2016 Medicare and You
We’re excited that 2015 marked the 50th anniversary of President Lyndon B. Johnson signing into law the Medicare program. Medicare has been protecting the health and well-being of American families and saving lives for five decades. Over the years, Medicare has grown and today provides quality health coverage for more than 50 million Americans. But we’re not stopping there. Every day, we’re working to make Medicare even stronger to offer you better care and to keep you healthy. Having Medicare provides peace of mind, but it’s also important that you’re getting the most out of your coverage. Use this handbook as a resource to help... read more
2016 Plan Directory
This directory contains information for Medicare Advantage, demonstration, PACE, and cost organizations that have an active contract with CMS at the time of the directory’s publication. These data have been extracted from the Health Plan Management System (HPMS), maintained by the Center for Drug and Health Plan Choice/Medicare Drug Benefit and C & D Data Group/Division of Plan Data (CPC/MDBG/DPD). This directory will be updated on a monthly basis. The plan directory contact data is maintained by each organization in HPMS. If an organization needs to update its contact data, the plan user should use the following navigation path in HPMS: HPMS Homepage > Contract Management > Contract Management > Select a Contract Number > Contact Data > Plan Directory Contact for Public Website. The enrollment number displayed in this directory has been pulled from the “Monthly Enrollment by Contract” file posted on the CMS public website. This enrollment number represents the number of enrollees for which the contract received payment for the month. As asterisk in place of the enrollment number indicates that the count is less than 10. Pilot contracts are excluded from this... read more
2016 Medicare Enrollment
All types of insurance are complicated to figure out, and Medicare is no less so. There are certain things that may be useful to know if you are thinking of applying for Medicare next year, or if you would like to make changes from an already existing plan. Medicare plans are often altered, with the costs, coverage, pharmacies and providers changing almost constantly. Therefore, this is the period where you can re-evaluate whether a particular plan is good for you or not. Open Enrollment Period From the 15th of October to the 7th of December the Medicare Open Enrollment Period will be running. It runs at the end of every year. During this time you can make changes to your Medicare plan, or, if you do not already have a plan, you can sign up for Medicare. Usually, information for next year’s plans is released in October, giving you time to decide whether you would prefer a switch or not. If you apply for Medicare in this period you will be covered from the first of January next year. During the Open Enrollment Period you can: Change your plan from an Original Medicare plan to a 2023 Advantage plans, or vice versa. Get drug coverage by signing up for a 2022 Part D plan. Get a new Part D plan if you are unhappy with the one you have now, or if circumstances have changed and you need to make adjustments in your plan. Definitions of Key Terms Original Medicare: Original Medicare is a health insurance program funded and managed by the federal government. If you are eligible and you get Medicare... read more
Medicare Advantage (Part C) Plans
About 6 to 12 months before most Americans turn 65, they are bombarded with junk mail offers for different Medicare-related insurance products such as Medicare supplements, Part D prescription drug plans, Medicare Advantage plans, annuities, and life insurance policies. It is no wonder that most consumers that are Medicare eligible are confused about the choices. It almost seems like some companies want you to feel that way. In this article, we will explain in layman’s terms exactly what a Medicare Advantage plan is, how it works, what they usually cost, and then, you can decide for yourself if they are right for you. What is the difference between a Medicare Supplement and Medicare Advantage Plan? • A Medicare supplemental insurance policy is a standalone health insurance policy that is purchased by seniors to cover some of the costs not picked up by traditional Medicare, the most significant cost being the 20% of Part B expenses not covered by Medicare. Also referred to as a Medigap policy, one of the most popular benefits is that you can use this kind of policy with any Medicare provider. You do not have to worry about networks or unexpected out-of-pocket costs. If you need prescription drug coverage, you would need to pick up a separate Part D drug plan, since Medigap policies do not cover outpatient prescription drugs. • A Medicare advantage plan also referred to as Part C, is a health plan that includes outpatient prescription drug coverage, also called Part D. Advantage plans have special times during the year when you can sign up called “Enrollment Periods.” If you fail to... read more
Humana Walmart RX Plans
Humana and Walmart teamed up back in 2010 to offer one of the most price competitive drug plans in the history of the Part-D drug program, and they have been going strong ever since. One of the reasons why their partnership is so successful is using a Walmart or Sam’s Club pharmacy to fill your prescriptions will get you the lowest cost possible for your prescription drugs versus going to any other pharmacy. Another reason for the success of the program is the four dollar generic prescription drug program that they have been pioneering for the last several years. Last but certainly not least, the cost of the drug plan is so low that pretty much any senior looking for a drug card can afford it, especially if they are only taking generic or low-cost brand drugs. For 2015, the premium for the Humana Walmart RX plan is only $15.60 per month, with a co-pay as low as one dollar after the deductible is met if you fill your prescription at Walmart-branded pharmacies. What’s amazing is that some drugs can come at absolutely no cost to the consumer if they use mail order, after the deductible is met. The plan covers over 1,500 generic prescription drugs, which happens to be quite more than some of their competitors. The deductible this year for this drug card is $320, and this is for all tiers of drugs. It includes your tier 1 cheap generic medications as... read moreSeniors Cope With Drug Plan ‘Donut Hole’
