Let it not be said that the health insurance industry is easing off the throttle in its campaign to save Medicare Advantage plans in the coming battles on what to cut when it's time to slash the federal budget deficit. The newest evidence of this campaign is a report put out by the America's Health Insurance Plans trade group May 3 showing the high proportions of minority groups and very low incomes among seniors who enroll in MA plans. Read more

If Medicare Advantage plans sometimes wonder why CMS puts so much emphasis on marketing surveillance and compliance, they may have gotten the answer in a presentation by a CMS official at the agency's 2012 MA and Part D spring conference in Hunt Valley, Md., April 12. Read more

It's 2013; do you know what quartile your Medicare Advantage plan's county is in? That's hardly an idle question based on CMS's final 2013 MA payment rate notice and call letter released April 2. As a result of the agency's final rebasing of counties for next year, 27% of the counties changed payment-rate phasedown quartiles, according to consultant Bill MacBain, senior vice president of Gorman Health Group, LLC. Read more

You want a sign that Medicare Part D is now a mature business? The best evidence of this may be that Part D plans seemingly have become CMS’s prime regulatory focus. And the clearest indicator of that may be the 2013 Medicare Advantage and Part D call letter CMS issued last month. There are at least three significant new regulatory initiatives directed at Part D plans, and it looks as though they only will grow in future years. Consider first the issue of preferred versus nonpreferred pharmacy... Read more

To understand the Florida Medicare Advantage market, you first have to recognize the cogency of Willie Sutton’s response when he was asked why he robs banks. “Because that’s where the money is,” Sutton replied. The concept applies to why MA plans are once again engaged in a round of expansions and acquisitions in Florida: because that’s where the seniors are. In fact, 10% of all Medicare beneficiaries reside in Florida, and, while there is no apparent analogy between UnitedHealth Group and a... Read more

It seems like it was just the other day when Jonathan Blum, then relatively new in his position as director of CMS's Center for Medicare, told a Medicare Advantage industry meeting that as regards such aspects as the plan bid process, "we are not your partner, we are your regulator." The statement then seemed to encapsulate the change from the previous Bush administration, which seemed to regard the private Medicare plans as a partner, perhaps leaving the industry too open for abuses and... Read more

If there is a "hot potato" that Medicare Advantage plans want to avoid catching, it might just be non-HMO beneficiaries in Northern California. And if one leading securities analyst is right, Health Net, Inc. may have to take a bite out of that hot potato in 2012. The history began, as securities analyst Carl McDonald of Citigroup Global Markets writes in a Feb. Read more