New Affordable Care Act rules shed light on high health insurance rate hikes

New proposed Affordable Care Act regulations announced today by the U.S. Department of Health and Human Services (HHS) will bring new transparency and scrutiny to proposed health insurance rate increases. These proposed rules allow HHS to work with states to require insurers to publicly disclose and justify unreasonable rate increases.

“Year after year, insurance company profits soar, while Americans pay more for less health care coverage,” said Secretary Sebelius. “The Affordable Care Act is bringing unprecedented transparency and oversight to insurance premiums to help reign in the kind of excessive and unreasonable rate increases that have made insurance unaffordable for so many families.”

Health insurance premiums have risen rapidly over the past decade, straining pocketbooks for American families and businesses. Since 1999, average premiums for family coverage have risen 131 percent.

The Affordable Care Act has already begun to help states strengthen or create rate review processes. On August 16, HHS awarded $46 million to 45 states and the District of Columbia to help them improve their oversight of proposed health insurance rate increases. This is part of $250 million that the health reform law makes available to states to take action against insurers seeking unreasonable rate hikes.

Today’s proposed regulations will build on these efforts by requiring insurers in all states to publicly justify any unreasonable rate increases beginning in 2011. In 2011, proposed rate increases of 10 percent or higher will be publicly disclosed and thoroughly reviewed to determine if the rate increase is unreasonable. After 2011, state-specific thresholds would be set using data and trends that better reflect cost trends particular to each state. Insurance company’s justifications for unreasonable increases will be posted on HealthCare.gov and the insurance plan’s website.

“The proposed rate review policy will empower consumers, promote competition, encourage insurers to do more to control health care costs and discourage insurers from charging premiums which are unjustified,” said Jay Angoff, director of HHS’ Office of Consumer Information and Insurance Oversight.

Under the proposed regulation, states with effective rate review systems would conduct the reviews. If a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them. Meanwhile, HHS will continue to make resources available to states to strengthen their rate review processes.

In 2014, the Affordable Care Act empowers states to exclude health plans that show a pattern of excessive or unjustified premium increases from the new health insurance exchanges.

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60 Participants in Fulton County Retirement Plan Take Advantage of MassMutual's LifeBridge(SM) Free Life Insurance Program

/PRNewswire/ -- As part of MassMutual's LifeBridge(SM) Free Life Insurance Program, 11,500 individuals across the country have received $575 million in free life insurance, including employees of Fulton County, Georgia. To date, the program has provided 60 participants in the Fulton County Defined Contribution 401(a) Plan each with a $50,000 free term life insurance policy, totaling $3 million in free coverage from MassMutual.

Under the program, MassMutual pays all insurance premiums for a $50,000 10-year term life insurance policy. If an insured parent or legal guardian dies during the term of the policy, $50,000 will be put in trust to pay the educational expenses of his or her children. The program is available to all parents between the ages of 19 and 42 who meet the criteria of the program. Individuals need not participate in a retirement plan administered by MassMutual or be a client of MassMutual's to apply.

"MassMutual offers this great program, not just to its retirement plan clients, but to any working parent in the country who qualifies. Our MassMutual retirement plan relationship manager made us aware of this program and we're thrilled that so many of our employees have been able to take advantage of it," says Tammy Goebeler, Investment Officer of Fulton County. "As a parent, you want the best education possible for your children. This program can give a parent peace of mind in the event that something unexpected happens. Our hope is that other working parents in our community will explore the LifeBridge Program and take advantage of this great program as well," says Goebeler.

"We're pleased that so many Fulton County employees were able to take advantage of this great program," says Elaine Sarsynski, executive vice president of MassMutual's Retirement Services Division and chairman and CEO of MassMutual International LLC. "By offering group meetings for its employees, Fulton County has helped raise awareness of this valuable free life insurance program among its retirement plan participants. We encourage every MassMutual retirement plan sponsor to inform their employees about the availability of the LifeBridge program," she adds.

MassMutual also offers a convenient onsite application event for large groups. For more information about the LifeBridge Free Life Insurance Program, please call (800) 272-2216 or visit www.massmutual.com/lifebridge. Existing MassMutual Retirement Services clients interested in learning more about the program can also request information from their MassMutual relationship manager.

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State-Run Property Insurers Lose Customers but Gain Risk

/PRNewswire/ -- Florida and Louisiana have reduced the number of high-risk policyholders covered by their state-run property insurers of last resort since 2008 while still leaving non-coastal property owners vulnerable to paying for these same insurers' potential coastal losses, according to the Insurance Information Institute's (I.I.I.) recently updated Residual Market Property Plans: From Markets of Last Resort to Markets of First Choice.

