The Centers for Medicare and Medicaid released their reimbursements rates for Medicare Advantage plans by each county in the United States. Commonly known as the capitation rate, the table shows what Medicare pays to a private Medicare Advantage plan each month for each beneficiary enrolled in the health plan. The lowest reimbursement is in San […]
Posts related to Medicare Advantage plans which are original Medicare health benefits provided by private companies.
A five star Medicare Advantage will be paid $890 in Sacramento County, $947 in San Francisco County, $951 in Los Angeles County and $856 in San Diego County per month by the Centers for Medicare and Medicaid for each enrolled member. The data and calculations that go into determining the monthly reimbursement or capitation rate for Medicare […]
Individuals who recently acquired Parts A and Part B of Original Medicare may find they have to pay more per month than their existing ACA health plans. Under the ACA rules, once someone accepts Medicare, they must exit any ACA health plan they purchased through the exchange and the tax credits that make it affordable. […]
Blue Shield of California sent notices to their appointed insurance agents that the agent’s Social Security number had been displayed during the course of member’s online payment. The letter from Blue Shield, dated February 18, notifying agents of the breach to their private personal information does not mention how many agents had their Social Security number’s compromised. While I was not shocked to receive the letter informing me that my personal information was displayed, I was angry that Blue Shield let this happen.
Orange County Health Authority’s CalOptima OneCare Medicare Advantage plan was served a notice of immediate sanctions by the Centers for Medicare and Medicaid Services (CMS) on January 24, 2014. The immediate sanctions mean that CalOptima can’t market or enroll new members into their OneCare Special Needs Plan until the sanctions are lifted. CMS cited “widespread and systemic failures impacting CalOptima’s enrollees’ ability to access health care services and prescription medications” as a summary for issuing immediate sanctions.
Blue Shield has introduced a very competitive Medicare Advantage plan in ten select counties through out California. With the acquisition of GEMCare, Blue Shield will be able to more easily offer a version of their Blue Shield 65 Plus HMO plan in the GEMCare service area. While some Medicare Advantage plans seem to be reducing plan benefits and dropping counties, Blue Shield has been selectively increasing their MA-PD footprint in California.
Health Net and several other administrators of Medicare Advantage plans were issued fines from the Center for Medicare and Medicaid Services (CMS) for errors in their updates to people enrolled in the MA-PD plans. The penalties, issued in October 2013, were for incorrectly stating plan information in annual notices to Medicare beneficiaries enrolled in the Advantage plans and ranged from $23,410 up to $86,530.
If a Medicare Advantage plan has been awarded a 5 Star rating from Medicare you’ll see that trumpeted in TV commercials and print advertising. The star rating that either the Medicare Advantage or Part D Prescription Drug plan must display is a composite of 35 different measurements. Perhaps the most important rating for most beneficiaries is the level of customer service if there is a problem.
Medicare beneficiaries who suffer from chronic and debilitating illnesses such as cancer, dementia, HIV/AIDS or have suffered a stroke may be eligible for a Medicare Advantage Special Needs Plan (SNP). These SNPs may offer transportation to and from doctor appointments, hearing aids and special language interpreters for doctor appointments.
Thousands of Medicare Advantage plan members in California are receiving letters that their health plans are closing from carriers such as Anthem Blue Cross and Health Net. Some of the health insurance companies will be leaving some counties completely while others will be offering new Medicare Advantage (MA) plans to their members. Regardless of the reasons, the plan closure triggers a Special Enrollment Period for Medicare beneficiaries to select a new plan offered in their county.