan G option (unless you request a different letter designation). When I quote, I will include the application for that plan unless you have informed me it is appropriate to seek approval for the higher cost option. That option will be your second quote and, where you have indicated it is appropriate, I will include its application.

As to those of you who have Medicare Advantageyou are locked into your current plan for this calendar year. We can re-shop your coverage this fall (October 15th to December 7th) for 2019. To that end―and for those who have Medicare Supplement plans and simply cannot bear the premium increases and / or cannot qualify for new Supplement coverage―I have a new website for those willing to accept the copays and provider limitations of Medicare Advantage. You will be able to get quotes and apply for these options this fall. Click on this link or – if necessary – copy and paste into your browser:

https://medicareful.com/AgentKentonHenry

I anticipate this letter will generate an increase in activity on my part. As such, my phones may be very busy. If it is important you speak with me right, and  convenient for you, you may want to text me during this period. My cell phone number appears below. I look forward to keeping you as a client or acquiring you as one in the first place. I commit to working to limit your medical and Medicare-related insurance expenses and providing the best of service. Thank you for reading and carefully considering this correspondence.

Sincerely,

Kenton Henry

Office: 281.367.6565

Text my cell @ 713.907.7984

Email: Allplanhealthinsurance.com@gmail.com

Http://Allplanhealthinsurance.com

Http://TheWoodlandsTXHealthInsurance.com

For the latest in health and Medicare relative news, follow my blog @ Https://HealthandMedicareInsurance.com

MEDICARE PREMIUM AND DEDUCTIBLE INCREASES AND BLUECROSS PPO ELIMINATION SLATED FOR 2016!

cropped-the-medplus-messenger2.jpg

By D. Kenton Henry

Clients and Friends of Kenton Henry and ALL PLAN MED QUOTE,

It is that time again. We are approaching the end of the calendar year and I write to thank you for your business and for the trust you placed in me to represent your health insurance needs to the best of my ability. This month marks my 29th year in the industry and that would not be possible without you.

Because there are so many changes coming your way-not only for Medicare recipients but for my Under Age 65 clients-following me here will be the easiest way to be informed of vital information affecting your coverage as it becomes available to me. This is your one source for the good, the bad and the ugly of the Medical insurance market. I will be posting the good part later when I determine what that is. Happy New Year.

BREAKING NEWS FOR MEDICARE RECIPIENTS: On Thursday, October 15, the Social Security Administration announced that there will be no cost of living adjustment (COLA) for 2016. At the same time, the Medicare Part B Premium and deductible is expected to increase significantly for some people next year. The Part B basic premium is expected to go from $104.90 to $159.30 per month Additionally, the Medicare Part B calendar year deductible is slated to also increase from $147 to $223! This latter increase would affect approximately the entire Medicare population of 17 million and will in turn trigger premium increases from the supplemental insurances such as Medicare Supplement and Medicare Advantage which pay that deductible for the insured person! Together, these increases could cause people to drop their Medicare Part B insurance resulting loss of coverage for doctors visits, diagnostic testing, lab work and out-patient surgeries. For more details and information on just who this affects please watch this video of a FOX NEWS LIVE report by Martha MacCallum video I recorded just today:

MEDICARE PREMIUM INCREASE 2016

https://youtu.be/9DVGiEa074E

  • Additionally, if you are Part D Prescription Drug Plan client of mine (or not) email me a list of your current prescription drug regimen (drug and dosage) and I will scan the market to identify your lowest total of pocket cost plan and make my recommendation. allplanhealthinsurance.com@gmail.com

UNDER AGE 65 INDIVIDUAL AND FAMILY NEWS:

Most relevant at this time for individuals and families under the age of 65 is the elimination of BlueCross BlueShield of Texas’s “Individual and Family” Blue Choice PPO network which over 370,000, insured members (including myself) utilize. I informed all my clients (sharing this coverage) in a letter mailed via the US Postal Service just a few days ago. I also addressed this issue in my latest blog post entitled “BlueCross BlueShield of Texas Tells Clients ‘Say GoodBye To Your PPO Plan’”. (The more sarcastic side of me considered entitling it, “Take A Bite Of This Sandwich” but my more professional self intervened.) In the letter and post, I informed those who have HMO coverage their policy would not be affected other than an anticipated rate increase. It turns out that is not the case as I was just informed that many who have HMO coverage will also have to select another version. And so it seems that, with my assistance, many of you will be seeking alternative coverage for 2016.

