If Joe Biden Asked, Here’s His Healthcare Policy

Joe Biden isn’t calling, but if he did….this is what his healthcare platform should be.
Note that this is not an endorsement of any political party or candidate (sheesh, we are required to do this, in our society these days).

a. Medicare school free. Physicians can elect to pay back via service. Medical schools object? No more research dollars, effective immediately.
b. Long-term care. New Medicare Part L. Looks and feels like Medicare Part D. Carriers are required to offer, and if they don’t, they don’t get to offer Medicare Advantage or Part D, either.
c. Medicaid must go to carriers, all of it, in a competitive bid, per location.There is something called “dutch auction,” where the highest acceptable amount is paid to the 2 accepted bid per location. This is how US Treasury bonds are auctioned now, I am not inventing the idea.
d. Rx: zero side deals. Most Favored Nations as soon as a prescription leaves the pharmaceutical. There are wayyyyyy too many toll-takers involved between the time the drug is produced to the time that the patient takes a medication (long-time subscribers know that I have been pleading Amazon to get involved in Rx distribution, they could single-handedly solve this in about a month).
e. Medicare Optional Buy-In at a younger age (50 is my guess, so that the AARP doesn’t continue with its wrongly-placed, academically wrong, and distorted slogan “No Age Tax.”). It is the case that Medicare is superior to the individual market, the employer-sponsored market, every other health insurance in the U.S.
If the employer isn’t smart enough to get employees to take the Optional Buy-In, it is wasting money, that happens today. That said, if the horse doesn’t want to drink superior water, so be it. Can there be exceptions? Yes, in which case the employees stays on the employer-provided plan.
f. States can elect to create re-insurance pools, and the CMS matches the amount. One way to lower premiums is to encourage risk by the carriers, by providing a “backstop” in case they start losing money. Note that this was inadequately funded under the original ACA, and on top of that, the federal government is trying to not make payments, after the fact (boo). The concept however is sound, because we need some way to lower health insurance premiums. The issue that every location is so different with respect to healthcare costs, so the health insurance premiums vary from state-to-state, wildly. So every state can choose to fund a re-insurance program, and the CMS matches the funding, to effectively double the re-insurance pool, for those locations that have voted to enact this path. Note: there are a couple of states that have enacted something similar to this, without my feature of “dollar matching.”
g. A twist to point f is that we can get financial markets to solve this overnight, with the government as the backstop, if an only if required. It’s complicated, but Wall Street investment bankers will figure it out. The reason that they have not done so already? There has been no viable backstop.
h. Make health insurance premiums tax-deductible. This may help appease the AARP. While I have been sharply and openly critical of the way that the AARP has campaigned as stated in point e, there is political and demographic reality.

Sigh, Joe Biden isn’t walking through that door….

Medicaid and Extra Help Don’t Have a Calendar 

Every year, the way that Extra Help and Medicaid interact changes. This year is no exception.

If you receive Extra Help, the federal program under which you can receive premium and copay relief, there are special, not widely-known factors that come into play.

  • The Part B and Part D Late Enrollment Penalties are waived.
  • You are not bound by the Annual Election Period, which runs from October 15 – December 7. You have the regulated right to a Special Enrollment Period (SEP) which allows you to change your Part D or Medicare Advantage plan (including those that include prescription drug benefits), at any time during the year.

Many people are aware that Medicare Advantage premiums, deductibles, and copays change. That is the nature of all Medicare Advantage and Part D plans. They are annual contracts, that run from January 1 through December 31st.

What many people do not know is that when a person qualifies for either Medicaid or Extra Help, then the premium of the Medicare Advantage plan can be lower than the published premium. The reason for this is that the allocated funds, resulting from Extra Help, are allocated to the premium of the Medicare Advantage plan. The net result of this is that the actual premium due by the Medicare Advantage policyholder can be lower than the published premium.

The remaining question is then: are the funds from Extra Help allocated in the same manner towards every Medicare Advantage Prescription Drug or Part D plan? The answer to this is no. Let’s take an example.

  • Medicare Advantage Prescription Drug plan #1: $50 monthly premium (remember, Part A and Part B enrollment are required).
  • Medicare Advantage Prescription Drug plan #2: $65 monthly premium
  • Medicare Advantage Prescription Drug plan #1 with Extra Help: $40.
  • Medicare Advantage Prescription Drug plan #2 with Extra Help: $35.

