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The Connecticut Consumer’s Guide to 2010 Medicare Advantage

Open enrollment season for Medicare Advantage plans began Thursday, November 15.  Over the next few weeks, health insurance companies will be communicating with seniors about their 2010 Medicare Advantage plan offerings.  Whether you’re just turning 65 or you already have a Medicare plan, understanding the different options and choosing the right plan can be a daunting task.

Medicare is divided into three main categories – Original Medicare, which is managed by the federal government, and Medicare Advantage and Medicare supplement – or Medigap – plans, which are offered through private health insurance companies.

Original Medicare is composed of three sub-categories – Part A, which covers hospital expenses, Part B which covers doctors’ expenses, outpatient care and some other medical services not covered under Part A, and Part D, which covers prescription drugs.  Costs vary for each of these.  While Part A is usually provided with no monthly premium, Part B premiums are usually about $100 per month, except for higher-income individuals and Part D premiums range from $40-100 per month based on the drug plan you choose. There is a 20% coinsurance for Original Medicare and the current Part B deductible is $135. It is unclear whether or not this will increase for 2010.

In addition to enrolling in traditional Medicare, seniors may also choose to add benefits through Medicare Advantage or Medicare supplement plans.  Since Original Medicare has deductibles and coinsurance, seniors may purchase a supplement plan to pay a portion or all of those out-of-pocket costs. Alternatively, they may opt to enroll in a Medicare Advantage plan – choosing between HMO, POS and PPO plan types.  Typically Medicare Advantage plans offer more extensive benefits than Original Medicare, including annual physical exams and routine hearing and vision exams, at additional low monthly premiums, although they usually require physician and hospital copayments.  Medicare Advantage plans typically include a Part D drug plan.

Is Medicare Advantage the Best Option for You…?

Choosing Between an HMO or PPO/POS Plan

HMO, POS and PPO plans differ primarily by cost and network, so it pays to invest time in deciding what you want and what you can pay when making your final decision.  While HMOs may have the lowest monthly premiums, plan members may only be able to access care from their carriers’ network, except in the case of emergency care.  And, while some Medicare HMO plans may have no monthly plan premium and include a Part D drug plan, it may have significant hospital and surgery copays.  Often, the most popular Medicare Advantage HMO plans cost between $100-150 in monthly premiums and have no or low inpatient hospital copays.

For seniors who do not want to be restricted by a limited HMO network, such as those individuals who travel a lot, a Medicare PPO or POS plan might be a good alternative (PPO and POS plans are equivalent). While these plans often offer the same overall benefits as HMOs, higher monthly plan premiums and greater cost-sharing for out-of-network services allow greater flexibility in accessing health care. Seniors insured under a PPO/POS plan are not restricted by a network.

While there are private fee for service – or PFFS – plans available in 2009, they are not covered here as they tend to more expensive than other Medicare Advantage plans and are being phased out after 2010.

What’s Different from 2009

Seniors living in Connecticut will be able to choose from many Medicare Advantage plans, including 23 from the major carriers.  With Anthem’s reentry into the Connecticut market this year, competition will certainly be tough, particularly in Fairfield, Hartford and New Haven counties, where most major carriers have a significant number of plan choices.

Both Health Net and ConnectiCare will be offering four HMO plans and two PPO/POS plans to residents in all Connecticut counties.  Aetna is offering three HMO plans and two PPO/POSs for seniors living in Fairfield, Hartford, Litchfield and New Haven counties.  Anthem is offering four HMOs for Fairfield, Hartford and New Haven counties, while United Healthcare is offering one PPO to residents in all Connecticut counties and an HMO only in New Haven County.

In 2009, ConnectiCare had one of the most popular HMO plans in Connecticut, prompting many Health Net HMO members to switch carriers last year.  Smaller premium and low or no out-of-pocket increases for Health Net’s 2010 HMOs make these plans quite competitive this year. However, it is worth noting that both the ConnectiCare and Health Net HMO networks do not extend outside of Connecticut for its Medicare Advantage members.

For residents in Fairfield, Hartford and New Haven counties, Anthem and Aetna also have highly competitive plan options. Aetna’s plans are also available in Litchfield County and its Medicare Advantage members can access Aetna’s network nationwide.

