Proposed Changes to Medicare Advantage Plans in 2021

As President Elect of the San Diego Association of Health Underwriters (SDAHU), I feel a responsibility to share key industry updates with the general public that would not normally be published in the daily news.

Those of us who are involved in this organization share a vision of changing the world by taking pride in our profession and showing others how knowledge is power, and I cannot think of a better opportunity to share with you what I learned in Washington DC last week at our NAHU Capitol Conference.

I have great concern regarding healthcare law signed by President Obama on December 13, 2016. In 2021 the End Stage Renal Disease (ESRD) Exclusion is ending in Medicare Advantage Plans as written into the The 21st Century Cures Act, and Non-ESRD patients will be disserved by this change.

  • ESRD includes the sickest most expensive part of Medicare
  • There are 500,000 people in the United States with ESRD
  • The average annual cost of ESRD care is $100,000 compared to $10,000 Non-ESRD
  • MAPD Plans would likely increase the overall out of pocket risk on all plans to a federal limit of $10,000 and Non-ESRD patients would be immensely disserved by this change
  • MAPD Plans that currently have a $0 monthly premium would likely reflect a $10-$30 premium

What we learned under the Affordable Care Act (ACA) is that intrusive Government intervention has historically exasperated the problems in healthcare. It is clear that when The 21st Century Cures Act says Medicaid would no longer help pay for drugs that help patients restore hair we have a win, but forcing all insurance carriers who offer Medicare Advantage to cover the financial risk of ESRD will have a detrimental effect on the progress we have seen in the Medicare Advantage program in the past few years. Beneficiaries buy into Medicare Advantage because of low or zero monthly premiums and the added security blanket of a financial cap – the out of pocket maximum. We cannot allow this law to repeat the same pitfalls we saw under the Affordable Care Act which reduced competition, gave us double digit rate increases, and rose out of pocket maximums to the highest numbers in history.

If our Medicare Advantage insurers are forced to take on more risk, then the fate of the program will ultimately mean higher premiums and higher out of pocket costs to the majority of our seniors which goes against everything that has been done to conserve and improve this program.

The best alternate would be to ensure that every county across America offers a Chronic Condition Special Needs Plan (C-SNP) Medicare Advantage Plan designated for ESRD patients. In San Diego County Anthem offers the C-SNP MediBlue ESRP PPO Plan.  There are some counties across the US that do not currently offer a C-SNP Plan.

The C-SNP plans contract with the federal government for higher reimbursement rates to cover the added risk of this population. These plans offer better benefits than original Medicare, guarantee an out of pocket maximum and tailor their plan benefits, network and drug formulary to meet the needs of individuals who have these specific health conditions.

You can help save the Medicare Advantage program by writing a letter to Congress and voicing your opinion.

You can find your representative by entering your address here:  https://www.govtrack.us/congress/members/CA#representatives

This blog is an opinion piece and is not associated, endorsed or authorized by the Social Security Administration, the Department of Health and Human Services or the Center for Medicare and Medicaid Services. Medicare has neither reviewed nor endorsed this information.