Home Health & Hospice Week

GAO report leaves out other negatives of MA plans' home care policies, industry says.

Common knowledge about Medicare Advan-tage in the home care industry is now getting attention from the general public for the first time, and home health agencies hope the information will change managed care practices for the better.

Nearly 20 percent of beneficiaries enrolled in Medicare Advantage plans have higher cost-sharing for home care services under MA plans than they would in regular fee for service Medicare, says a new report from the Government Accountability Office. And 21 percent of beneficiaries have a plan that excludes home care costs from its out-of-pocket maximum cap, the report adds.

MA plans advertise benefits that beneficiaries can understand, like cheaper emergency room cost-sharing or lower prescription drug costs, notes Karen Hinkle with the Kentucky Home Health Association. "Initially they could get these added benefits at a lower cost than their Part B traditional coverage and that has been appealing," Hinkle tells Eli. But later they find out they have to pay more for services like home care.

"It has not been in the interest of [the Centers for Medicare & Medicaid Services] to make these is-sues clear to beneficiaries ... as CMS aggressively promoted MA plan enrollment," notes Bob Wardwell with the Visiting Nurse Associations of America. CMS says such information is already available to beneficiaries or is too burdensome for MA plans to publicize, says Wardwell, a former top CMS official.

"Of course the information ... is not available or is tucked away somewhere on the plan's Web site," Wardwell notes. That's "a favorite place for 85-year-olds to do research," he jokes.

For instance, many plans charge benes a copayment for home health visits while FFS does not, notes Joanne Cunningham with the Home Care Association of New York State. That information isn't always clear when selecting a plan.

Choosing an MA plan without adequate information "has become a guessing game for beneficiaries," Wardwell criticizes. "Those who guess poorly pay the price for whatever may be gained by others."

How it works: Most MA plans receive incentive payments on top of regular Medicare rates, notes Neil Johnson with the Minnesota HomeCare Association. Those "rebates" help put MA spending at 12 percent above regular FFS spending, the GAO report notes.

MA plans use a portion of their rebates to pay for general and administrative expenses and to boost their own profits, the GAO says.

Robbing Peter: "It's truly amazing to me that the increased cost of MA plans is being passed on as increased Part B premiums to those in traditional Medicare without any public reaction," Wardwell says. "Those extra dollars subsidize profits for the plans and extra benefits and reduced cost sharing for some benefits for MA enrollees."

Powerful Ways [...]