This begs the question: What will our options be with other insurance companies? Unfortunately, like BlueCross, most companies are yet to reveal the details of their policies. Within the next few days, I hope to have a quoting link available to you from which-in the very near future-you will be able to obtain all your 2016 options, subsidy or no subsidy, on or off the Federal Marketplace otherwise known as Healthcare.gov. Regardless, I will be introduced to these changes over the remainder of October and these, along with the quoting link, will be posted on my blog in real time. Rest assuredwhatever your best options are for 2016I will have them. And you will be able to elect them with the beginning of OPEN ENROLLMENT (OE) November 1st―through the end January 31st.

Do not hesitate to call me as we prepare for these changes. And to assure you will be informed of the latest information relative to your coverage – please click “follow” on my blog as I post all coverage changes and preview the options you will have.

If you are currently a client—thanks once again for your business. It is greatly appreciated  as will readership of healthandmedicareinsurance.com!

Sincerely,

BUSINESS PHOTO FINAL FOR BLOG 10 15 2015

Kenton Henry  Blog Administrator, Broker, Agent

Office: 281.367.6565; Toll Free: 800.856.6556

Email: allplanhealthinsurance.com@gmail.com

http://www.Allplanhealthinsurance.com

http://TheWoodlandsTXHealthInsurance.com 

Blog: http://healthandmedicareinsurance.com

ALL PLAN BILLBOARD FOR WOODLANDSONLINE

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CENTER FOR MEDICARE SERVICES DELAYS CUTS TO MEDICARE ADVANTAGE – OR DID THEY?

OBAMA CUTS TO MEDICARE

In a surprise announcement today the Center For Medicare and Medicaid Services gave notice they are reversing planned cuts to Medicare Advantage Plans for 2015. But after all variables are factored in will the end result be an increase or decrease in reimbursements for Medicare approved procedures next year?

If implemented the cuts would have resulted in 2% lower payments to Medicare providers on top of the 6% cuts for 2014. Instead, the agency says, payments will instead be increased 0.4%. Still, with all variables in play, Aetna anticipates payment reductions and Humana estimates a funding decline of 3%. (See feature article from Reuters below.)

OBAMA CUTS TO MEDICARE II

What is the end result of all this? 2014 reductions already saw the termination of thousands of providers from HMO and PPO Medicare Advantage networks. Further reductions are likely to result in more of the same along with probable increases in premiums and copays for medical procedures. And–if not now–certainly when they are ultimately implemented as mandated by the Affordable Care Act (ACA). Which begs the question: If all these cuts to Medicare Advantage were for the purpose of financing the ACA, what is the long-term impact of delaying them on the financial solvency of the Act? Or was the latter really ever a concern of the administration? Or is it simply the case that concern over the effect of cuts on this fall’s election over-rides the need for the Act to be financially feasible? (In case you were naïve enough to believe feasibility was realistic in the first place.) In light of all the approximately 38 delays and changes in the law since its passage, it is apparent to this author that political expediency rules the day in Washington. In other words, “business as usual”.

– Admin. Kenton Henry

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FEATURE ARTICLE

U.S. insurers still expect cuts in 2015 Medicare payments

By Caroline Humer

Tue Apr 8, 2014 1:40pm EDT

(Reuters) – U.S. health insurers said on Tuesday they still expected cuts in government reimbursements for privately managed Medicare health plans for the elderly next year even after the Obama administration rolled back the steepest reductions.

The government agency that oversees Medicare said late on Monday that on average, reimbursements to insurers for private Medicare plans would rise 0.4 percent, reversing what it said was a proposed cut of 1.9 percent.

The insurance industry and advocates for the elderly had lobbied against the cuts, which were first proposed in February, saying they would reduce benefits for older people.

Republican and Democratic lawmakers had broadly opposed further cuts as well, adding pressure on the administration at a time when President Barack Obama’s healthcare law was also under attack.

