HEALTH PLANS: Hidden gems for health plans in Part D

There have been some questions about why health plans and PBMs would want to be quite so enthusiastic about becoming Participating Drug Plans or Medicare Regional PPOs, or for that matter getting back into being Medicare, given that they all risk adverse selection.  The answer is pretty simple. The amount of money paid to Medicare HMOs went up dramatically at the start of 2004, and Part D PDPs and now the Medicare PPOs are all basically being insured by the government against losses.

The real test will com when those subsidies are taken away in a few years. Last time that happened, managed care dropped the Medicare ball in a big way.

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  1. Dr. John, you mean you don’t care if seniors had the freedom to purchase Rx coverage outlawed.
    If you were President you could try your government price controls but you won’t be elected anytime soon.
    President Bush on the other hand promised an option for Medicare Rx, and he delivered.

  2. Seniors vote or else no politician would care. Bankrupting Medicare is no way to show you care. You limit the cost by limiting that which drug companies can change for most prescription medications (a formulary concept). Canada does it and the drug companies comply. We are a bigger market.

  3. Dr. John,
    You ask why a Rx program in Medicare? It was illegal for a senior to even purchase Rx coverage that would cover a $1,500 a month Rx bill. Yes, in the land of the FREE, your government made the purchase of Rx coverage illegal. This sounds like Cuba but it was the USA. This is why President Bush started the ball rolling on Rx coverage in Medicare.
    Seniors with Rx coverage will no longer owe $18,000 per year on Rx because the maximum they can owe is $3,600 plus 5% of Rx with the new Rx program. The President just really cares.

  4. Eric,
    President Bush said from the start that he was going to put in an Rx program in Medicare. I hope I hear that seniors paying $1,000 per month in RX will now only pay $3,600 plus 5% of Rx. This is a great benefit for sick seniors. It is true that large corporations are getting free money to keep their Rx programs going. But some were screaming companies would stop their Rx programs and now they are not.
    Of course a stand alone Rx program will cost more than an integrated benefit plan but Medicare is an old program stuck in time, darn lethargic government programs. When Medicare is upgraded to the tax free HSA (Medicare Savings Accounts) the Rx amount will simply mean larger Federal Medicare deposits into senior’s MSAs, all tax free. I know you don’t like to hear this Matthew but the law is already passed, as you know. You should be telling people instead of me. Let’s face it, you have “The Health Care Blog.”
    I bet the Heritage PHD guy explained all about MSAs in Medicare to Dr. Novack. How they were passed in the BBA in ’97 and upgraded in 2003.

  5. Matthew- please also add that private employers are getting money to NOT drop their drug plans.
    In the vein of self-promotion, my interview with Robert Moffit, director of health policy studies at the Heritage Foundation, should be available by tomorrow at the website. (www.ericnovack.com) We discussed the new drug plan for nearly the full hour…
    Highlights: unfunded, open-ended entitlement program
    corporate welfare
    Jeff Flake’s legislation to postpone implementation for one year
    an excellent primer on the new program!
    PS- I am waiting for your thoughts on the new Harris poll…

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