Medicare Compliance & Reimbursement

The White House, House, and Senate all want to ensure health-plan choices for Medicare beneficiaries across the country - without drastic premium differences overwhelmingly favoring large urban areas - by requiring plans to serve relatively large, potentially even multi-state regions. Health plans haven't been shy about just saying no to this idea. As the Medicare conference proceeds, insurers large and small are laying out complaints about the plan to anyone who'll listen. For example, small local plans that have continued serving M+C even as some big national companies have abandoned it are annoyed that the big-region idea appears geared towards the behemoths. "It's very difficult to manage in these rural areas, and we think you're down to a handful of national providers who have any chance to bid on that option," HealthSpring Inc. chief Herb Fritch told the Nashville Business Journal August 1. "Those are the same companies that have pulled out and abandoned Medicare+Choice - Aetna, Cigna, Blue Cross - [and] none of those has a program in Tennessee," said Fritch, whose plan currently does 70 percent of its business in M+C.

"The local plans who have participated for many years don't want the government to give preference to the new plans, and the new plans are worried about preferential treatment of the old plans," Jack Ebeler, president of the small health-plan group Alliance of Community Health Plans, told the paper.