Major changes ahead for Medicare Advantage plans

During a recent government meeting, key discussions centered around health insurance plan structures and upcoming changes affecting retirees, particularly in relation to Medicare Advantage plans.

One significant topic was the integration of deductibles and out-of-pocket maximums for Tier 1 and Tier 2 providers. Members who reach their out-of-pocket maximum with a Tier 1 provider will only need to pay an additional amount when accessing Tier 2 services, streamlining costs for members. The meeting emphasized the importance of utilizing the Blue Cross Blue Shield (BCBS) EPO network, which provides a comprehensive list of participating providers online.

The discussion also highlighted the current out-of-network benefits, which mirror in-network benefits, making it challenging for members to seek care outside the BCBS network. A recommendation was made to adjust out-of-network benefits to align more closely with market standards, particularly since claims outside the network totaled approximately $1.2 million over the past year.

Attention was also given to the impact of the Inflation Reduction Act on the retiree population. The Act has led to significant changes in Medicare, including the elimination of the coverage gap and the introduction of a $2,000 annual maximum out-of-pocket limit for prescription drugs. These changes aim to reduce financial burdens on retirees, although they pose challenges for insurers like Humana, which rely on funding from both premiums and CMS subsidies.

Four options for post-65 retirees were proposed, including automatic enrollment in Humana's Medicare plan or BCBS's Medicare Advantage Plan, both allowing members to revert to commercial plans after one year. Additionally, changes to premium structures for retirees not enrolled in Medicare Parts A and B were discussed, as well as a new requirement for future hires to enroll in these parts upon retirement.

Overall, the meeting underscored the ongoing efforts to enhance healthcare access and affordability for members while navigating the complexities introduced by recent legislative changes.