Coventry Health Care just recognized Extend Health for efficiency and customer satisfaction, including zero customer complaints in 2011. Here’s a brief snip from the press release.

“Extend Health Inc., a leading provider of health benefits management services, including the nation’s largest private Medicare exchange, received two first place awards from Bethesda, Maryland-based Coventry Health Care, Inc. (NYSE:CVH) for exceptional customer service performance by a partner in 2011.

  • Zero customer complaints reported to the Centers for Medicare and Medicaid Services (CMS) by seniors signing up for Coventry private Medicare supplement plans through Extend Health;
  • The lowest 90-day plan cancellation rate — called rapid disenrollment — which, at just 0.5 percent, was far less than the typical rate.”

Click here to read the complete news release.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

Based on provisions in the Affordable Care Act, over the last two years CMS has stepped up its efforts to root out and prevent Medicare fraud with measures that include stronger penalties, enhanced provider screening and enrollment requirements, improved fraud prevention coordination and new high tech tools. This post takes a look at the success of those efforts so far.

Anti-fraud efforts by the Health Care Fraud Prevention and Abuse Control (HCFAC) recovered over $4 billion during 2011, and nearly $11 billion over the past three years. In February of 2012 the Medicare Fraud Strike Force busted a $375 million health care fraud scheme, arresting a Dallas area doctor, office manager, and five owners of home health agencies for their alleged participation.

Other accomplishments include:

  • Charged 323 defendants who allegedly billed Medicare for over $1 billion
  • Charged 1,430 defendants with health care fraud and convicted 743
  • Recovered approximately $2.4 billion under the False Claims Act (FCA) in 2011

Seniors on Patrol Against Fraud

CMS is bringing seniors into the effort to control fraud too. In November of 2011 CMS awarded $9 million to the Senior Medicare Patrol (SMP) program to help it continue the fight against Medicare fraud. The SMP program has 5,000 volunteers across the nation. The funds will help seniors learn how to prevent, detect, and report health care fraud.

According to CMS, “the SMP volunteers work in their communities to educate Medicare beneficiaries, family members, and caregivers about the importance of reviewing their Medicare notices, and Medicaid claims if dually-eligible, to identify errors and potentially fraudulent activity.”

Since the program began in 1997, more than 25 million people have participated in community outreach education events, and over 4 million Medicare beneficiaries have received education in one-on-one counseling sessions.

High-Tech Tools

In 2011 CMS added high-tech tools to help it “crack down on waste, fraud and abuse.” In June of 2011 CMS announced that it would begin using predictive modeling technology, similar to technology used by credit card companies, to identify potentially fraudulent Medicare claims and prevent them from being paid. The new tools will help CMS move from its former “pay & chase” approach to one that focuses on preventing fraud and abuse before it takes place.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

The 2012 Medicare Trustees Report released today echoes last year’s report estimating the Hospital Insurance Trust Fund (Medicare Part A) will stay solvent until 2024. The Medicare Board of Trustees issues this report annually and it has been projecting the year the program would become insolvent almost every year since the reports began back in 1970. A recently published chart  lists the projections from previous reports.

The 2012 report also says that premiums and revenue for Supplementary Medical Insurance program (Medicare Part B and Part D) are expected to cover costs.

The CMS press release and link to the report are available here.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

On Monday, March 12th the Department of Health and Human Services Center for Consumer Information and Insurance Oversight (CCIIO) released a set of final regulations that will govern the state-based health insurance exchanges created by the Affordable Care Act (ACA). The much-anticipated regulations will allow states to further their efforts to create marketplaces where individuals and small employers can purchase health insurance starting in 2014. What will the setup of these state-based health care exchanges mean for Extend Health clients? In this interview, our resident health care reform expert and Director of Product Marketing, John Barkett, who worked on drafting and implementing the ACA before coming to work at Extend Health, helps translate what’s going on.

Extend Health: What’s the difference between a state-based health care exchange and the ExtendExchange Medicare exchange platform operated by Extend Health? Are they the same thing?

John Barkett: They are not the same thing. The state-based exchanges and the ExtendExchange platform are both marketplaces where carriers can list their products and individuals can shop for and enroll in a plan. The New York Stock Exchange serves the same purpose for firms who wish to list and sell securities and investors who wish to buy them. But the state-based health care exchanges also have the power and responsibility to qualify plans. This is similar to how the SEC must certify a firm before it is permitted to sell its shares on a stock exchange. The regulations that were just released are 644 pages long (Download), in part because states are being tasked with setting up an insurance-world equivalent of both a stock exchange and a securities exchange commission for health insurance.