Florida Citizens Property Insurance Corporation, the largest property insurer of last resort in the U.S., provides insurance to residential and commercial property owners unable to purchase coverage in the standard market. Yet Florida Citizens saw the number of its total policies in force drop to 1.2 million at year-end 2009, down 14 percent from 1.4 million at year-end 2008. Meanwhile, Louisiana Citizens Property Insurance Corporation, the fourth largest state-run property insurer of last resort in the U.S. in terms of total policies in force behind Texas and Massachusetts, has seen an even more dramatic reduction in its total policy count. Louisiana Citizens had about 165,000 policies in force in June 2008, a figure that dropped to 127,000 policies as of June 2010, a reduction of around 40 percent.

"However, this year's report by the Insurance Information Institute, like the reports of the last two years, records the ongoing growth in the exposure base of the residual market property insurers along with the still-precarious financial condition of some plans. This growth comes despite a collapse in the housing sector that has brought development in many catastrophe-prone areas to a near standstill," write the report's co-authors, Dr. Robert Hartwig, president of the I.I.I. and an economist, and Claire Wilkinson, vice president of Global Issues at the I.I.I.

The I.I.I. estimates that, even as the number of policyholders in Florida, Louisiana and the 32 other Fair Access to Insurance Requirements (FAIR) Plans for which data are available dropped to 2.47 million from 2.62 million between 2008 and 2009, their cumulative exposure to loss grew to $614.9 billion in 2009 from $612.7 billion in 2008. The nation's FAIR plans account for by far the majority of policies and exposure in the U.S. overall residual property market. But when the FAIR Plan exposures are added to those incurred by Beach and Windstorm Plans, such as those in place in states such as Alabama and Mississippi, the U.S. residual market exposure to loss grows to $703 billion (2009) from $696 billion, according to the Property Insurance Plans Service Office (PIPSO).

"As long as [these] plans continue to grow, state finances will remain under threat and ultimately taxpayers, many of whom live nowhere near the coast, will continue to face the prospect of increased assessments in the years ahead," Dr. Hartwig and Ms. Wilkinson state.

Since state property insurers of last resort often charge premium rates that do not reflect the risk they are incurring on the policyholder's behalf, the claims paying capacity of FAIR, Beach or Windstorm Plans is relatively limited, and often exhausted quickly in the event of a severe storm. Should this occur, a number of capital-raising options are available to state-run property insurers. The two main options—levying assessments on all policyholders and issuing bonds that must be paid back by all state taxpayers—often result in higher costs for all of the state's policyholders, no matter where they live, as these costs are passed along in the form of premium surcharges or higher taxes. Every homeowners insurer doing business in a particular state is generally a member of a state-run residual market program, just as auto insurers join forces to spread the risks involved in covering problematic drivers through assigned risk programs.

"Increasingly plans are being bailed out by a diversion of tax revenues," the I.I.I. report states, pointing to the fact that in 2008, after Hurricane Ike struck the Texas coastline, $230 million of the $430 million in assessments incurred by the Texas Windstorm Insurance Association's (TWIA) member insurers were subject to premium tax credits. TWIA is the state's insurer of last resort for wind and hail coverage in 14 coastal Texas counties and parts of Harris County.

The report also notes that Mississippi enacted legislation in 2007 to allow a one-time diversion of $80 million in federal and state funds to the Mississippi Windstorm Underwriting Association (MWUA), one of the state's two residual market plans, to boost the MWUA's reserves for windstorm damage claims and protect MWUA policyholders against rate increases.

The I.I.I. report also offers a detailed analysis of the residual market plans in North Carolina and South Carolina, as well as the states cited previously, a list which includes Florida, Louisiana, Massachusetts, Texas, Alabama and Mississippi. Policymakers and other interested parties seeking an update on the pending federal pieces of legislation on the issue of natural catastrophe risk should consult the I.I.I. report's Appendix, which can be found on the final two pages of the 51-page document.

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New Affordable Care Act rules give consumers better value for insurance premiums

New regulations issued November 22 by the Department of Health and Human Services (HHS) require health insurers to spend 80 to 85 percent of consumers’ premiums on direct care for patients and efforts to improve care quality. This regulation, known as the “medical loss ratio” provision of the Affordable Care Act, will make the insurance marketplace more transparent and make it easier for consumers to purchase plans that provide better value for their money.

“Thanks to the Affordable Care Act, millions of Americans will get better value for their health insurance premium dollar,” said HHS Secretary Kathleen Sebelius. “These new rules are an important step to hold insurance companies accountable and increase value for consumers.”

Today, many insurance companies spend a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead, and marketing. Thanks to the Affordable Care Act, consumers will receive more value for their premium dollar because insurance companies will be required to spend 80 to 85 percent of premium dollars on medical care and health care quality improvement, rather than on administrative costs, starting in 2011. If they don’t, the insurance companies will be required to provide a rebate to their customers starting in 2012.