The same comparison can occur in standalone prescription plans (Part D).

How does this happen?
This happens because Medicare Advantage (and Part D) plan carriers are adjusting the plans every year, and as mentioned earlier, Medicare Advantage and Part D plans are annual contracts. That also implies that the carriers are re-allocating the Extra Help funds towards the premiums in a different manner every year. Voila, the combination of these factors results in the simple example provided.

Does This Matter?
It can matter a great deal, depending on your location and the healthcare providers that you want to use. If you look at the example above, it is notable that the network and the carrier were both unnamed. It can be the case that Medicare Advantage Prescription Drug Plan #1 is an HMO-POS, and Medicare Advantage Prescription Drug Plan #2 is a PPO. Since that can be the case, and if it matters to you that you would prefer a PPO, because your doctor or hospital only accepts the PPO, then it can be entirely possible that you would prefer Medicare Advantage Prescription Drug plan #2, and it may also have a lower premium.

The bottom line is that when you consider that Medicare Advantage Drug Plans (MAPD) and Part D plans change annually, and if you also receive Extra Help (also known as Limited Income Subsidy, LIS), then the manner in which the Extra Help funds may make a very large difference when deciding which Medicare Advantage (or Part D) plan is best for you.


Medicare Deadline Approaches: Special Notes

December 7 Approaches Quickly

The Annual Election Period runs between October 15 and December 7. During this period, you can change your Medicare Advantage or your stand-alone prescription plan. Further, you can change your mind, as many times, as you want, through the end of December 7. The last plan selected is the one that will be in effect on January 1, 2017.

Medicare Advantage Plans Evolve

Depending on the Medicare Advantage plan, you may be required to have a Primary Care Physician, whose referral is necessary in advance of seeing a specialist. Generally speaking, this is an HMO. For HMOs, it can be the case that you would be responsible for the entire cost if the healthcare provider is not part of the network. There is also a twist, called HMO-POS, where in some instances, you can receive healthcare services from providers that are outside the network.

There’s more. There has been an increasing number of HMO and HMO-POS plans that will allow you to visit a specialist, who is inside the network, without a referral. This may be called “Open Network” by your Medicare Advantage provider.  

As always the case, PPOs will allow you to receive healthcare services from providers outside the network, but you must keep in mind that your out-of-pocket expenses will very likely to be higher, when compared to using providers inside the network. In addition, it is usually the case that your health deductible will be much higher when you use providers outside the network.

Dental / Vision

Many Medicare Advantage plans have very basic dental and vision benefits embedded within the plan. However, these benefits are usually very light. For example, it is usually the case that major restorative dental services are not included.

Many (if not most) Medicare Advantage plans also include an enhanced dental/vision option. This year, there are additional restrictions, mandated by the CMS (Center for Medicare and Medicaid Services), that disallow the marketing of these enhanced features in advance of a person enrolling in a Medicare Advantage plan. However, if a consumer proactively asks, then the question can be answered.

Medicare Advantage and Observation Status

The newly-enacted “two midnight rule” should make the controversy that surrounds observation status and skilled nursing facility care less difficult to manage. To review, if you are a patient in a hospital for a period that crosses two midnights, then you are presumed to be admitted on an inpatient basis, in which case you are covered by Medicare Part A, and if you stay over 3 midnights, then that will allow you to receive skilled nursing care  (or home health care) for the first 20 days, without charge.

Unfortunately, that does not completely solve the issue. For example, you could be admitted to a Skilled Nursing Facility directly, without hospital admission. While not the most probable outcome, these types of circumstances can occur more than originally believed. The point? Certain Medicare Advantage plans eliminate the requirement for inpatient hospital stay altogether, and beneficiaries in those plans can receive skilled nursing facility care without fulfilling the 3-day inpatient hospital stay altogether.

The General Point

These are just a few simple examples of details embedded in Medicare Advantage plans. It is an admittedly incomplete list. However, the general point is that the details within the Medicare Advantage plans can offer features (or risks) that may mean that using the time, between now and December 7, to review the plans available to you, a worthwhile use of time.

Want to Change to Medigap?

I am an expert contributor (one of 5) to an excellent website, called MyMedicareAnswers.com, powered by Humana Inc, and here is the most recent article to that site.

