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Proposed cuts to Medicare Advantage might mean higher costs for local recipients

WASHINGTON – Western New York seniors on Medicare Advantage plans – particularly those offered by BlueCross BlueShield of Western New York – could see higher costs and reduced services next year due to cuts being proposed by the federal government.

All three of the local insurers – BlueCross BlueShield, Independent Health and Univera Healthcare – warned Tuesday that seniors could be affected by the cuts proposed late last week by the Centers for Medicare and Medicaid Services.

But they also all said it’s far too early to know the scope of any proposed changes in their HMO-style plans for seniors, to which about 54 percent of the region’s Medicare recipients subscribe. Overall, America’s Health Insurance Plans, an industry group, estimated at least a 4 percent cut in the reimbursement rate that the government pays insurers to offer such programs.

That cut could vary widely by locality as well as by insurer, though, and the local insurers were still struggling Tuesday to figure out exactly what the proposed change would mean for them.

One thing is for sure: BlueCross BlueShield would likely suffer the most locally.

That’s because the government now bases its Medicare Advantage reimbursement rate in part on the performance of particular insurers – and BlueCross BlueShield saw its rating fall to 3½ on a five-star rating system last year. A one-star drop in the rating can lead to a company losing as much as 5 percent of its federal reimbursement for the program.

Meanwhile, both Independent Health and Univera maintained their 4½ star ratings.

The star ranking system is based on 48 measures focusing on areas such as customer service, the management of chronic conditions and member satisfaction. Julie Snyder, a spokeswoman for BlueCross BlueShield, previously said the company had encountered some “challenges” in its 2012 clinical data and was working to improve.

As for the lower rating’s impact on BlueCross BlueShield’s federal reimbursement for Medicare Advantage, “it’s a concern,” said Donald R. Ingalls Jr., the insurer’s vice president for state and federal relations. “And we’re looking at what we have to do to mitigate that impact.”

Overall federal reimbursements for Medicare Advantage fell 6 percent this year, forcing all three of the local insurers to tweak their plans slightly by increasing premiums and/or co-pays and in some cases reducing covered services.

The insurers worry that more of the same may be in store for 2015.

“There could be more tweaks” in Univera’s offerings because of the federal reimbursement cut, said Michael Burke, the company’s senior vice president for government programs.

Robert Tracy, senior business director for government products at Independent Health agreed, but he added: “Medicare Advantage is still a very good option” for many seniors.

The federal government will finalize the proposed cuts after a 45-day comment period, and Congress is already anxious to comment.

Sen. Charles E. Schumer, D-N.Y., helped round up 40 senators to write to Medicare Administrator Marilyn Tavenner to ask that the reimbursement rates be frozen. Medicare Advantage “has been a great success and should remain a competitive choice for our constituents,” they wrote.

Meanwhile, Rep. Chris Collins, R-Clarence, accused the Obama administration of cutting Medicare Advantage subsidies again in order to fund new programs under Obamacare. He said the latest subsidy cut proves that he was right when he warned during his 2012 campaign that the administration wanted to destroy the program.

“It was obvious to me 18 months ago that the Obama administration doesn’t like Medicare Advantage,” Collins said.