CMS cuts reimbursement rates for Medicare advantage plans by 4% to 4.5%
07 04 09 - 16:57
U.S. Reduces Subsidies for Private Medicare
By VANESSA FUHRMANS and JANE ZHANG
The federal government made good on its plan to cut 2010 payments for private Medicare plans, whittling the subsidies to health insurers sooner than the industry originally expected.
The cuts, announced late Monday by the Centers for Medicare and Medicaid Services, are slightly less severe than the 5% reduction the federal agency signaled in February, but still raise concerns about what has been a critical source of profit growth for many health insurers. Reimbursements to private insurers that administer so-called Medicare Advantage plans would fall by as much as 4% to 4.5% next year.
The agency said it would raise the baseline rate for the private plans by 0.81%, slightly more than the 0.5% it proposed in February, though significantly less than the roughly 4% insurers have seen in recent years. But the payment rates also include a 3.41% reduction as a result of a change in how the government uses a reimbursement scale pegged to enrollees' health.
The move makes clear the Obama administration's intent to swiftly rein in the private plans. More than 10 million Medicare beneficiaries get their medical and drug benefits through Medicare Advantage plans. Republicans during the Bush administration pushed the plans' extra benefits for seniors and subsidies to insurers to promote more private-sector involvement in Medicare. But President Barack Obama has argued that insurers are overpaid to administer the plans, and he wants to finance part of his health-care overhaul by paring their subsidies.
Health insurers, though, hadn't expected cuts to begin until 2011 and were caught off guard by the February regulatory announcement. Last month, the administration also set stricter terms for companies bidding to offer such plans in 2010, including a requirement that they can't charge sick, low-income patients more than what they would pay under traditional Medicare.
Humana Inc., Coventry Health Care Inc. and other insurers that have made big bets on Medicare Advantage are expected to feel the rate cuts the most. With more than 1.4 million Medicare Advantage members, Humana is the second-biggest provider of private Medicare plans, and the business comprises roughly half of its overall revenue. UnitedHealth Group Inc. is the biggest provider of such plans with about 1.5 million members.
Medicare Advantage plans wrap physician and hospital services in one, often with vision and drug coverage. Unlike traditional Medicare, the government doesn't pay physicians and hospitals directly but instead pays insurers to manage care. Currently, though, a patient in these plans costs the government an average of 14% more than if he or she stayed in traditional Medicare.
The cuts mean beneficiaries enrolled in the private plans could see higher premiums or cost-sharing amounts next year, depending on the extent to which insurers try to preserve the 3% to 5% profit margins they usually make on the plans. The Blue Cross Blue Shield Association, for instance, said it had calculated average monthly premium increases of $50 to $80 if the 2010 cuts were to go through. That won't be clear until plans submit bids and benefit designs later this year.
Insurers and Republican lawmakers say the administration's cuts go too far, particularly because they assume a prospective 21% cut in Medicare reimbursements to doctors that Congress is all but certain to override later this year. Medicare officials said that if the physician fee cut is reversed, they would work with Congress to incorporate the change into Medicare Advantage payments then.
Humana declined to comment. UnitedHealth said it was still reviewing the Medicare announcement, but that it would continue to offer affordable plans. "We have long-standing experience with addressing the changing rate environment within Medicare Advantage and we will use all our business levers to make the adjustments necessary to manage these changes for 2010."
Write to Vanessa Fuhrmans at vanessa.fuhrmans@wsj.com and Jane Zhang at Jane.Zhang@wsj.com