For seniors interested in a PPO/POS plan, Health Net introduced a new plan, which features a low monthly premium and comparable copays to other PPO/POS plans offered in the state. ConnectiCare remains a strong choice, with its competitively priced POS plans. With moderately low physician and hospital copays, the Aetna’s PPO plan and ConnectiCare’s POS plan also may be good options.

Eligibility for Financial Assistance

State Assistance Programs

If you cannot afford Medicare premiums, you may qualify for state assistance. Depending on what state you reside in, you could have one or more options. In Connecticut, seniors who qualify have the option of enrolling in ConnPACE, a program designed to help seniors in paying for prescription medications.

ConnPACE is a state funded prescription drug assistance program for Connecticut’s senior citizens and people with disabilities. ConnPACE covers most prescriptions, insulin, and insulin syringes. Out of pocket expenses for ConnPACE are a $30 annual application fee and a $16.25 copay for each prescription medication.

You are eligible for ConnPACE if you have been a Connecticut resident for at least 6 months, you are 65 years or older or a disabled person over the age of 18, you are not receiving Medicaid benefits, you do not have an insurance plan paying for all or some of each prescription on a continuous basis and you have an adjusted gross income of less than $25,100 for a single person and $33,800 for married people.

Or You May Consider a Medicare Supplement Plan?

Medicare supplement options may certainly be described as an alphabet soup of coverage, ranging from Plan A to Plan J.  Like Medicare Advantage, Medicare supplement plans are sold by private insurers but these plans are primarily designed to help individuals fill payment gaps.

While these plans typically have higher monthly premiums, Medicare supplement plans pay your share of the costs of Medicare-covered services thus eliminating or reducing out-of-pocket payments, including co-insurance, deductibles and Part A and B premiums.  These are separate from Medicare Advantage, employer- or union-sponsored group coverage, Veterans Administration benefits or TRICARE for military personnel and their families, so come with no value-added benefits.  Enrollees would have to purchase a stand-alone Part D drug plan, as none are offered as part of these plans.

While many smaller insurers offer Medicare supplement plans in Connecticut, two plan options from major insurance carriers are worth considering based on their monthly premiums – UnitedHealthcare/AARP Plan J ($184/month) and United of Omaha Plan F ($190/month).  Enrollees would have to purchase a stand-alone Part D drug plan, as they are not offered as part of supplement plans.

In 2010, there will be a few changes to Medicare supplement. Two new plans, M and N, are going to be added. It is believed that these plans will have lower premiums and involve more cost-sharing. They should be introduced by June 2010.

How Should I Decide?

With so many options available to seniors in Connecticut, it may be difficult to identify the one plan that is best for you.  Earlier, we discussed price, which in the case of Medicare supplement plans, should guide your decision since benefits are identical.  While some states do allow for different pricing based on age and gender, Connecticut does not.

For Medicare Advantage Plans, the quality and breadth of the physician and hospital networks, as well as value-added benefits, should also be taken into consideration.  Are you sure your physician is in your plan’s network?  Does your physician admit to hospitals that also are in the carrier’s network?  For example, if your physician only admits to Norwalk Hospital in Fairfield County, it may be worth noting that only one health plan has Norwalk Hospital in its Medicare Advantage network.  The size and quality of an insurer’s network is not critical for individuals purchasing Medicare supplement plans because there are no networks tied to these plans.

In addition to ensuring that your prescription medication is covered under a Part D or Medicare Advantage plan, you need to know what tier your health insurer has placed your drugs in, as different pricing tiers will impact your out-of-pocket costs.

Important Dates

  • November 15 – Open enrollment season begins
  • December 31 – Open enrollment season ends
  • January 1 – Changes made during open enrollment period take effect
  • January 2 to March 31 – If you are not satisfied with your Medicare Advantage Plan, you may still switch plans up until this date. You can only make one change after December 31 and you may not add or drop Medicare Part D.

Professionals Here to Help

For more information or to answer questions regarding specific plans, in addition to any concerns regarding Part D drug coverage, please visit www.medicaresolutions.com or www.healthplanone.com or call 1-877-270-0612.

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