If You Want to Change, Now is the TIme to Think
Let’s say that your personal situation has changed, or that you have decided that Medigap is a superior option. Or, let’s say that you want to switch Medigap carriers. While it may be entirely possible, there are some subtle points that require some thought and care. If this is you, then the Annual Election Period (AEP) is the most practical time to consider this, because you will be also be able to enroll in a standalone prescription drug plan, effective January 1, 2017.

Medigap Open Enrollment Lasts Until 65.5 Years Old

Let’s back up a moment. Carriers in your state have no choice, they must accept you. If you apply for Medigap before 65.5 years old, then you can access every Medigap plan available in your state (you must be enrolled in Medicare Part A and Part B). Carriers do have the right to charge more, if you use tobacco, or if your height/weight statistics allow. That said, your application will be accepted.

Special Enrollment Periods Exist

There are a set of conditions, under which you can enroll in Medigap, even if you are greater than 65.5 years old. You may be qualify for guaranteed acceptance under a Special Enrollment Period. The list can be found in Choosing a Medigap Policy, an official CMS publication. Please note that not every Medigap plan is included within the Special Enrollment Periods.

Certain States Have Additional Medigap Enrollment Periods

There are minimum standards that exist at the federal level, i.e. it is true in every state. Further, in certain states, the rules have been expanded, so that you may be able to enroll in Medigap, even if you are older than 65.5 years old, and even if CMS-defined Special Enrollment Periods do not apply to you.

Carriers May Have Different Standards
Let’s say that you do not qualify for any of the situations described in the earlier paragraphs, and that you wish to apply for Medigap. Here are a few things to keep in mind. First, the medical questions and the medical standards used by carriers can differ. We cannot control the questions that are asked. We cannot control the decisions that are made by the carrier. You should be aware that the different carriers can ask widely different questions. For example, some Medigap carriers have extensive questions about diabetes, and some will not.

Second, there is something called a “pre-existing condition waiting period,” which a carrier can imposed if a medical situation was diagnosed or treated for the 6-month period before your Medigap policy is effective. Importantly, this waiting period can be waived if you have had health insurance coverage in the time immediately prior to the your Medigap effective date.

Why Is This Important?

There are many reasons that the different questions matter. Perhaps the most significant reason is that some carriers will ask you if you have been denied by another Medigap carrier. While we cannot control the decision that an individual carrier makes, it is probably does not require a crystal ball to predict what would occur at the 2nd Medigap carrier, if it was aware that an application was already denied at the 1st Medigap carrier. In other words, if you have any risk of being denied, it may be advisable to seek outside assistance in selecting and applying for Medigap outside the Medigap Open Enrollment Period, and outside the Special Enrollment Periods.

Expect Higher Medicare Premiums in 2017

“Hold Harmless” Will Become News Again

To many, a new phrase entered Medicare beneficiaries’ vocabulary last year. That phrase is “hold harmless.” This single phrase had ripple effects last year, and it is very likely going to be the case again this year.


What Happened Last Year

When Social Security has zero COLA adjustments, the bottom line is that Medicare Part B premiums cannot increase for people who are currently Medicare beneficiaries and received Social Security benefits during November and December of the prior year. Last point is that the person cannot have exceeded the $85,000 ($170,000 married couple) income threshold. That is the threshold that exposes a Medicare beneficiary to higher Part B premium.

At the end of last year, it was announced that there would be no COLA adjustment for 2016. It took a last moment agreement in order to limit the increase the 2016 Medicare Part B premium for new beneficiaries. There were other modifications to Medicare, which will take effect in 2020 (Medigap plans C and F will no longer be available to new Medicare beneficiaries, existing beneficiaries will be able to keep their policies).

As a result of the “hold harmless” provision, that basically meant that the funding had to come from “somewhere,” which meant higher Part B premiums for new beneficiaries, and higher premiums for those that exceed the $85,000 ($170,000 household) threshold. It could have been more than $150 a month for these new beneficiaries. The Bipartisan Budget Act of 2015 limited the increase of Medicare Part B premiums to $121.80 a month. This was made possible due to the closing of certain unintended loopholes for married couples that collect Social Security benefits (“file and suspend” strategies).


