Medicare Advantage

This blog section contains information on Medicare Advantage plans. Learn about Medicare Part C and discover when you can change your plan during the Open Enrollment Periods. Moreover, find out about Silver Sneakers, Dental Plans, and compare Supplement plans to Medicare Advantage plans.

Medicare Bob - Robert Bache

Medicare Advantage Plans Merging:

CMS finalizes 2016 payment and policy updates for Medicare Health and Drug Plans


April 6, 2015

Contact: CMS Media Relations

(202) 690-6145 |

CMS finalizes 2016 payment and policy updates for Medicare Health and Drug Plans

Rate Announcement Details Plan Payments and Other Program Updates for 2016


The Centers for Medicare & Medicaid Services (CMS) today released final Medicare Advantage (MA) and Part D Prescription Drug program changes for 2016 that provide fair and accurate payments to plans, and encourage the delivery of high-quality care for all populations.


“These policies strengthen Medicare Advantage for current and future consumers by encouraging higher quality care,” said Andy Slavitt, acting CMS Administrator. “As the Medicare Advantage marketplace continues to grow, consumers are getting access to better care through more choice and competition. Seniors and people with disabilities, including the dual-eligible population, will continue to have an extensive choice of plans, affordable premiums, and better and more transparent information about provider networks and pharmacies.”


The Medicare Advantage and the Part D Prescription Drug programs’ enrollments and quality continue to grow and improve since the Affordable Care Act became law. Medicare Advantage has reached record high enrollment each year since 2010, a trend continuing in 2015 with a cumulative increase of more than 40 percent since 2010. At the same time, premiums have fallen by nearly 6 percent from 2010 to 2015. And, more than 90 percent of Medicare beneficiaries have access to a $0 premium Medicare Advantage plan.


The finalized policies fully consider the many comments received during the public comment period. Particular care is being taken to ensure that plan sponsors have the right incentives to care for dual eligible populations over the long term. The Rate Announcement finalizes changes in payments that will affect plans differently depending on the characteristics of those plans. On average, the expected revenue change is 1.25 percent without accounting for the expected growth in coding acuity that has typically added another 2 percent.  The final revenue increase is larger than the February advance notice largely because the Medicare actuaries recently updated Medicare per capita spending estimates for 2014 and 2015. Medicare per capita spending in 2014, 2015 and 2016 is still expected to be below historical standards.


Today’s announcement drives important improvements to the star rating system, additional accuracy and transparency of provider networks, and continues to promote improvements in quality of care for beneficiaries. The policies in the Rate Announcement and final Call Letter reflect Secretary Burwell’s commitment to a Medicare program – including Medicare Advantage – that delivers better care, spends health care dollars more wisely and results in healthier people. In the Final Call Letter, CMS continues to update the Star Ratings measures to drive improved quality for Medicare Advantage and Part D enrollees. To enhance program integrity and payment accuracy, Medicare Advantage plans will continue to be provided stringent oversight for improper payments, just like other providers in the Medicare program.


Lastly, the final policies will provide enrollees with greater information to make informed and timely decisions about their care and their coverage. The Final Call Letter takes steps to require Medicare Advantage plans to maintain accurate provider directories in a timely manner and make those directories widely available. These steps will help enrollees better understand the providers and choices available to them. In addition, CMS will ensure that Part D sponsors provide clear and accurate access to information on preferred cost sharing pharmacies in their networks so that all beneficiaries have access to affordable coverage.


To view a fact sheet on the 2016 Rate Announcement and final Call Letter, please visit:

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Shared by: Robert Bache

Twitter @MedicareBob






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Medicare Advantage Plans Pinellas County

United Healthcare / AARP is offering 3 PPO Medicare Advantage Plans in Pinellas County Florida for 2015:

(Call 1-855-368-4717 to enroll)

