“If the patient asks me about the general [individual] Medicare Advantage plan, I can go to the Plan Finder and get all the details. We all have access to that information,” Hoadley said. “But if I’m working with a retiree group exemption plan, then I’m limited to whatever the employer offers retirees.”
Employers transferring retirees to Medicare Advantage plans, Hoadley said, should provide an extension so that patients can continue seeing their current doctors—if the doctors will eventually be disqualified. removed from the program—and informed about how the program is expected to change over time. Many employers initially offer generous out-of-network coverage to try and sell plans to patients, he said, but fail to maintain the benefits over time.
Employers should also explain to retirees how they can opt out of their group Medicare Advantage plan and sign up for traditional Medicare or other forms of insurance, he said. They should clarify if an individual will be subject to different enrollment deadlines or be penalized for choosing a standalone plan.
“Companies that communicate changes well tend to be less responsive. But if communication doesn’t work, or if the changes become more dramatic—let’s say an HMO with a limited network is the only option—there’s a good chance you’ll get some feedback, ‘ Hoadley said.
Hoo said any reimbursements and policy changes to a Medicare Advantage plan could also slow down the application process. CMS is weighing a number of moves that could increase the cost of Medicare Advantage plans, which could reduce incentives for insurers and save employers. In December, the agency proposed reducing and automating Medicare Advantage providers’ use of pre-licensing and refining their quality rating system. The agency also said it would finalize a long-awaited rule in February on how to audit federal payments to private Medicare carriers.
Despite these obstacles, Hoo said she sees the future of the Medicare Advantage group as bright, as employers increasingly look for ways to save on healthcare costs for retirees.
“It is still very strong,” she said.