Read the rest of this entry »

As employers consider alternatives to offering retirees traditional group Medicare insurance, they may evaluate more than one supplemental insurance solution. Employers often compare an Employer Group Waiver Plan (EGWP) solution with a private Medicare exchange such as the one provided by Extend Health. Both solutions offer some clear benefits, including:

  • Financial relief provided by CMS subsidies
  • GASB and FAS liability reductions
  • Catastrophic payment relief
  • Increased benefit flexibility

However, only a Medicare exchange can reduce an employer’s administrative burden, and only a Medicare exchange can provide post-65 retirees with the flexibility to choose a supplemental plan that meets their needs, often at a lower cost. These are solid reasons to move to a Medicare exchange solution, but employers with certain populations, such as unions that have strong contractual benefits obligations, may prefer not to migrate their full Medicare-eligible population to an exchange.

Understanding that both solutions offer advantages for employers, Extend Health has partnered with Medco to provide an Extend Health EGWP solution. Employers can leverage the power of the individual Medicare marketplace through the nation’s largest private Medicare exchange, recognize savings, and meet ongoing obligations to retain a group prescription drug program where necessary.

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Read on to learn more.  Read the rest of this entry »

Key Takeaway from Day 3:

Based on the Justices tough questions to law’s challengers and defenders, anything is possible.

What happened:

Two questions were considered on Day 3. The first question asked whether other parts of the law should be struck down if the individual mandate was struck down. The Solicitor General (SG) argued if the mandate were to be struck down, then the guaranteed issue and community rating provisions should also be struck down, but the rest of the law should stand. The Challengers argued if the mandate were to be struck down, the rest of the law should go with it. The Court appointed a third party lawyer to argue if the mandate were to be struck down, everything else should stay in place. The justices were equally tough on all three arguers, and by the end of the day the consensus was that the court could conceivably go in any of these directions if the mandate were struck down, although some suggested that striking down the mandate while leaving everything else in place was the least likely option.

The second question asked whether Medicaid expansion called for by the Affordable Care Act (ACA) was unconstitutional. The ACA offers to pay 90% of the costs of expanding Medicaid coverage to all state residents earning less than 133% of the Federal Poverty Level. States that refuse to do so could risk losing not only those funds but all federal Medicaid funding. The ACA’s challengers argued that such an arrangement was coercive, a way to force states to spend more on health care coverage for low-income residents at a time when state budgets make that difficult. Justices from across the ideological spectrum questioned the challengers’ argument, but they also pushed the SG for examples of why the Medicaid expansion did not constitute coercion. Many commentators noted that none of the lower courts had ruled that the Medicaid expansion unconstitutional, and one could speculate that the nature of the Court’s questions would suggest it was poised to follow suit.

The Justices will vote on all questions of the case in their private Conference, and then begin to write the opinions, which are expected to come out by the end of June. After researching the ongoings these last few days, it seems the only conclusion to come to is that anything is possible. I don’t envy their task.

John Barkett

Director, Extend Health, Inc. and former HHS analyst
Extend Health, Inc.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

Key Takeaway from Today: 

The constitutionality of the individual mandate seems up in the air after tough questions from the bench.

What Happened:

Today the Court heard oral arguments on the constitutionality of the individual mandate (IM).  The Solicitor General (SG), arguing on behalf of the Obama Administration, was faced with a barrage of questions from four of the Justices (Kennedy, Roberts, Alito, Scalia), while the fifth (Thomas) did not ask a question but is widely expected to vote against the constitutionality of the mandate.   Their questions aimed at establishing whether there are any limiting principles that apply to the mandate to purchase health insurance.  In other words, if the Court were to declare the mandate is constitutional, would they be setting a precedent that an individual mandate for any product is also constitutional, or are there aspects of health insurance that make it special in the eyes of the constitution?  The SG’s response, over and over again, was that health insurance is different than other products.

The question of whether health insurance was meaningfully “different” from other products continued to be debated during the challengers’ oral arguments.  The questions of four justices (Kagan, Sotomayor, Ginsburg, and Breyer) seemed to suggest they agreed with the argument the Solicitor General had put forth.  Despite his earlier questions, Justice Kennedy, who is often the swing vote when the court votes 5-4, left room for the possibility that health care is, in fact, different than other products:  “…And the government tells us that’s because the insurance market is unique. And in the next case, it’ll say the next market is unique. But I think it is true that if most questions in life are matters of degree, in the insurance and health care world, both markets — stipulate two markets — the young person who is uninsured is uniquely proximately very close to affecting the rates of insurance and the costs of providing medical care in a way that is not true in other industries.  That’s my concern in the case.”