After analyzing the final rate notice from the Centers for Medicare and Medicaid Services (CMS) and comparing it with their own models, health insurers said on Tuesday that the 2015 Medicare Advantage payment rates represented a cut to payments from 2014 levels.

Humana Inc, which derives two-thirds of its revenue from administering Medicare Advantage plans, said it expected a funding decline of about 3 percent for 2015 plans from 2014, according to a filing with the Securities and Exchange Commission.

This is slightly better than Humana’s initial forecast for a drop of 3.5 percent to 4 percent in those rates, based on the proposal issued on February 21.

Aetna Inc, which also provides Medicare Advantage plans, said it also anticipated a decline.

“Despite CMS’s actions, Medicare Advantage plans will still face rate decreases for 2015,” Aetna spokeswoman Kendall Marcocci said in a statement. The company is still evaluating the impact, she added.

CMS officials were not immediately available for comment on the insurers’ or analysts’ analyses.

Humana shares fell 1.7 percent on Tuesday. Aetna was little changed, and UnitedHealth Group Inc slipped 0.4 percent.

APPLES-TO-ORANGES

The comments from individual insurers echoed that of industry trade group America’s Health Insurance Plans, which said it was concerned about how the policy will affect the 15 million people who receive privately managed benefits. The balance of the more than 50 million older and disabled people who use Medicare are in a different program run by the government.

“The changes CMS included in the final rate notice will help mitigate the impact on seniors, but the Medicare Advantage program is still facing a reduction in payment rates next year on top of the 6 percent cut to payments in 2014,” AHIP President Karen Ignagni said in a statement.

Wall Street analysts saw an improvement of 2 to 3 percentage points in the government’s funding proposal, but they estimated about a 3 percent cut overall, not an increase of 0.4 percent.

They described an apples-and-oranges comparison between how they calculate the total impact of Medicare reimbursement rates versus how the government does so.

One difference may be that the government analysis did not reflect the 1 percent insurance tax that funds Obama’s Patient Protection and Affordable Care Act, while some analysts included it.

Another factor, some said, is that CMS adjusted its estimates to reflect the worsening health of some Medicare members, while analysts did not.

Analyst Sheryl Skolnick of CRT Capital described the final funding announcement as being “less worse” than anticipated.

“The market was assuming that the final rate would be better than the proposal, and that’s what it got,” Skolnick wrote in a note.

Each year, the government releases its formulas for determining how it will reimburse the insurers for plan members’ procedures and doctor visits. Insurers use this information to decide on the markets where they will offer plans and what benefits they can provide.

(Reporting by Caroline Humer; Editing by Michele Gershberg, Lisa Von Ahn)

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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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That Giant “Sucking Sound” Is Your Providers Exiting Your Preferred Provider Network!

Op-Ed by Kenton Henry, Administrator

I have just completed my Affordable Care Act (ACA) training and certification in order to offer ACA compliant plans to my clients, and the public in general, beginning October 1. However, even in this final hour with only eight days until the new plans are to be available – the insurance companies have still not released the premiums the insure will pay for these options. “Any day now” is what I am being told. However, I will share with you a thing or two I do know based on what I have studied.

Most of it came as no surprise to me. One major company (whose name I cannot divulge as the information they provided was yet to be approved by the Department of Health and Human Services (HHS) who will be in charge of the Federal-Run Exchange–Marketplace–in Texas, Indiana and Ohio–where I have clients) previewed plans. The lowest plan deductible available was $1,500. All plans will be limited to a maximum out-of-pocket of $6,350 per individual and $12,700 per family. While older people will probably find a $1,500 deductible acceptable in terms of affordability, I am not certain how twenty year olds are going to feel about that. I certainly don’t think that and higher deductible options will be an incentive for them to enroll even with the convenience of doctor’s office co-pays and prescription drug cards. I can almost guarantee you that unless they receive a subsidy – they won’t be signing up.

Beyond that, the benefits sounded perfectly acceptable until I came to the part about “special care centers”. It turns out, at least with this company (which happens to be a very large, conspicuous player in the Texas health insurance market we’ll just refer to as company XYZ)when you are in need of a special surgical procedure such as a hip or knee replacement: “You may only receive one by going to an ‘XYZ Approved Hip and Knee Replacement Center'”. I have had a hip replacement and had it at the relatively young age of 49 and I don’t know about you but I didn’t want just anyone performing mine. I still had dreams of remaining very active and athletic to the point of partaking in very aggressive martial arts training among other activities such as mountain biking. Fortunately, I have been able to do so but would I had I gone to some “Preferred” (discount) provider who agreed to accept lesser fees for greater patient volume?