Insurance Plan Summary
Insurer UnitedHealthcare/Medicare Complete UnitedHealthcare/Medicare Complete UnitedHealthcare/Medicare Complete
Plan AARP MedicareComplete Choice Plan 2 R5287-001 AARP MedicareComplete Choice H5532-001 AARP MedicareComplete H1080-004
Monthly Premium $0.00 $29.00 $0.00
Medical Coverage
Primary Care In Network $15 copay; Out-of-Network $45 copay In Network $15 copay; Out-of-Network $45 copay $5 copay
Specialist Visits In Network $50 copay; Out-of-Network $70 copay In Network $50 copay; Out-of-Network $70 copay $45 copay
Routine Annual Physical $0 copay $0 copay $0 copay
Routine Annual Eye $50 copay (for up to 1 every year) $50 copay (for up to 1 every year) $45 copay (for up to 1 every year)
Inpatient Hospital Care In Network $395 copay per day, days 1-4; Out-of-Network 40% of the cost In Network $395 copay per day, days 1-4; Out-of-Network 40% of the cost $335 copay per day, days 1-5
Diagnostic Tests, X-rays, & Lab Services $22 to $25 copay (or 20% of the cost) $13 to $16 copay (or 20% of the cost) $13 to $16 copay (or 20% of the cost)
Outpatient Surgery In Network 20% of the cost; Out-of-Network 40% of the cost In Network 20% of the cost; Out-of-Network 40% of the cost 20% of the cost
Emergency Care $65 copay, waived if admitted $65 copay, waived if admitted $65 copay, waived if admitted
Urgent Care $30 to $40 copay $30 to $40 copay $30 to $40 copay
Ambulance $300 copay $250 copay $250 copay
Home Health Care $0 copay $0 copay $0 copay
Skilled Nursing $0 copay per day, days 1-20; $155 copay per day, days 21-64; $0 copay per day, days 65-100 $0 copay per day, days 1-20; $155 copay per day, days 21-59; $0 copay per day, days 60-100 $0 copay per day, days 1-20; $155 copay per day, days 21-59; $0 copay per day, days 60-100
Annual Deductible N/A N/A N/A
Out-of-Pocket Maximum $6,700 to $10,000 $5,900 to $10,000 $5,900.00
Out-of-Network Coverage It may cost more to get care from out-of-network providers, except in an emergency. See Plan Details for additional information. It may cost more to get care from out-of-network providers, except in an emergency. See Plan Details for additional information. It may cost more to get care from out-of-network providers, except in an emergency. See Plan Details for additional information.
Prescription Drug Coverage
Amount you pay for prescriptions up to $2,960
Pharmacy Deductible $200 for Tiers 3 and 4 only $250 for Tiers 3 and 4 only $220 for Tiers 3 and 4 only
Retail (one month) $2/$8/$45/$95/33% $2/$8/$45/$95/33% $2/$8/$45/$95/33%
Mail (three month) $4/$16/$125/$275/33% $4/$16/$125/$275/33% $4/$16/$125/$275/33%

You can get more Florida Medicare Plan Rates.

What is a Medicare Advantage Plan?

What is the difference between Medicare Advantage Plans and Medicare Supplement Plans?

Physicians United Plan

The State of Florida is seeking to dissolve Physicians United Plan (PUP).

Florida is looking to dissolve the local Medicare Advantage health insurance company.

Health News Florida is reporting, The Florida Department of Financial Services filed a petition in Leon County Circuit Court to place the Orland-based plan into receivership because it is insolvent. The company’s May financial statement reported assets of $92.4 million while liabilities amounted to $105.3 million.

Florida’s commissioner of insurance regulation, “PUP’s insolvency poses a serious danger to the financial safety of the policyholders, subscribers, claimants, creditors and citizens of the state of Florida.”

Physician’s United is a Private health insurance company offering Medicare Advantage Plans to Medicare Beneficiaries in the following Florida Counties: Brevard, Broward, Hillsborough, Lake, Marion, Miami-Dade, Martin, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Seminole, Sumter, St. Lucie and Volusia.

This news is in line with a Blog / Video that I posted last year, “Is Obamacare going to destroy Medicare Advantage Plans?”. Click here to watch video:

The Affordable Healthcare Act is cutting funding to Medicare Advantage Plans, as mentioned in last years blog I wrote, “I believe that the smaller insurance companies will either be purchased by a larger insurance company, or go out of business”, Robert Bache.

PUP is an example of  a Company going out of business because it ran out of money. It is reported that in April, PUP’s leaders acknowledged that the company needed $30 million in capital by June 3rd to avoid liquidation. Obviously, they were not successful in getting the capital and now that State of Florida has asked for automatic liquidation on July 1.

What does this mean to PUP Policyholders?

We are not sure, however the most likely scenario that will occur is:

Policyholders will receive a letter from CMS (Centers of Medicare Services) stating that they are losing their Plan and will have 63 days to find a new Plan. To see what Plans are available please call Senior Healthcare Direct toll free, 1-855-368-4717.

