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Posted by Klukie in General Discussion (1/22-2007 thru 12/14/2010)
Wed Aug 12th 2009, 05:43 AM
From CNBC...and the July second quarter earnings report

UnitedHealth Group posted stronger-than-expected second-quarter profit on Tuesday, helped by growth in the insurer's plans for elderly and low-income Americans and in its drug benefit business

Revenue in the company's Ovations unit serving seniors rose 13 percent to $8 billion. Enrollment in its Medicare Advantage plans jumped nearly 20 percent to 1.74 million.

At its unit serving Medicaid plans for low-income Americans, revenue shot up 45 percent to $2 billion, spurred by strong enrollment gains.

"Medicare and Medicaid enrollment growth was strong," Wells Fargo analyst Matt Perry said in a research note

Good info from the Center for Medicare Advocacy....

Many advocates involved in representing Medicare Advantage plan care enrollees find that the system is fraught with difficulties. Beginning with the absence of clear explanations, and thus clear understandings on the part of enrollees, as to what services may be covered under what circumstances, to the concern of advocates that economic issues, rather than quality of care, guide some coverage determinations, the Medicare Advantage system can present great problems for enrollees. The requirements that enrollees use only the HMO's providers and that specialty care must be approved in advance are often viewed as disadvantages to the Medicare Advantage program. This difficult situation is compounded by an appeals system that is often vague and can involve frequent delays.

Another problematic area has been private insurance marketing activities. Although certain marketing techniques are prohibited, including the prohibition of activities that would mislead, misinform, confuse, or defraud Medicare beneficiaries, abuse by some companies has been an ongoing problem. Unfortunately, the regulations provide no direct remedies that the beneficiary subjected to prohibited marketing activities may pursue.

On the other hand, there are some advantages for HMO enrollees. For many enrollees, deductibles or coinsurance payments are reduced or eliminated. In addition, there are no claim forms to be filled out and some plans offer benefits not covered by Medicare.

Each year, many Medicare Advantage plans have decided to withdraw entirely from the Medicare market due to insufficient profits. Under current law, HMOs may decide each year whether to offer a Medicare plan and may discontinue the plan after providing their enrollees with written notice 60 days prior to termination. The closing of plans in many areas of Connecticut and the nation has been frightening and confusing for enrollees.

These uncertain circumstances, variations in the services that a plan may offer, and the charges that plans may impose point out how important it is for a prospective enrollee to examine carefully the benefits and costs of the services offered by the HMOs. A comparison of these benefits and costs with the original Medicare program, combined with coverage from a Medicare supplemental policy (Medigap), should be conducted before enrolling in a Medicare Advantage plan.

Medicare beneficiaries of modest means should also carefully review eligibility for the Qualified Medicare Beneficiary Program (QMB) and Connecticut's prescription drug program (ConnPACE) as a possible alternative to Medicare Advantage enrollment.

A little info on Ovations.....

MINNEAPOLIS -- Ovations, a business unit within UnitedHealth Group (NYSE:UNH), has informed the Centers for Medicare & Medicaid Services (CMS) of the company's intent to participate nationally in the Part D drug benefit program. While this action is non-binding, it represents the first of a series of steps to be taken as CMS finalizes the details around the program implementation.

The Part D drug benefit represents one of the most significant changes in the history of the Medicare program. Through the program, millions of older Americans who are Medicare eligible will have access to prescription medications independent of their other health care coverage

Could it be that the Health Insurance industry smells where the profits are going to be...medicare part C anyone?
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