IRMAA Increases

For those that earn more than $85,000 (modified adjusted gross income, as measured two years prior, and $170,000 for married couples, it is not only that IRMAA will continue to exist, but the amount, and the percentage increased, and will continue to increase. For those that are fully employed and choosing whether or not to enroll in employer-provided health insurance, this will add a layer of complexity to the decision-making process.  

COLA Increases Unlikely for 2017 Means That…

Economists that are keeping track of CPI, the statistic on which COLA is based, have noted that for 2017, it is very likely that COLA will not increase. The almost-inevitable result of this will be that the “hold harmless” provision will likely become a topic in the public view again, during a federal election season, and without further legislative action, further increases to the Part B for new Medicare beneficiaries, and those that are subject to IRMAA, is very likely.


Nothing from BCBS Michigan yet….

Tick, Tock…

It doesn’t change my thought process. I have very specific thoughts for those that are:

  • Turning 65 years old this year, OR have turned 65 after Feb 1, 2016
  • In good to excellent health and under the age of 70
  • Over 70
  • Has a poor health situation

If you have Legacy Plan C, the silence is deafening. I have placed the call to both the carrier and the regulator. If you fit one of the 4 groups very specifically, you can contact us for our individual thoughts. We cannot reveal these online because we are concerned that the meaning may be misunderstood or misconstrued by you, or the person that reads this. It’s our responsibility to avoid this, at all costs.

All BCBS has said is that “it will change, we are unaware of what those changes will be.” Nothing more than that. This is of little or no comfort to those left without the information required.



Get Your Turning 65 Flyer Here

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Federal Employee Health Benefit (FEHB): How-To

The Federal Employees Health Benefits Program (FEHB) is a comprehensive benefits program for both active employees and retirees. There are a lot of important details to keep in mind.

a. The Part B Late Enrollment Penalty is not waived if you decide to enroll in Medicare Part B in the future. That amount will be 10% for each 12-month period that you were eligible to enroll in Medicare Part B, but did not. The penalty never expires. This may be important because the facts provided here presume a level of income. You will need to consider whether this level of income is projected to remain stable in the future. This has additional complications, since IRMAA (which you have included in your calculations) is also projected to increase as a result of the two legislative actions enacted earlier this year, the “permanent doc fix,” and the Bipartisan Budget Act passed in late autumn.
b. FEHB plans will vary depending on the state of your residence. The implication is that the premium also varies widely, the network will also vary, and can change at any time. The information provided suggests that costs are minimized by staying with the FEHB program, but that is highly dependent on the fact that you would be subject to IRMAA. If you were not subject to IRMAA, and your Part B premium was the standard $121.80/month, then the conclusion that you could reach may be entirely different. Enrollment in Medicare Part B is possible, without a conflict with an FEHB platform.
c. Notably, enrollment in Medicare Part B and Medicare Advantage, along with FEHB, also poses no conflicts. That means that enrollees can receive benefits above and beyond those included in original Medicare, such as discounts on health clubs, weight loss programs, and limited dental/vision benefits. Certain Medicare Advantage plans have zero premium (but they will all require enrollment in Medicare Part A and Part B). Last point: you can change your mind if you cancelled FEHB benefits, enrolled in a publicly-available Medicare Advantage plan, and the wanted to re-enroll in the FEHB program.
Once you have considered all of the points stated here, you should also consider the premium being charged by the FEHB versus the plans available in the private market, such as Medigap or other Medicare Advantage plans. While the FEHB is undoubtedly a good program the question is “price,” and whether the competitive market provides a superior price with superior coverage.
It is very important to note that married couples are affected greatly here since you the premium for the annuitant (retiree) is lower than the premium charged to the spouse. That means that a separate selection may be best for the spouse of the annuitant because of lower cost, superior benefits, or both.
For example, Medicare Part B with a Medigap plan can be very close in premium to FEHB premiums, but without any network, and Medigap coinsurance/copayment levels will remain constant through time, at a time that it would be more likely that you would require medical attention. The flip side of this coin is that FEHB plans have no Part D “Coverage Gap,” otherwise known as the “donut hole,” which is scheduled to close in 2019.
For FEHB-eligible retirees (“annuitants”), then, the choices are complicated, and will vary greatly among these factors. In these instances, a highly-qualified, unbiased advisor may be a good idea in order to help “sort out” all of the moving parts.

