Friday, April 30, 2010

CMS data shows that most Medicare Advantage beneficiaries are not enrolled in quality Part C plans; more on 2010 Part D Donut Hole

Avalere Health, a major consulting firm, issued a report today analyzing the quality of Medicare Advantage plans. According to Avalere, a majority of Advantage beneficiaries are enrolled in programs rated as low or medium by CMS, the Centers for Medicare and Medicaid Services. Only about 0.3% of enrollees belonged to top plans. The link is here.

I could not find a reference on CMS for the “Part C Report Card”; Part C does refer to Medicare Advantage.

Part of the problem lies with the incentives in the market; agents make a living selling Medicare Advantage with quotas to meet and may not always be objective in assessing the plans they sell and get cuts of.

More on the Part D Donut Hole (or coverage gap) in 2010

I couldn't find a conclusive post on the Medicare Part D Coverage Gap or Donut Hole in 2010, on this blog, but here is a great reference by Michael Bihari from, "Understanding the Medicare Part D Donut Hole", link here. The best example here is "Sarah" where the example writes: "•Since she has already spent $708 out-of-pocket, she will be responsible for an additional $3,842 while in the donut hole ($4,550 - $708 = 3,842) ".  People or caregivers managing senior's drug plans should plan for about $4600 out of pocket drug expenses a year.

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