Medicare Advantage enrollment on the rise

Friday, October 10, 2014

YARMOUTH, Maine – Medicare has said it expects enrollment in Medicare Advantage plans to increase, a trend providers say they are seeing already.

“We are seeing a lot more this year then we have in the past,” said Dan Heckman, president and general manager of Heckman Healthcare in Decatur, Ill. “There was never a lot of penetration in this area by managed care. I think they are marketing it more aggressively.”

A recent release from CMS said that enrollment in MA plans in 2015 is expected to reach an all time high. From 2010, when the Affordable Care Act was implemented, and 2015, enrollment in the plans is projected to increase 42%.

One reason for the increase: Many of the plans offer better drug coverage, say providers.

“We have some particular patients—the more chronic patients—that have aged in to Medicare and they have been used to a Blue Cross-type policy,” said Laura Williard, senior director of regulatory affairs for High Point, S.C.-based Advanced Home Care. “They need something similar to what they are used to.”

Advanced has seen an increase in MA plans of about 2% among its oxygen and CPAP patients, she said.

The plans are often easier for HME providers to deal with, too, they say.

“They do pretty much everything that Medicare does,” said Ron Frantz, medical director for home health at Bell Apothecary in Easton, Pa. “Their rules and polices aren’t the same, but they pay the same as far as the equipment. We are able to do beds, oxygen and nebulizers—all the normal DME that we didn’t win a bid for.”

One big way in which MA plans are different from Medicare is audits.

“Technically, they aren’t immune from audits, but we are not seeing one audit from MA plans,” said Heckman. “I don’t know if they just haven’t thought of it.”

The annual open enrollment period for Medicare began Oct. 15. The mass enrollment period is always a challenge, says Williard. When beneficiaries change plans or switch from traditional Medicare, HME providers are often the last to know. 

“We have an insurance change process during this time and we put extra resources to that,” she said. “We find that we know that a change is happening, but we don’t know who the new plan is. That can impact and delay getting authorizations.”


In our area, we've experienced an increase in Medicare Advantage enrollment in the past 3 years and so far, it hasn't been a positive experience for our DME company. As a result, we've lost several clients because we are no longer in-network with the new HMO. The challenge that we're faced with is that when we applied to become a provider for these HMOs, our applications were denied for the reason that according to them "they already have enough HME providers in the area".  Although, most of these clients still wants us to continue to provide their supplies and equipments. I just don't understand why HMOs have to limit the number of providers to their benificiaries especially if a company is willing to accept their terms and follow Medicare guidelines.