United Healthcare Dropping Medicare Docs

United Healthcare Dropping Medicare Docs

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United Healthcare Dropping Medicare Docs.  United Healthcare has notified 10-15% of its Medicare Advantage Providers that they will be dropped from their network this February.

Providers are calling the move by the insurer to increase their star rating in order to increase Medicare (CMS) reimbursements. Quality-incentive payments to insurers under CMS’ five-star rating system for health plans will get stricter in 2014, eliminating payments to any plan earning fewer than four stars. Over the past two years, plans with 3 or 3.5 stars received payments.

According to today’s WSJ article  UnitedHealth Culls Doctors From Medicare Advantage Plans – The company said it is managing its network, in part, to provide more value for members, particularly given Medicare’s new five-star rating system that ties bonus payments for insurers to certain measures of cost and quality.”That’s what’s driving our actions,” said Austin Pittman, president of UnitedHealth’s networks. He also said, “It’s no secret that we are under substantial funding pressure from the federal government.”

According to a study by the Kaiser family Foundation, United received $540 million in bonus payments in 2012 — the largest share for any single carrier. United had a CMS rating of 3.17 stars that year, according to the study.

Medicare Advantage Graph WSJ

This is important as  AARP endorses the popular AARP Medicare Advantage  Insurance Plans, insured by UnitedHealthcare Insurance Company. According to WSJ article AARP issued a

statement saying it “has heard from a small number of our members regarding this decision” and was encouraging anyone with concerns to contact UnitedHealth directly.

The article points out “Medicare Advantage, an alternative to traditional Medicare, combines hospital and doctor coverage and often includes prescription drugs and perks like gym memberships. Enrollment has more than doubled since 2004 to 13 million in 2012, which represents about 27% of Americans on Medicare.”  Also worth noting, “providers have the right to an appeal within 30 days.”

2014 Medicare Open Enrollment is here. Medicare Open Enrollment for 2014 ends Dec 7th. We, at Millennium Medical Solutions Inc,  are working  closely with affected members to help them find new providers and that patients enrolled in its commercial, Medicaid and Medicare supplement plans are not affected by the changes.   Some members may turn back to original Medicare as a result of possibly losing their Doctors.

RESOURCES:

Medicare Advantage vs. Supplement Plans
2014 Medicare Open Enrollement is Here
Medicare FAQ

Download a Copy Of The Medicare and You 2014 Handbook Here.

Is your Doctor still in the network?  Is Medicare Advantage still right for you?  Please contact us for immediate review at  (855) 667-4621. Please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.

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Fiscal Cliff Deal: Doc Cuts Spared

Fiscal Cliff Deal: Doc Cuts Spared

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Fiscal Cliff Deal: Doc Cuts Spared. Happy 2013 Fiscal Cliff  averted! At least for another year the dreaded 27% Medicare reimbursement have been spared. The so-called “doc fix” would boost the deficit by $31 billion. The President stood firm against any proposed Republican cuts to the Affordable Care Act.

The fear in provider cuts is grounded. According to The Lewin Report  Patient Protection and Affordable Care Act (PPACA): Long Term Costs for Governments, Employers, Families and ProvidersAbout half of program costs will be funded with reductions in payments to providers and health plans under the Medicare and Medicaid programs, which the CBO estimates will amount to $498 billion over the ten year period“.  The new cost estimate has been updated to $1.4445 trillion from original estimate $938 billion over 10 years.

With millions of new uninsured patients slated to enter the system this would help providers recover reimbursement losses. Additionally, the President was firmly against any Provider cuts in 2013.

The Lewin Report  predicts in fact that Provider Reimbursement will recover losses long term and in fact increase gross payments  to $129.8 billion under the Act.

“..estimate that utilization of physician services will increase by about $102.7
billion under the Act. This estimate reflects Medicaid the payment levels for the portion of
newly insured people covered under that program and commercial payment levels for those
who become covered under private insurance. As discussed above, our key assumption is that
utilization of services for newly insured people adjusts to the levels reported by insured
individuals with similar age, gender, health status and income characteristics.
Physicians also will be paid for services formerly provided free to uninsured people resulting in
revenues of $8.4 billion. There will be an increase in reimbursement for people who shift from
Medicaid to private coverage, and payment rates for Medicare primary care services will be
increased for a three year period under the Act. These factors will add 18.7 billion in revenues
for physicians.

While there was large Senate  consensus 89-8  approval for the American Taxpayer Relief Act the health care debate is far from over.  With rising health care costs, combined with the aging of the baby boomers, means the entitlement programs will remain at the heart of the tax-and-spending battles to come.