Megan Banta,
Lansing State Journal Published 6:00 a.m. ET Sept. 3,
2019
LANSING – Three years from now, Sparrow
Health System expects a large chunk of revenue to come from Medicare Advantage
plans, according to CEO James Dover.
"We’re going to be paid a lot more from
Medicare Advantage plans than we are from fee-for-service Medicare," Dover
said in a recent interview.
He said to get ahead of the national trend and
control the local market, Sparrow's Physicians Health Plan is launching its own
plan.
According to a news release, the Lansing-based
insurer is partnering with Saginaw-based Covenant HealthCare to launch a
Medicare Advantage plan in 12 Michigan counties.
Eligible enrollees can begin to sign up for
the new plan during the Medicare annual enrollment period starting Oct. 15,
with coverage starting Jan. 1, 2020, according to the release.
"We’re doing it now to be ready for the
near and the far when we expect 30% of our revenue is going to be coming from
Medicare Advantage plans," he said. "We don’t want some company from
out of state telling our Medicare citizens where they’re going to get their
care and how it’s going to be delivered."
What's Medicare Advantage?
Fee-for-service Medicare, better known as
traditional or original Medicare is available to people 65 and older, some
people younger than 65 with disabilities and people with permanent kidney
failure requiring dialysis or a transplant.
Generally, you're automatically enrolled in
traditional Medicare if you're already getting Social Security benefits or
enroll once you turn 65, and it covers:
·
In-patient
care at hospitals, skilled
nursing facilities and some nursing homes through what's known as Part A.
·
Out-patient
care, including preventive
care, doctor visits and lab tests through what's known as Part
B.
·
Limited
prescription coverage in certain
situations, but typically not take-home medicines.
Through Medicare Advantage, private companies
offer that government-sponsored coverage and tack on additional benefits.
For example, the Medicare Advantage plans
offered through Sparrow's Physicians Health Plan and Covenant HealthCare
will include prescription drug coverage, also known as Part D.
Medicare Advantage plans also can cover
vision, dental, and hearing services and offer incentives such as fitness
memberships.
Sparrow spokesperson John Foren said Centers
for Medicare and Medicaid Services prohibits plans from sharing detailed
benefit information, including extras such as vision coverage or incentives,
until enrollment begins Oct. 1.
How much will this cost?
Some companies charge an extra premium for
Medicare Advantage plans, and that premium can vary by coverage area.
Premiums for the plans offered by Sparrow's
PHP and Covenant Advantage will be available Oct. 1, since CMS also bars plans
from sharing price details before then, Foren said.
People enrolled in all of the plans are still
responsible for traditional Medicare costs — they still pay a premium for
Part B coverage. That premium, which varies from $135.50 to $460.50 this year
based on income, is either automatically deducted from benefits through Social
Security and similar payments or billed to the individual.
There also are some cost savings, including
the addition of an out-of-pocket maximum, through Medicare Advantage
plans.
Where will it be available?
The partnership will result in three plans
covering 12 counties:
·
Sparrow
Advantage will be available in
Clinton, Eaton, Gratiot, Ingham, Ionia, Montcalm and Shiawassee counties.
·
Covenant
Advantage will be available in
Bay, Saginaw and Tuscola counties.
·
PHP
Advantage will be
available in Calhoun and Kalamazoo counties
Contact reporter Megan Banta at (517) 377-1261 or mbanta@lsj.com. Follow
her on Twitter @MeganBanta_1.
https://www.lansingstatejournal.com/story/news/local/2019/09/03/sparrows-physicians-health-plan-covenant-healthcare-medicare-advantage/2142471001/
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