This week, we have a study on Medigap enrollment and consumer protections across states, details on how Medicare Advantage rankings will impact disadvantaged populations, information on Medicare Advantage outperforming Medicare for people with chronic conditions, and an update on Individual Life premium growth.
Medigap Enrollment and Consumer Protections Vary Across States | Kaiser Family Foundation | July 11, 2018
One in four people in traditional Medicare (25 percent) had private, supplemental health insurance in 2015—also known as Medigap—to help cover their Medicare deductibles and cost-sharing requirements, as well as protect themselves against catastrophic expenses for Medicare-covered services. This issue brief provides an overview of Medigap enrollment and analyzes consumer protections under federal law and state regulations that can affect beneficiaries’ access to Medigap. In particular, this brief examines implications for older adults with pre-existing medical conditions who may be unable to purchase a Medigap policy or change their supplemental coverage after their initial open enrollment period.
- The share of beneficiaries with Medigap varies widely by state—from 3 percent in Hawaii to 51 percent in Kansas.
- Federal law provides limited consumer protections for adults ages 65 and older who want to purchase a supplemental Medigap policy—including, a one-time, 6-month open enrollment period that begins when they first enroll in Medicare Part B.
- States have the flexibility to institute consumer protections for Medigap that go beyond the minimum federal standards. For example, 28 states require Medigap insurers to issue policies to eligible Medicare beneficiaries whose employer has changed their retiree health coverage benefits.
- Only four states (CT, MA, ME, NY) require either continuous or annual guaranteed issue protections for Medigap for all beneficiaries in traditional Medicare ages 65 and older, regardless of medical history (Figure 1). Guaranteed issue protections prohibit insurers from denying a Medigap policy to eligible applicants, including people with pre-existing conditions, such as diabetes and heart disease.
- In all other states and D.C., people who switch from a Medicare Advantage plan to traditional Medicare may be denied a Medigap policy due to a pre-existing condition, with few exceptions, such as if they move to a new area or are in a Medicare Advantage trial period.
Medicare Advantage rankings hit plans serving disadvantaged populations hard | Healthcare Finance | July 10, 2018
Federal rankings of Medicare Advantage plans may unfairly penalize those who enroll a disproportionate number of non-white, poor and rural Americans, according to new research from Brown University.
The study, published in Health Affairs, used data collected by the Centers for Medicare and Medicaid Services to measure the quality of care provided in Medicare Advantage plans, and adjusted performance rankings for race, neighborhood poverty level and other social risk factors. After the adjustments, plans serving the highest proportions of disadvantaged populations improved considerably in the rankings.
MA outperforms traditional Medicare for people with chronic conditions, study finds | Healthcare Dive | July 11, 2018
- Medicare Advantage enrollees with chronic conditions had 23% fewer inpatient stays and 33% fewer emergency room visits than beneficiaries in traditional fee-for-service Medicare, according to an Avalere Health study released Wednesday. There were similar results for dual-eligible beneficiaries, among which MA recipients had 33% fewer hospitalizations, 42% fewer ER visits and 20% lower costs.
- Chronic care patients with MA plans also performed better than those in FFS in higher rates of preventive screenings and tests, along with other key quality measures. Among clinically complex and dual-eligible/low-income subsidy beneficiaries, cost savings and quality of health were significantly better for MA beneficiaries than F
- The study sampled more than 1 million beneficiaries in MA and FFS each and compared metrics in three populations with chronic conditions: hypertension, hyperlipidemia and diabetes — all of which are in the top five most common conditions among Medicare recipients.
Individual Life Combination Premium Grows 18% in 2017
Total new premium for life combination products (which combine life insurance with long-term care or chronic illness coverage) increased 18 percent to $4.1 billion in 2017, according to LIMRA’s 2017 Individual Life Combination Products Annual Review. This is the third consecutive year of premium growth.
Life combination product market share of individual life insurance premium has increased 10 percentage points over the last two years and represents 25 percent of total new U.S. life insurance premium in 2017.