Stakeholder Perspectives - Health Plan Positions
Key Issues Raised by National Institute on Health Policy Paper on Medicare Modernization Act Geographic inequities in payment are exacerbated The MJC has long argued that the geographic differences in payments to health plans for Medicare+Choice (now Medicare Advantage) severely disadvantage Minnesota seniors who receive fewer benefits than their counterparts living in Florida, Louisiana and New York. Although the MMA did increase payments nationally, the largest increases in the bill were for the highest paid regions in the country. While Minnesota health plans received a 2.8% increase to be used for benefits improvements for their members, the national average increase was 10.6%and health plans in high payment areas received as much as a 27% increase in reimbursement over last year. In addition, the MMA fails to consider the quality of care seniors receive in determining reimbursement rates. Minnesota and other midwest states continually produce some of the best quality outcomes in the country and receive no financial reward for these results. No permanent solution to extend current Medicare options for seniors through Cost ContractsIn Minnesota, nearly 60,000 Medicare beneficiaries are served by Cost Contracts. Under the MMA, the future of these popular plans remains uncertain. At a time when change in Medicare is so significant, it is not in the best interest of members to eliminate (or threaten) this choice. Lack of level playing field for all participating plansLocal plans are at a disadvantage under the Regional PPO structure for a number of reasons, including the creation of $10 billion in bonus payments, beginning in 2006, for Medicare Advantage Regional plans that enter the market. This money is to be used as incentive for Regional PPO plans to enter the market, remain in the market and to share risk with the federal government. This money is not available to the local plans. This unlevel playing field may cause great disruption to future market offerings and may call into question the long-term viability of local plans. There is also legitimate concern about what will happen after five years when this bonus money is no longer available. Will the regional PPOs plans then exit the market, leaving their beneficiaries with no coverage?
Clear communication to members will be a challenge.
Medicare beneficiaries will be faced with significant changes in health plan options and in drug coverage. The need to focus on education and communication is significant. A complex system is undergoing complex change. Beneficiaries will need detailed information about the health plan options available to them, including premium, cost-sharing and drug coverage, in order to make the right choice about their Medicare coverage. We, as well as the state and federal government and consumer organizations, will face challenges in educating and supporting beneficiaries through this transition. For-Profit vs. Non-Profit
Minnesota law requires that HMOs are non-profit. Yet this new approach was designed to attract large, for profit plans into the newly configured Medicare market. We believe that Minnesota grown, non-profit plans bring value to Medicare members and to the state by providing member-centered care and that much of this will be lost with the introduction of for-profit plans, which are accountable to their shareholders, not their beneficiaries and the community in which they operate. |
Issues and Activism 
