Fewer Beneficiaries To Be Dropped From Medicare+Choice Plans in 2004
The rate of health plans leaving Medicare+Choice "will slow to a trickle" next year, with about 39,000 beneficiaries expected to lose M+C coverage in 2004, according to an American Association of Health Plans survey, the New York Times reports. Between 1999 and 2003, 2.4 million beneficiaries lost M+C coverage, as health plans scaled back or ended their participation in the program. M+C, which includes 11.5% of the 40 million people enrolled in Medicare, generally offers prescription drug and preventive care benefits not available under traditional fee-for-service Medicare. Private plans participating in M+C had until the end of Monday to tell CMS if they intended to end coverage in certain areas, as well as if they planned any changes to benefits, premiums and copayments. The AAHP survey did not collect information on the latter changes (Pear, New York Times, 9/9). Blue Cross and Blue Shield of Georgia, Georgia's largest health insurer, accounts for 19,000 of the total number of beneficiaries who will lose M+C coverage. The health plan decided to no longer participate in M+C in the Atlanta area, citing inadequate federal reimbursements. In the Atlanta area, former members of BCBS of Georgia's M+C plan can enroll in another M+C plan or join traditional fee-for-service Medicare (Miller, Atlanta Journal-Constitution, 9/9). Private health plans say that the 2% annual increases in payment rates are too small to keep pace with medical costs, which have risen between 10% and 20% per year, the Arizona Daily Star reports (Erikson, Arizona Daily Star, 9/9). According to AAHP, 39,000 beneficiaries is the smallest number of beneficiaries dropped in six years (San Francisco Chronicle, 9/9). According to HHS, HMOs dropped 407,000 beneficiaries in 1999, 327,000 in 2000, 933,600 in 2001, 536,000 in 2002 and 198,315 this year.
AAHP President Karen Ignagni said that private health plans "are poised to expand their participation in Medicare" if Congress increases reimbursement rates (New York Times, 9/9). "This places a great deal of pressure at Congress's doorstep to act this year," she said (San Francisco Chronicle, 9/9). However, Ignagni added that if Congress does not increase payments to private plans, "then I think we are looking at trouble in the future. We've done pretty much all we can do to continue offering these choices to beneficiaries" (Arizona Daily Star, 9/9). CMS Administrator Tom Scully said, "The trend [of plan withdrawals] is in the right direction," adding that M+C "is stabilizing, in anticipation that Congress will change it for the better." The House and Senate have passed Medicare bills (HR 1 and S 1) that would add a prescription drug benefit to the program, as well as increase payments for providers, the Times reports. Rep. Benjamin Cardin (D-Md.) said, "It's terrible that we are not seeing HMOs come into this market," adding that private plans "are [not] really interested in the senior market" because they are "worried about the uncertainty of government reimbursement, and they believe the senior market is not lucrative" (New York Times, 9/9).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.