Here are the rates. countyrate2010
Essentially, with some coding changes, this will represent a 5% reduction from 2009 payments. Assuming 5% trend (which is probably low), you get a 10% differential in 2010 versus 2009. Essentially, CMS assumed (for purposes of calculating the rates) that the physician’s payments would be cut by 21% in 2010 which President Obama already said will not happen.
I’d prefer that they be honest about how they calculate the number seeing that the government can do whatever it wants anyway.
Round numbers, this means that the medicare beneficiaries will see about a $1,000/year reduction in benefits (higher cost sharing, fewer extra benefits, higher out of pocket maximum costs, etc.) in 2010 versus 2009.
I’ll break down some of these numbers and what impact this will have on 2010 plans in future posts.
Do you have the link for this website? You shared this during the Medicare webinar. It shows by state and county MA plans and number of enrolled.
Thanks
John
John:
Here is a link to the spreadsheet directly from CMS:
http://www.cms.hhs.gov/MCRAdvPartDEnrolData/MMAESCC/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=2&sortOrder=descending&itemID=CMS1223270&intNumPerPage=10
I’m going to reformat this and post to the blog.
Craig
When determining the rates that the insurance companies get per month per county: Do we look at the final column? Could you please explain what each means. Thanks
Jeff:
My expertise here is a bit thin, I have a general idea of how this works, but not a full understanding (which is OK with me!).
Generally, I’d say to look at the column to the right. This wouldn’t include the payment for Prescription Drugs (in cases of MAPD). This number is being adjusted downward by 3.41% to account for something they call “Coding Intensity”. This is the reason why they say the actual rate will be 4.0% to 4.5% LOWER than 2010. The exact number will vary on a beneficiary by beneficiary basis, as the companies are paid more for Medicare Beneficiaries with chronic conditions or multiple conditions that they “Code” to CMS.
Regarding the column headings, they should read: Aged Part A; Aged Part B; Disabled Part A; Disabled Part B and Risk Parts A & B. The last column, “Risk Parts A & B” is what I look at when calculating the effect on plans in 2010.
If you look at one county (take the first one Autauga, AL), the 2009 rate was $818.77/month and the 2010 rate is $814.35/month. If trend is 5% (some estimate 2009 trend as much higher), then the company would need $859.71/month in 2010 to have the same dollars to work with. If you take the 2010 number ($814.35) and deduct 3.41% you get a rough idea of the ACTUAL average payment ($786.58).
The difference between the “steady state” rate $859.71 and the actual rate $786.58 is $73.13 which is what the health plan will need to make up by (1) cutting internal (likely marketing) expenses, (2) cutting benefits, (3) cutting profits, or (4) raising premium. Likely, they will spread the costs around. However, if you think in the most simple terms, if you added $73.13 to the 2009 MA plan premium in order to arrive at your 2010 plan design, you’d be back to even.
Ok, my head hurts.
[...] 6 – 2010 Capitation rates are to be issued on April 6th, 2009 (NEW: Click here for blog post on 2010 capitation rates!). The premliminary rates issued by CMS, along with other changes, will amount to a 3.5% to 5.0% [...]