Affordable Care Act Delivers Punishing Blow to Medicare Advantage Plans

The widely debated Affordable Care Act has left no American untouched. Some have raved about the positive impact it has had on their lives, while others have denounced it as a terrible law that will surely lead to the demise of the United States. Truth be told, your opinion really depends on your unique situation and how you and your family are personally affected.
Medicare recipients for the most part haven’t noticed many changes. The vast majority that have noticed changes have been impacted positively as their out of pocket costs for prescriptions have decreased as a result of the closing of the “donut hole”. However, some Medicare Advantage plan enrollees are furious as their doctors have been terminated and their out-of-pocket costs have increased.

CBO CutsThe Affordable Care Act will cut approximately $200bn in funding to the Medicare Advantage program over the next few years and while only 4% of these cuts have gone into effect, the pain is already beginning as insurance companies are bracing for the future. This year insurance companies have experienced payment cuts of 6.5% and an even steeper decrease is expected for 2015. These cuts have forced insurance companies to operate more efficiently to maintain profitability. In an effort to meet financial goals major insurers such as United Healthcare have already terminated several physicians and specialists in their networks.

Thousands of people enrolled in Medicare Advantage Plans have lost their physicians and specialists as a result of these changes and they are undoubtedly enraged at the thought of having to find a new medical provider. To add insult to injury, monthly premiums are expected to increase over the next few years while co-payments and coinsurance costs will surely rise. In total, beneficiaries on average will experience an additional $220 in out-of-pocket costs in 2014, with an expected $3,500 in added out-of-pocket expenses over the next decade.

Medicare beneficiaries aren’t the only people struggling with these cuts. Doctors are incredibly frustrated as they have been terminated from these plans for seemingly no reason. They are at a loss for answers and are struggling with how to help their long-time customers going forward. Some have chosen to see their patients for free while others have referred them to doctors they trust and who have had the good fortune of staying in the plan network.

In the coming weeks insurance companies, medical associations and seniors will embark on a media blitz in an effort to convince the federal government to limit the payment cuts to Medicare Advantage plans in 2015. These cuts however, are inevitable and arguably necessary for the Affordable Care Act to be successful and meet the goals set forth by the Congressional Budget Office.
Fortunately, Medicare recipients do have options if their physician has been terminated from their plan network or their out of pocket costs have skyrocketed. The Medicare Advantage Disenrollment Period extends from January 1st to February 14th and during this period beneficiaries have the option to drop their Medicare Advantage plan and return to original Medicare. Original Medicare offers excellent coverage and is accepted by almost all physicians and hospitals. If enrollees do not use this special election period they must wait until the Annual Enrollment Period this fall to change their plan.

Leave a Reply

Your email address will not be published. Required fields are marked *