Michigan seniors have been hit with the full cost of brand name drugs, thanks to new legislation. Effective this year, the law eliminated Medicare’s Part D prescription drug plans offering coverage during the gap period, dubbed the “donut hole.” People such as Janet Clapper, 72, of Battle Creek are finding out some of their brand-name drugs covered in 2006 are not covered this year. She said she reached the gap period around March or April and has had to dip into her savings for the about $700 a month cost of her multiple prescriptions. “I saved my money because I knew I’d need it when I got old, but now the government’s taken it all,” she said. Seniors eligible for Medicare in 2006 selected from a list of competitive Part D plans offered by private insurance companies to cover the cost of prescriptions. The sign-up period generally is Nov. 15 to Dec. 31 for coverage without penalty beginning the following year. But many seniors were shocked last year to discover coverage stopped when the total cost reached $2,251. Most seniors taking expensive, brand-name drugs ended up paying thousands of dollars out-of-pocket for prescriptions mid-year. The donut-hole coverage gap lasted until the total cost hit $5,100; then emergency coverage kicked in, bringing the cost down to just a few dollars for each drug. Some plans in 2006 offered coverage during the donut hole for a higher premium cost. This year, that’s not even an option. “Regardless of anything, I would have had to pay full price for all them drugs,” Clapper said. “That was the new law.” In Michigan, there... read more
AARP Medicare Advantage Complete Plan
As someone who is reviewing Medicare plan options either for yourself or for a loved one, I can almost a guarantee that you have heard of the AARP brand before, if you are not already deeply familiar with the organization. AARP is a consumer organization whose goal is to help seniors of every walk of life. They are not actually an insurance company. If you are interested in health insurance, the AARP branded medical insurance plans are actually underwritten by Aetna insurance company. In the case of Medicare supplements and/or Medicare advantage policies, they are underwritten by United HealthCare insurance company. The AARP Medicare complete plan is a type of Medicare advantage policy, and not a Medicare supplement. Medicare advantage also goes by the name of Part C, which is a combination of traditional Medicare benefits and a private insurance policy merged together to provide an all-in-one plan for seniors. Depending on where you live, this Medicare advantage policy might be branded as Secure Horizons instead of AARP, something you should be aware of in case you think they are totally different companies. This happens to be a very popular Medicare advantage plans option for seniors this year because the premiums are starting at zero dollars. Even if this policy does not charge you a monthly plan premium, you’re still responsible for paying your Part B premium to traditional Medicare. A number of other factors are making this a very successful plan for this enrollment period. First of all, there is no medical plan deductible that needs to be satisfied before services are covered. Secondly, you can use in and... read more
10 Highest Rated Medicare Advantage Plans For 2014
The providers listed below offer consistently high rated Medicare Advantage plans. CMS developed these 2014 Medicare Advantage Ratings in advance of the annual enrollment period. Each of the evaluated plans are rated and then scored on a 5 star scale. These plans receive a high performing score as a result of there performance on the Overall Part C measures. There was no change in the number of Medicare Advantage plans receiving five star rating in 2014. Plans ranking in the four or higher categories have increased from 26% in 2013 to 35% in 2014 The CMS main focus on evaluating each of these plans is based on five domains: Outcome: measures focus on improvements to a beneficiary’s health as a result of the care that is provided. Intermediate outcomes: Intermediate outcome help move patients closer to the “outcome” as defined above. Controlling Blood Pressure is an example of an intermediate outcome where the outcome would be better health status for beneficiaries with hypertension. Patient experience: Patient experience measures represent beneficiaries’ perspectives about the care they have received. Access: Access measures reflect issues that may create barriers to receiving needed care. Plan Makes Timely Decisions about Appeals is an example of an access measure. Process: Process measures the method by which health care is provided. Provider Name Plan Name State Rating Kaiser Permanente Kaiser Permanente Advantage Inland Empire California Group Health Cooperative Group Health Coop Clear Care Basic Washington Gundersen Health Plan, Inc. Gundersen Senior Preferred WI,IA Cigna-HealthSpring Cigna-Courage Advantage (HMO) Florida Providence Health Plans Providence Medicare OR, WA Medical Associates Health Plan Medical Associates Basic Plan (Cost) Iowa Dean... read more
2014 Medicare Plan Changes for Open Enrollment on Oct.15.
Medicare recipients who want to enroll or change their Medicare health care and Part-D coverage for 2014 will be able to this week from Oct. 15 to Dec. 7. Beginning the 15th seniors can now change any type of Medicare coverage you choose but changes don’t take effect Jan. 1. But now is the best time to review your needs. Reviewing your options earlier rather than later will provide you a better position if you need to make changes. If you are already enrolled your plan will provide you information about plan changes each fall for the new year. You should review your needs and compare next year’s plan for a possible change in your monthly deductibles, premiums and co-payments. Medicare Supplement providers can also change your prescription drugs coverage by changing tiers or dropped medications from the list of drugs ( formulary). Seniors should check that your plan will continue to offer equivalent medication coverage on your medications and will continue to work with your pharmacy. If you are displeased with your plan or upcoming changes, you can make changes to your coverage during this open enrollment. If you are pleased with your current Medicare plan, consider looking at other or new Medicare choices in your area that may exceed your individual needs for the new year. Questions to Ask. Have you changed the medications you take? Are your medications still covered on your current plan in 2014? Have you been diagnosed with a new medical diseases or conditions? Has your health care provider situation has changed? Are your plan premiums, co-pays or deductibles increasing? Have you moved... read more