To underscore my concern relative to an obvious attempt to ration our selection of providers, if not the procedures themselves, I received an email today informing me the primary Medicare Advantage Plan I enrolled my clients in last year is having an inordinate number of Primary Care Physicians drop out of its network and that I should be prepared to re-shop their Advantage Plan. The problem is, if this very large nationally recognized plan is experiencing this kind of “provider drop-out” – what can I expect from smaller companies with less capital? Again, I have had to delete their name as the information was proprietary and for “agent use only” but the letter they sent their clients is attached below. If you are one of my current Medicare clients I placed with this plan – you may have already read this. Otherwise, I apologize for breaking the news to you like this.

Our feature article appeared in today’s New York Times (September 23rd) and describes how patient options will be restricted as a result of the ACA. Think about it. If the insurance companies have no choice in who they insure and must cover any and all pre-existing conditions . . . and if they are informed by the Department of Health and Human Services their profit and, more specifically, the ratio of claims they must pay relative to the premium they take in, i.e., 80% to 20% – how else can they manage losses except to restrict access to procedures, providers and what your providers are paid? Something had to give.

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Letter to Medicare Advantage Clients

Update to Physician Network Changes

At  ————- , we manage the physician networks for our plans to help meet the evolving needs of health care consumers. This includes adjusting the size and composition of our physician network as we strive to meet the specific needs of Medicare Advantage and/or Medicaid plan members.

As a result, in the coming months, select physicians for one or more of your Medicare Advantage and/or Medicaid members will no longer participate in our Medicare and Medicaid plan networks. Please note: these changes do not affect members enrolled in Medicare Supplement or commercial plans.

Member transitions
We know that members are impacted when we make changes to our network, and are taking steps to support members with smooth transitions to new care providers as appropriate to help ensure continuity of care.

We will be sending letters to affected members to notify them of care providers that will no longer participate in the —————– Medicare and Medicaid plan network as early as January 1, 2014 (network changes for New Jersey Medicaid plans have an October, 2013 effective date.) When appropriate, letters will suggest new care providers for members to consider for their ongoing care. Members are encouraged to call the number on their member ID card if they need help with identifying a new care provider.

In some plans, members may choose to continue seeing their current care providers on an out-of-network basis, in accordance with their out-of-network benefits. These changes have no impact on plan benefits, and members undergoing a treatment plan will be able to continue seeing out-of-network care providers consistent with federal requirements.

Provider directories
These network changes will be reflected in our online provider directory as of October 1, 2013. It is highly encouraged to refer to the online provider directory in all cases to confirm care provider network and panel status for all potential enrollees, as changes may not be reflected in previously printed and/or downloaded directories.

It is important to note that when searching for an in-network provider on the online directory, a provider’s “Accepting New Patients” status must indicate “OPEN“, even if the potential enrollee is an existing patient.

Talking points for member inquiries
Please refer to the Physician Network Changes – Frequently Asked Questions for Member Discussions that provide additional information and may be used in the event you receive any member inquiries.

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Lower Health Insurance Premiums to Come at Cost of Fewer Choices

By ROBERT PEAR

Published: September 22, 2013

WASHINGTON — Federal officials often say that health insurance will cost consumers less than expected under President Obama’s health care law. But they rarely mention one big reason: many insurers are significantly limiting the choices of doctors and hospitals available to consumers.                        

From California to Illinois to New Hampshire, and in many states in between, insurers are driving down premiums by restricting the number of providers who will treat patients in their new health plans.

When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.

Some consumer advocates and health care providers are increasingly concerned. Decades of experience with Medicaid, the program for low-income people, show that having an insurance card does not guarantee access to specialists or other providers.

Consumers should be prepared for “much tighter, narrower networks” of doctors and hospitals, said Adam M. Linker, a health policy analyst at the North Carolina Justice Center, a statewide advocacy group.

