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Excellus BlueCross BlueShield gets lawmaker support for Medicare Advantage plans


Excellus Blue Cross Blue Shield logo

A bipartisan group of upstate lawmakers is trying to get a change in the way that some health insurance companies cover costs for customers of their Medicare Advantage plans.

The president and CEO of Excellus BlueCross BlueShield, Jim Reed, said the situation goes back to last year when the federal government increased the Medicare Wage Index by 20-40% for hospitals in Upstate New York.

Reed said the problem is that nonprofit health plans in the region, like Excellus and MVP, use the federal reimbursement rates to determine the payments for hospitals who treat Medicare Advantage members.

He said the health plans are now reimbursing hospitals more for those Medicare Advantage subscribers without a corresponding increase in government funding.

“Ultimately, when the premium comes in from the federal government, we have to be able to cover the costs,” said Reed, and so if there is a premium shortfall, then at some point in the future, we will need to change plan designs, change benefits, change beneficiary premiums to account for that shortfall.”

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Reed said legislation backed by a group of Democratic and Republican members of Congress in the region would adjust the amounts reimbursed to the health plans, and he praised the lawmakers for working together on this.

“A really cross-party, bipartisan support for an unintended consequence here; all of our elected delegation were ready, willing and eager to jump in to help,” said Reed.

Those Congressional members include Claudia Tenney (R-24), Joe Morelle (D-25), Elise Stefanik (R-21), Paul Tonko (D-20), Nick Langworthy (R-23), Brandon Williams (R-22), Marc Molinaro (R-19).

Reed is hopeful this legislation will get final approval later this year. Otherwise, he says it could potentially result in higher out of pocket costs and reductions in benefits for Medicare Advantage customers.

In a statement, Tenney said that the bill “will ensure that Medicare Advantage plans continue to provide the robust benefits that so many members of our community rely on.”

The CEO of MVP Health Care, Chris Del Vecchio, also thanked the bipartisan effort by lawmakers, and said it would ensure that MVP “can continue to innovate with our community provider partners and provide critical supplemental benefits to our Medicare members.”

Randy Gorbman is WXXI's director of news and public affairs. Randy manages the day-to-day operations of WXXI News on radio, television, and online.