Guidelines For Medicare Advantage Plans In 2013

The 2013 policy guidelines for health insurers planning to participate in the Medicare

Advantage plan program have been released by the Obama administration. Will benefits offered by these plans fall if premiums decrease?

Since the guidelines did not include an official preliminary estimate for the net average percentage change in reimbursements, it left a lot of insurers clueless about the potential impact of the 2013 Medicare Advantage guidelines on the industry.

Low Premiums And Stable Benefits Will Likely Continue

Private health care plans in Medicare, popularly called Medicare Advantage Plans and prescription drug plans (Medicare Part D) have reasonably low premium charges and stable benefits. Federal officials believe that this trend will likely continue for 2013.

The officials released a growth percentage for Medicare's per capita expenditures and stated that this will be used to determine and set rates for Medicare Advantage plans in 2013. According to the Centers for Medicare and Medicaid Services (CMS), the guidelines for 2013 project an overall annual growth rate of 2.47 percent and 2.3 percent per capita growth rate next year.

According to the CMS, "This positive growth trend will help ensure that beneficiaries maintain a choice of plans without significant increases in premiums or decreases in benefits."

The CMS also said that it accepted public comments on the 2013 payment and policy guidelines for Medicare Advantage and prescription drug plans. According to the Advance Notice and draft Call Letter for 2013, the CMS exercised its authority granted by the Affordable Care Act to deny bids from plan insurers that proposed "too significant" an increase in beneficiary cost-sharing or a decrease in benefits.

What Are Medicare Advantage Plans?

About 25 percent or 48 million of Medicare beneficiaries participate in Medicare Advantage plans. Unlike traditional Medicare, Advantage plans are offered by private health insurance companies. Medicare Advantage plans are meant to replace Medicare, whereas Medicare Supplement Insurance plans supplement Medicare Part A and Part B.

Advantage plans are very popular among beneficiaries because they do not require any medical underwriting. All Medicare beneficiaries are guaranteed acceptance unless they have End Stage Renal Disease (ESRD). Advantage plans are also called Medicare Part C because they combine the benefits given by Medicare Parts A, B and D.

Another reason that these plans are appealing is that they have low premiums. This is because they are subsidized by the federal government. In exchange for the low premiums, you only have coverage for in-network providers who have negotiated with the insurance company, except in emergency situations. Before deciding to enroll in one of the Medicare Advantage plans, you need to weigh the pros and cons to see if this is the best type of coverage for your health care needs.

by: Wiley Long

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