Oral arguments often but not always signal where a Supreme Court justice is on a given issue.  But many commentators today suggested the challengers presented the more effective argument.

For a more detailed recap of the day’s events, go here.

And for an interesting perspective on whether insurance is different than other products, read this post on Robert Toth’s Business of Benefits blog.

John Barkett

Director, Extend Health, Inc. and former HHS analyst
Extend Health, Inc.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

To listen to audio recordings of the Supreme Court oral arguments, or read written transcripts, go to http://www.supremecourt.gov.

Monday 3-26-2012

Tuesday 3-27-2012

Wednesday 3-28-2012

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

Key Takeaway from Today:

The Supreme Court is likely to decide on the constitutionality of the law this June.

What Happened:

Today the Court heard arguments from three parties on whether the Anti-Injunction Act (AIA) applies to challengers of the individual mandate. The AIA prohibits parties from bringing forth a lawsuit that challenges a tax before the tax has actually been assessed. The Court appointed a third party lawyer to argue the case for the AIA’s application, as neither the Justice Department nor law’s challengers (26 states, the National Federation of Independent Businesses, and various independent parties) were willing to argue that the mandate’s penalty is a tax.

The overwhelming consensus among commentators today was that the Justices were skeptical that the penalty should be considered a tax. In other words, the road has been cleared for the justices to decide on the individual mandate’s constitutionality. For a longer-but-still-in-plain-English write-up on the day’s activities, see here: http://www.scotusblog.com/2012/03/anti-injunction-act-oral-argument-in-plain-english/

For a 15 minute audio play-by-play, see here: http://www.scotusblog.com/2012/03/we-listen-to-the-whole-aia-argument-so-you-dont-have-to/

I’ll be back tomorrow with an update on the day’s SCOTUS activities.

John Barkett
Director, Extend Health, Inc. and former HHS analyst
Extend Health, Inc.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.

On March 26 the U.S. Supreme Court will begin hearing arguments in the case on health reform. At the center of the controversy is the constitutionality of the individual mandate. Advocates say the mandate is the key to making the law work and congress has the power to regulate commerce among the states, but opponents argue that Congress does not have the authority to require all citizens to buy health insurance or pay a penalty.

The decision, due in late June, could be one of the most important the Supreme Court has ever made. The Court will hear six hours of arguments over three days – more time than any case in over 45 years. So, what happens if the Court strikes down the individual mandate?  Will the entire health care law go down with it?

The individual mandate is an integral part of the health care law. Its purpose is to increase participation and minimize the adverse selection that could happen if a large percentage of healthy people do not buy insurance.  But is the mandate the only way to ensure enough participation? Many, including the GAO, have suggested alternatives that might work as well, maybe even better than, the individual mandate. Here are a few of the proposed options:

  • Strict enrollment periods. If missed, the individual would have to wait until the next year to be eligible for insurance.
  • Levy a tax on those who don’t purchase insurance and offer a tax credit to those who do.
  • People could opt-out without paying a penalty, but would be ineligible for benefits for a specified length of time. In addition, people who neither opt out nor purchase insurance would be charged a penalty.
  • Raise premiums for people who don’t purchase insurance during the initial open-enrollment period. This option is similar to rules for enrollment in Medicare Part B and Part D, where individuals who don’t enroll during their initial elegibility period pay a penalty in the form of a higher premium, for as long as they are Medicare beneficiaries.
  • Let states adopt their own individual mandates.

If the court finds that the “individual mandate provision is both unconstitutional and ‘necessary and essential’ to the health care reform law, then the entire law will go down with the provision,” according a recent InsuranceNewsNet artcle by Bryce Williams. If the court strikes down the mandate, but allows the rest of the health care law to stand, there are many alternatives that could take its place. But would Congress be able to work together – during an election year – to revise the health care law? More likely, any changes to the law to ameliorate the loss of the individual mandate would have to wait until 2013 after a new Congress is seated.

Opinions and predictions from experts on both sides of this political – and now legal – football abound. At Extend Health, we tend to believe that the Court will uphold the mandate, and if they don’t uphold it, they will rule that it is severable from the rest of the ACA’s provisions. No one knows for sure, but you can count on the prognostications and rhetoric to continue as we all wait for the court to announce its decision in June.

Visit Extend Health to use the ExtendExchange™ platform – the nation’s largest private Medicare exchange.