In 2011, the new rules will protect up to 74.8 million insured Americans and estimates indicate that up to 9 million Americans could be eligible for rebates starting in 2012 worth up to $1.4 billion. Average rebates per person could total $164 in the individual market. Important details regarding the new regulation are included below.

The medical loss ratio regulation outlines disclosure and reporting requirements, how insurance companies will calculate their medical loss ratio and provide rebates, and how adjustments could be made to the medical loss ratio standard to guard against market destabilization.

Beginning in 2011, the law requires that insurance companies publicly report how they spend premium dollars, providing meaningful information to consumers. Also beginning in 2011, insurers are required to spend at least 80 percent of the premium dollars they collect on medical care and quality improvement activities. Insurance companies that are not meeting the medical loss ratio standard will be required to provide rebates to their consumers. Insurers will be required to make the first round of rebates to consumers in 2012.

“These rules were carefully developed through a transparent and fair process with significant input from the public, the States, and other key stakeholders,” said Jay Angoff, director of the Office of Consumer Information and Insurance Oversight at HHS. “As we build a bridge to 2014, when better, more affordable options are available to consumers, these rules will help make health insurance fairer for consumers now.”

The Affordable Care Act required the National Association of Insurance Commissioners (NAIC) to develop uniform definitions and methodologies for calculating insurance companies’ medical loss ratios. Insurance commissioners in every State have a responsibility to protect the interests of the general public, policyholders, and enrollees within their respective States. Today’s regulation certifies and adopts the recommendations submitted to the Secretary of HHS on October 27, 2010 by the NAIC. It also incorporates recommendations from a letter sent to the Secretary by the NAIC on October 13, 2010.

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Misleading Postcards Are Not From Medicare

The Department of Human Services urges older adults to be on the alert for misleading post cards titled “Important: Projected Medicare Changes.” The cards are sent on behalf of insurance salespeople and are not endorsed by Medicare.

“Private insurance companies request signatures, ages, and other details on these post cards and then use the information to make sales calls and visits to people’s homes,” said Dr. James J. Bulot, Director of the Georgia Department of Human Services (DHS) Division of Aging Services. “If consumers have questions about Medicare changes, they should contact the GeorgiaCares network.”

The GeorgiaCares State Health Insurance Assistance Program (SHIP) offers individuals free, one-on-one help provided by trained local counselors. The program is managed statewide by the DHS Division of Aging Services and Georgia’s 12 Area Agencies on Aging. To contact GeorgiaCares, call 1-800-669-8387 toll-free or visit www.MyGeorgiaCares.org.

Callers may request personalized information about Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, the resolution of billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.

The GeorgiaCares team is ready to answer questions now about open enrollment for Medicare Part C (prescription drug coverage) and Part D (Medicare Advantage plans). Enrollment began November 15th, and recipients will have until December 31, 2010, to make their choices. After this period, beneficiaries may make limited changes during the annual Disenrollment Period of January 1 - February 14th of each year. Beneficiaries who do not want to make a change can remain in their plan from 2010.

GeorgiaCares SHIP counselors will answer hotline calls from individuals and provide community education sessions for any group throughout the state to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.

GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.

For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).
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Many Important Health Insurance Choices Must Be Made Now in Georgia

PRNewswire/ -- For employees who work for companies that offer health insurance benefits through late November/early December, this is usually the time when important health plan decisions must be made for the upcoming year - 2011. Interestingly, studies show consumers typically spend more time researching car and computer purchases than they do when selecting a health insurance plan. These studies also indicate that most people spend an hour or less reviewing their insurance plan options and often default to the plan they had the previous year.

With health care reform changes in the mix, the comprehensive long-term impact is still uncertain. Nevertheless, employees must make educated and well-thought-out decisions for their 2011 benefits now, using the information that is currently available to them. Equally important, employers must do everything they can to provide their employees with the information necessary to make an informed decision. And, since open enrollment season is upon us, this is the best time to share tips to help employees navigate through the choices they must make.

Many of Georgia's companies offer more than one health insurance plan option, which typically have different costs to the employees, both in the amount deducted from their paychecks and the total cost of the coverage for deductibles, co-pays and co-insurance during the course of the year. In addition, many employers are offering base coverage plans and then offer a 'buy up' plan option where employees can purchase additional coverage not covered by the employer.

"It's a mistake not to review your health plan options each year and carefully weigh which plan will be the best fit for you and your family," said Morgan Kendrick, President, Blue Cross and Blue Shield of Georgia (BCBSGa) who noted that often consumers choose the plan that has the least impact on their paycheck when that option may not be the best choice overall.

Plans with higher monthly premiums and lower co-pays and deductibles might be best for those who anticipate using a lot of health care services throughout the course of the year. On the other hand, young and healthy employees without kids might save more with a plan that features low premiums and a high deductible.