Medicare 2016 Changes

My blog post as Expert Contributor to Humana-powered website, www.mymedicareanswers.com, is here.

Medicare 2016 Changes

There are some changes to Medicare that are forthcoming, above and beyond the changes announced in the headlines.

Please see an updated grid of original Medicare rates here.

Higher premiums

In 2016, the Part B premium will not increase for 70% of existing Medicare beneficiaries. Originally, an increase of greater than 50% was supposed to occur, but last-moment legislative action prevented this. Therefore, only new Medicare beneficiaries and high-income earners (subject to IRRMA) will face higher Part B premiums. Bottom line: existing Medicare beneficiaries that earn less than $85,000 ($170,000 for married couples) will face no increase in Part B premiums. New enrollees will not be as fortunate: $121.80 a month will be the monthly Part B premium.

Higher Deductible and Copays

In 2016, the Part A deductible will be $1288.00 per benefit period, from $1260.00 in 2015. The Skilled Nursing Facility coinsurance amount will be $161.00 per day, during days 21-100. The Part B deductible will be $166.00 for the year. It is important to note that the “hold harmless” provision that would’ve protected 70% of Medicare beneficiaries (when Social Security benefits do not increase) does NOT protect beneficiaries from Part A or Part B deductibles or copays.


For high-income earners, Medicare Part B and Medicare Part D adjustments will increase. The reality is that the increase is the result of two factors. First, the “permanent doc fix” enacted in April 2015 made an initial increase in the IRRMA. Second, the last-minute budget deal during November 2015 created a second increase. This means that while the second factor may decline, the first reason for an increase in IRMAA will remain intact. Further, you must remember that IRRMA is, in fact, a “rate,” not an “amount.” The “permanent doc fix” has legislated a higher rate, which implies that if Part B increases, then the IRRMA will increase by a higher rate, meaning that the IRMAA will also be higher.

Two-Midnight Rule

Retroactive to October 1, 2013, the much-discussed “two-midnight rule” will take effect. This means that if you are admitted to the hospital, and that hospital stay is expected to cross two midnights, then you will be presume to have inpatient hospital status. This is very important because it addresses many misunderstandings regarding Part A. First, inpatient hospital status means that Part A will be the coverage, and not Part B. Second, and related to the first point, Skilled Nursing Facility care can be covered by Part A, if your hospital stay lasts over three midnights.

It has been the case that Medicare beneficiaries have been unaware of their patient status in a hospital, and then have been transferred to a Skilled Nursing Care facility. If the patient was not admitted on an inpatient basis, then the Part A benefit under Skilled Nursing Facility care would not apply, but instead, would be covered by Part B (with 20% coinsurance, after covering the Part B deductible). Under the “two-midnight rule,” one important layer of this confusion should be resolved. It is important to note that the three-day criteria still remains in effect. A patient must be both admitted on an inpatient basis, and that hospital stay must cross three midnights, in order to be covered by Part A at a Skilled Nursing Care facility.

Don’t Do This: #Medicare Mistakes

This Happens.

Medicare beneficiary is currently using the most expensive PPO which is a version of a Medicare Advantage plan. In deciding what configuration will be in effect for 2016, it was pointed out to the person that less expensive options were available. The reason that this was pointed out to the prospect was because the medications she took were generic, the network would remain unaffected, and the resulting premium would be lower by more than $700 per year. Further, the dental, vision, and health club memberships would be identical
At the outset I tried to explain that the cost the existing configuration would be in fact greater then under a Medigap policy, even after a stand-alone prescription plan, Part D, was selected, and that Medigap would provide superior coverage if medical care was required, not to mention the fact that the terms and conditions of the coverage would remain the same over time, unlike Medicare Advantage, when the “fine print” was subject to change annually.

The reason the prospect decided to stay with a Medicare Advantage plan was due to the additional benefits that were included (even though these would remain the same under the less expensive option). This observation can be found widely among Medicare Advantage plans: the most expensive plan is usually not worth the extra premium cost, in the absence of some known anticipated medical costs in the future. That was the case in this instance.

So you would have thought that the applicant would change to the less expensive Medicare Advantage plan, saving $700 a year, and continuing to reap the benefits which were the dental vision and health club membership, OR switch to Medigap and stand-alone prescription coverage. Nope.
Instead, the rationale I was given was quite stunning. The reasoning was that since inpatient hospital admission would have been more expensive under the low lower premium plan (true), that the higher cost Medicare Advantage plan would remain in place.