Robert W. Bache aka “MedicareBob™”

President / Producer

Senior Healthcare Direct

Direct Toll Free: 1-800-525-0299

Company Toll Free: 1-855-368-4717

Learn more about Robert aka “MedicareBob™”


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Medicare Advantage Cuts Proposed for 2015

(MedicareBob™) – The U.S. government on Friday proposed a cut in payments to private health insurers for 2015 Medicare Advantage plans, a move Republican lawmakers said would hurt benefits for the elderly and disabled.

The proposal, released in a document by a division of the U.S. Department of Health and Human Services, appeared to cut payments by more than the 6 to 7 percent the insurance industry had expected, one Wall Street analyst said.

“Now the lobbying begins: can the plans get Congress to help make the cut less severe?” CRT Capital analyst Sheryl Skolnick said, adding that her assessment of the hundreds of pages of information was preliminary.

Friday’s notice of proposed rates opens a window for negotiations on the final ruling, due April 7.

Insurers and lawmakers have said cuts will mean smaller networks of doctors and hospitals and higher out-of-pocket costs. Insurers have said they could only maintain benefits if there was no change in payments for 2015 from 2014.

Many factors go into determining the government’s total reimbursement to insurers. These payments are based in part on the assumption that Medicare Advantage spending per person will fall 3.55 percent in 2015. Total reimbursement to insurers, however, is influenced by factors such as payments for patients who are sicker than average.

An executive at one company that manages Medicare Advantage plans said that insurers are facing cuts in the 8 percent to 10 percent range when factoring in the per capita spending decline and other planned reductions. These include a new health insurance tax under President Barack Obama’s healthcare law as well as other risk adjustments.

Other industry officials said they were still reviewing the Medicare notice to determine its full impact. Republican lawmakers said any additional cuts to the program were unacceptable.

“These Medicare Advantage cuts are misguided, threaten a successful program for seniors, and must be overturned,” Republican Senator Orrin Hatch said in a statement.

“Medicare Advantage is extremely popular for a reason – run through the private market, seniors gain access to high-quality and coordinated care with additional benefits that they otherwise wouldn’t get,” he said.

The criticism from Hatch and other leading Republicans adds to pressure from the party over Obama’s signature domestic policy achievement. The Patient Protection and Affordable Care Act, which aims to extend health coverage to millions of uninsured Americans, includes provisions to cut Medicare spending.

UnitedHealth Group Inc, Humana Inc and Aetna Inc are among the insurers who manage private Medicare plans for about 15 million of the 50 million Americans eligible for Medicare.

The shares of insurers fell in after-hours trading. Humana posted the biggest loss with a 4 percent decline.


The proposed payment rates are a key factor in how insurance companies plan theirbusiness for the coming year, including in which markets they will offer health plans, what their medical and administrative costs will be and at what level to set premiums and doctor visit co-payments.

Insurers have said that 2014 was a difficult year for Medicare Advantage because of cuts to payments estimated at about 6 percent overall by the industry group, called America’s Health Insurance Plans (AHIP).

“As 2015 payment rates are finalized, we urge the Medicare agency to protect seniors from facing higher costs and fewer benefits by keeping Medicare Advantage payment rates flat,” AHIP Chief Executive Karen Ignagni said in a statement.

The Centers for Medicare and Medicaid Services said in a statement that the proposed changes for 2015 are smaller than those implemented in 2014.

It also said in the statement that it planned to calculate risk scores in 2015 with the same methodology as in 2014. It said it would change a part of its risk payment formula to account for the increasing proportion of baby boomers entering Medicare, who tend to have better health.

It was not immediately clear how these and other formula changes in the document would affect the industry overall or specific insurers.

Medicare Advantage and other government paid-healthcare services like Medicaid are among the insurers’ fastest growing businesses.

But if the costs to insurers of providing the healthcare services outpace the payments from the government, the difference is paid by the insurers, undermining their ability to profit from these plans.

“Medicare Advantage plans are fully at risk under this program. So if their estimate is off, for better or for worse, they are at risk for that,” said Anne Hance, a lawyer at McDermott Will & Emery in Washington, D.C. who focuses on regulation.

Robert Bache’s thoughts:

This is the trend that we have seen over the past 6 years, and it will continue. I anticipate less and less Medicare Advantage Plan options every year for at least the next 3 years.