Medicare Advantage Plan Changes coming soon

Last month I got an urgent call from a woman worried about the UHC Medicare Advantage plan of her father. He received a letter in a mail informing his father about the cuts in the supplier, including his upcoming GP. UHC suggested to the father to look for new providers, as most of them would be eliminated. Annoyed and bewildered, this woman didn’t know what step to take, and I spoke about a Medicare supplement instead of looking for another Medicare Advantage plan. The unfortunate thing is, his father had just left the hospital recently, leaving him with no medical qualifications at the moment. Insurance companies only need to notify their beneficiaries 30 days in advance, but for many this 30-day warning is not enough.

The father would be losing eight of his doctors in the supplier’s court. Until January 1, you will not be able to pay to any of your current providers.

After learning about this phenomenon, I began investigating the cuts in Medicare Advantage for 2014 and found that being UHC had a reason to help some doctors.

I was right. Due to changes in government funding for Medicare Advantage plans, the company has taken steps to optimize its provider network for MA plans only. UHC Medicare Supplement policyholders will not be affected by these cuts.

Doctor Fix is ​​part of a 10-year plan to reduce Medicare Advantage plan spending by $ 156 billion. For those with MA plans, they know funds are already scarce. Although premiums increase only slightly, there will be further cuts in the future for MA plans. This includes new plans related to payment from the provider. There is new legislation (well, new for you and me) that will stop medical cuts for now, but it will contain a new formula.

This formula will be the method by which Medicare determines payment to individual suppliers. Physicians will be judged in various areas aimed at assessing the quality of the practitioner. Currently, doctors make a flat fee to meet patients and flat rates for the different services they provide.

 

With fewer resources for its Medicare Advantage plans, UHC was “compelled” to reorganize its provider network, meaning that UHC Medicare Advantage’s 14 million beneficiaries may need to find new providers. In a USA Today report, Susan Jaffe of Kaiser Health News writes that officials of Medicare are presently reviewing provider networks of UHC, which could lead to another reconfiguration, with hopes for the future.

Jaffe also calls for “losing a doctor not to be an exception” to the special enrollment period. A registration period is available only for strange situations. For example, leaving your network or the insurance company that declares bankruptcy are situations in which you would qualify for a special enrollment period outside of open enrollment.