This is a failure of logic on multiple levels. If it were the case the applicant was worried about the out of pocket cost of an inpatient hospital stay, then Medigap would have provided far superior cost-sharing details. If that was the dominant concern, then Medigap would be superior. If the “extra benefits” was the preimary goal, then the less-expensive PPO would be superior. Instead, by remaining with her existing configuration, let’s take a look at what is implied. The applicant has determined that she is worried about inpatient hospital stay yet still wants to keep the dental, vision, and health club memberships. In fact, the only way this works out is if she does go to the hospital exactly once. If the person is hospitalized for a serious medical situation, then the out of pocket cost will most likely be higher, the premium will be higher, and it is likely that future enrollment in Medigap would be rejected. If she was not hospitalized, then she has overpaid $700+ in premium, per year.

In other words, this person would require a crystal ball, and be hospitalized once (and only once, because multiple hospitalizations would result in much higher costs than Medigap), witha medical condition that did not prevent future Medigap acceptance, in order for her to have selected the most efficient option. If this is in fact the case, then she has a crystal ball, in which case she doesn’t have to worry about insurance at all. She could make more than enough money to cover any and all potential future costs, without limit.

Nevertheless, This Happens.


Medicare Open Enrollment Ends Soon

Halfway Point of the Annual Election Period

The Medicare Annual Election Period ends in 4 weeks on December 7th. Current Medicare beneficiaries have the unrestricted right to change Part D (stand-alone prescription drug) plans, and Medicare Advantage plans.

Observations from the Market

There are many reasons that one should review their benefits annually. The main one is that since Medicare Part D and Medicare Advantage plans are annual contracts, all terms and conditions are subject to change. That means premiums and cost-sharing can change. The approved drug lists, otherwise known as the formulary, can also change. In fact, it would be reasonable to conclude that the moving parts are likely to change. Let’s examine why.

First, Medicare itself can change the list of approved medications for a particular medical condition. Second, beneficiaries should be aware that the carriers are trying to balance the costs of their respective plan, and remain competitive in a very competitive world. This can be observed in the market, that certain plans have improved, on an overall cost basis, when compared to others. It isn’t all good news: the average number of plans have declined per region for 2016, when compared to 2015. Further, premiums have increased, from an average of $33.41 in 2015 to an average of $34.10 in 2016. This also means that the Late Enrollment Penalty for Part D has increased from .3341 to .3410 a month (which you multiply by months, and then round to the nearest $0.10).

Networks in Medicare Advantage Can Change

This can be both positive and negative. There are subtle changes among the many Medicare Advantage plans in the market. The “not subtle” changes centers on the providers in a network. While premiums have remained relatively steady, you may notice that providers that accept a particular Medicare Advantage plan in one year, may not the next year. Every January and throughout the first quarter, beneficiaries are frequently surprised when the provider that they have seen may not be included in a network in the following year. That will result in either a) higher out-of-pocket expenses if you have a PPO, or b) no coverage at all for certain HMO Medicare Advantage plans.

Assisted Living / Skilled Nursing Facilities Remain Tricky

If you live in an assisted living facility, but do not require skilled nursing facility care, then Medicare Advantage can be challenging to administer. In many cases, there are on-site, or on-call medical providers at the facility. The facility and the provider may separately be considered in or out of network. Trying to get the accurate information regarding the network “status” can be very frustrating for a Medicare beneficiary and his/her family members. Further, diagnostic tests may be conducted off-site, or an in-network doctor may be required to use a testing facility that is out-of-network. The handling of this can vary wildly from facility to facility. Given that these are all subject to change annually, a Medicare Advantage beneficiary may want to check as many of these as he/she can, in advance.

It’s Not Likely to Ease

Recent headlines regarding a potential Medicare premium increase for existing beneficiaries, as well as the last-minute measures to prevent this (in 2015) have highlighted one central fact: the demographic and fiscal challenges remain to both Social Security and Medicare, and beneficiaries will need to keep informed for the changes that result.


You can see all of Jae’s articles on MyMedicareAnswers.com, a consumer-oriented website, powered by Humana, Inc., the nation’s second largest carrier of Medicare plans.