“That can be positive for consumers if it holds down premiums and drives people to higher-quality providers,” Mr. Linker said. “But there is also a risk because, under some health plans, consumers can end up with astronomical costs if they go to providers outside the network.”

Insurers say that with a smaller array of doctors and hospitals, they can offer lower-cost policies and have more control over the quality of health care providers. They also say that having insurance with a limited network of providers is better than having no coverage at all.

Cigna illustrates the strategy of many insurers. It intends to participate next year in the insurance marketplaces, or exchanges, in Arizona, Colorado, Florida, Tennessee and Texas.

“The networks will be narrower than the networks typically offered to large groups of employees in the commercial market,” said Joseph Mondy, a spokesman for Cigna.

The current concerns echo some of the criticism that sank the Clinton administration’s plan for universal coverage in 1993-94. Republicans said the Clinton proposals threatened to limit patients’ options, their access to care and their choice of doctors.

At the same time, House
Republicans are continuing to attack the new health law and are threatening to hold up a spending bill unless money is taken away from the health care program.

Dr. Bruce Siegel, the president of America’s Essential Hospitals, formerly known as the National Association of Public Hospitals and Health Systems, said insurers were telling his members: “We don’t want you in our network. We are worried about having your patients, who are sick and have complicated conditions.”

In some cases, Dr. Siegel said, “health plans will cover only selected services at our hospitals, like trauma care, or they offer rock-bottom payment rates.”

In New Hampshire, Anthem Blue Cross and Blue Shield, a unit of WellPoint, one of the nation’s largest insurers, has touched off a furor by excluding 10 of the state’s 26 hospitals from the health plans that it will sell through the insurance exchange.

Christopher R. Dugan, a spokesman for Anthem, said that premiums for this “select provider network” were about 25 percent lower than they would have been for a product using a broad network of doctors and hospitals.

Anthem is the only commercial carrier offering health plans in the New Hampshire exchange.

Peter L. Gosline, the chief executive of Monadnock Community Hospital in Peterborough, N.H., said his hospital had been excluded from the network without any discussions or negotiations.

“Many consumers will have to drive 30 minutes to an hour to reach other doctors and hospitals,” Mr. Gosline said. “It’s very inconvenient for patients, and at times it’s a hardship.”

State Senator Andy Sanborn, a Republican who is chairman of the Senate Commerce Committee, said, “The people of New Hampshire are really upset about this.”

Many physician groups in New Hampshire are owned by hospitals, so when an insurer excludes a hospital from its network, it often excludes the doctors as well.

David Sandor, a vice president of the Health Care Service Corporation, which offers Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma and Texas, said: “In the health insurance exchange, most individuals will be making choices based on costs. Our exchange products will have smaller provider networks that cost less than bigger plans with a larger selection of doctors and hospitals.”

Premiums will vary across the country, but federal officials said that consumers in many states would be able to buy insurance on the exchange for less than $300 a month — and less than $100 a month per person after taking account of federal subsidies.

“Competition and consumer choice are actually making insurance affordable,” Mr. Obama said recently.

Many insurers are cutting costs by slicing doctors’ fees.

Dr. Barbara L. McAneny, a cancer specialist in Albuquerque, said that insurers in the New Mexico exchange were generally paying doctors at Medicare levels, which she said were “often below our cost of doing business, and definitely below commercial rates.”

Outsiders might expect insurance companies to expand their networks to treat additional patients next year. But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.

Even though insurers will be forbidden to discriminate against people with pre-existing conditions, they could subtly discourage the enrollment of sicker patients by limiting the size of their provider networks.

“If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors,” said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm. “Some insurers do not want those patients who, for medical reasons, require a broad network of providers.”

In a new study, the Health Research Institute of PricewaterhouseCoopers, the consulting company, says that “insurers passed over major medical centers” when selecting providers in California, Illinois, Indiana, Kentucky and Tennessee, among other states.

“Doing so enables health plans to offer lower premiums,” the study said. “But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that’s being treated at a hospital that has been excluded from their health plan.”

In California, the statewide Blue Shield plan has developed a network specifically for consumers shopping in the insurance exchange.

