Medicare Advantage: Trends, challenges and solutions


Medicare Advantage has been a hot-button issue this year, with billions of dollars in overpayments, controversial payment changes, and provider network cuts. So what else is in store for insurers offering Medicare Advantage plans? They can expect more competition and less reimbursement.

With more competition comes the need for Medicare Advantage insurers to keep operating costs low while maintaining compliance with regulations, Robert Tracy (pictured), senior business director of government products at Buffalo, New York-based Independent Health, told FierceHealthPayer in an exclusive interview. Thanks to shrinking government reimbursement, MA insurers also need to invest in automated systems, as well as electronic tools to communicate with members.

"Plans are required to mail large amounts of letters and correspondence to members, which are all subject to audit and have strict timeframes that must be met," he said.

Nonprofit Independent Health has found ways to meet requirements from the Centers for Medicare & Medicaid Services with limited resources. It has put a priority on greater automation--of enrollment and reconciliation, and billing and collection.

It also uses automated model CMS letters and ID card fulfillment to better handle a large volume of transactions and meet federal timelines. Tracy also highlighted the importance of real-time eligibility verification to speed up application processing and improve accuracy at the point of enrollment.

In addition to dealing with slim margins, member education during the Annual Election Period (AEP) will pose a big challenge for MA insurers. Each year, consumers need to decide whether they want to sign up for a new MA plan, return to traditional Medicare or keep their existing coverage--so insurers must educate members about any plan changes and premiums.

"The exchange marketplace has also brought about significant changes and the process is much different than what members have been exposed to, so this requires new resources and processes to accommodate the exchange populations," Tracy added.

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