Juan Carlos Davila, an executive vice president of Blue Shield of California, said the network for its exchange plans had 30,000 doctors, or 53 percent of the 57,000 doctors in its broadest commercial network, and 235 hospitals, or 78 percent of the 302 hospitals in its broadest network.

Mr. Davila said the new network did not include the five medical centers of the University of California or the Cedars-Sinai Medical Center near Beverly Hills.

“We expect to have the broadest and deepest network of any plan in California,” Mr. Davila said. “But not many folks who are uninsured or near the poverty line live in wealthy communities like Beverly Hills.”

Daniel R. Hawkins Jr., a senior vice president of the National Association of Community Health Centers, which represents 9,000 clinics around the country, said: “We serve the very population that will gain coverage — low-income, working class uninsured people. But insurers have shown little interest in including us in their provider networks.”

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Can we really say we didn’t see the cuts to Medicare Part B coming? (These are described in the Houston Chronicle, our feature article below.) Last year the administration made the decision to cut $716 billion from Medicare over the next ten years. $156 billion of this is predicted to come from Medicare Advantage. If you are a Medicare Advantage policyholder, did this news somehow fail to appear in your “Annual Notice of Change” which arrived last October? If so–could this be because we were in the middle of a Presidential election and cuts to your Medicare Advantage Plan might not have helped someone’s re-election? Fortunately for me, I have always encouraged my clients to enroll in Medicare Supplement to fill in their gaps in Medicare if it was at all affordable.
Admin. – Kenton Henry

*OBAMACARE CUTS

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Feature Article:
Houston Chronicle Medicare Part B, life and death
By Michael Hazel | July 19, 2013 | Updated: July 21, 2013 7:04pm
Across Texas, seniors with serious medical conditions could soon lose access to the medical treatments they need.
Right now, in an effort to trim federal spending, lawmakers are considering cuts to Medicare Part B, the component of Medicare that covers cancer treatments and other medicines that are administered by physicians. Lawmakers must reject this proposal and work to balance the budget without restricting access to medical care.
Under Medicare Part B, health care providers purchase drugs that require administration by the provider and are later reimbursed by Medicare, after administering the treatments in their office, according to a preset formula.
For almost a decade, physicians have been reimbursed the average sales price (ASP) of each medicine plus an additional 6 percent. That extra 6 percent helps to cover costs related to the shipping, handling and storage of the drugs, in addition to health care providers’ other overhead and administrative costs.
The federal “sequester,” which took effect in April, has in effect reduced Medicare Part B’s payment formula for drugs from ASP, plus 6 percent, to ASP, plus 4 percent. Now, some lawmakers want to cut that reimbursement rate even further. Such reductions could mean big problems for Medicare patients.
Medicare patients in Texas are understandably worried. John Peterson, a patient at Texas Oncology who’s been battling leukemia for 12 years, is concerned about future treatments. “I have a lot of exotic drugs that we have Medicare pick up the cost … it’s been a life saver,” Peterson told News Channel 25 in Waco. He fears Part B reductions will make continuing treatments at his current cancer center impossible.
Such reservations are not unfounded. Further Medicare Part B cuts could very well force cancer clinics to start closing. According to the Community Oncology Alliance, approximately 240 oncology clinics have closed in the past four and a half years and another 400 are struggling financially.
“Without adequate reimbursement, providers will close their doors, forcing patients to either forgo treatment or be relocated to inpatient facilities, many outside their communities or region,” reports the National Patient Advocate Foundation.
Such closures are particularly problematic in states like Texas, because our state is home to so many rural residents. With fewer community clinics available, rural Texans will have to travel far distances to other centers or hospitals for treatment. For those suffering from life-threatening illnesses, unnecessary travel is exactly what they should be avoiding.
Treating patients in hospitals instead of doctors’ offices is also far more expensive. Milliman, a respected actuarial firm, found that a chemotherapy patient who receives treatment at a hospital costs Medicare about $600 more per month than a patient who is seen at a physician’s office.
For Texans like John Peterson, Medicare Part B is a matter of life and death. It’s unacceptable that politicians in Washington are considering further reductions to the program’s payments for Part B drugs.
Texas’ representatives should make certain that patients can continue to access the medical care they need.

Michael Hazel is the incoming president of Texas Nurse Practitioners.


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