We encourage employers to provide their employees with the tools and resources needed to help them make informed decisions about their health care coverage. Below are a few things employers can do to make this process easier:

1. Encourage Healthy Behaviors. Research shows that approximately 85 percent of ill health comes from poor health choices. Therefore, open enrollment provides a great opportunity for the promotion of health and wellness programs and incentives, including smoking cessation or weight management courses, gym subsidies, etc. Not only will this help contain company costs long-term, it also helps employees feel and perform better.
2. Hold open enrollment meetings. If possible, make them mandatory, but make them fun and interactive. Bring in an account manager from your insurance carrier or have an onsite benefits manager/HR representative explain the various health care options and answer questions on-the-spot.
3. Avoid acronyms when communicating with employees. Use simple terms and definitions, and communicate early and often. An Institute of Medicine report showed that nearly half of all U.S. adults have difficulty understanding healthcare benefits information. As a result, the materials go unread and plan selections are made haphazardly.
4. Help Familiarize Employees with Consumer-Driven Health Plans (CDHPs). CDHPs continue to gain popularity because they help employers and employees control health care costs. CDHPs provide you with health account options to help you pay for the costs of health care such as Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs). Companies that are the most successful in introducing and migrating to CDHPs take time to explain these plans to employees up front, which usually results in higher adoption rates.


Here are some items employees should keep in mind when choosing a health insurance plan:

1. Do your homework and take advantage of the tools offered to you. If your company holds open enrollment meetings, attend at least one and be prepared with questions. Take the information home and review the details in a more relaxed environment. Make sure to follow up with your company benefits advisor if you have additional questions – that's what the benefits advisor is there for.
2. Understand and learn what basic health insurance terms mean. Use online tools provided by your current health plan or other tools such as www.wikipedia.org as a reference. For example, make sure you can answer the following:
-What is the difference between co-payment and co-insurance?
-What does deductible mean and how could it impact your out-of-pocket costs?
-What does it mean to seek "out-of-network" services?
3. Examine your family's past health care spending. An excellent way to determine a good plan fit for 2010 is to understand what health care services your family used in 2010 and take into consideration what expenses may occur in the coming year—like having a child or if you will have to deal with a chronic health condition like diabetes.
4. Before continuing on your current plan, read the details. What you signed up for last year may have changed. Have the co-pays and deductibles increased? Often employers will adjust these levels as a result of the increasing cost of health care services. Pay attention to the details in order to avoid surprises down the line.
5. Verify in advance that your physician and hospital are part of the network for the plan you are choosing. This is especially important if the insurance company is changing or if you are switching to a different health plan.
6. Take advantage of your HSA, HRA or Flexible Spending Account (FSA) if appropriate. Make sure you understand the difference between an HSA, HIA, HRA and an FSA, as well as any changes in access to these funds, for example, FSA accounts have new prescription requirements surrounding over-the-counter medications.


"In the past, consumers may have quickly looked over their benefit options and made a selection without seriously considering the comprehensive financial impact it could have on them and their family," said Kendrick. "But this year, with the additional economic pressures consumers are facing and new health care reform mandates, it makes sense to really study all plan options in order to make the best choice to meet their needs."

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Good News for National Diabetes Month: People with Type 1 Diabetes Have Better Life Insurance, Long Term Care Insurance Options

(BUSINESS WIRE)--During National Diabetes Month, there is good news about insurance options for people living with type 1 diabetes. “Many people who in the past have been declined life insurance and long-term care insurance (LTC) solely on the basis of their type 1 diabetes diagnosis are now seeing some of the barriers come down,” said Danny Mensh, president of Mensh Insurance “Under certain circumstances, several major carriers are now willing to underwrite and issue both long-term care insurance and term life insurance policies.”

In the past, insurance carriers did not know how to price the risk on life insurance and long-term care insurance for people with type 1 diabetes and automatically declined their applications. However, within the last 24 to 36 months, the insurance industry has become more lenient on this chronic condition. “Due to improved medications, advancements in the manner in which they are distributed and more precise blood sugar level monitoring, underwriters are increasingly more comfortable with the longer life prospects and health maintenance of those with stable histories of type 1 diabetes,” Mensh said.

Some of the basic underwriting criteria for issuing policies to a person with type 1 diabetes include:

* Controlled A1c < 8
* < 60 units of insulin
* Controlled height and weight
* Average fasting blood sugar < 200
* Blood pressure, 140/90
* No transient ischemic attacks (TIAs) within past five years
* No smoking within last two years
* No cardiac complications or retinopathy associated with eye impairments
* No chronic steroid usage

“Many people with type 1 diabetes are very stable and can easily demonstrate via medical records that they should qualify for approval from major insurance carriers,” Mensh said. “It has been exciting to open up the options for future financial planning to people with this chronic condition.”

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Open Enrollment for 2011 Medicare prescription drug and health plans begins Nov. 15th

The Centers for Medicare & Medicaid Services (CMS) is encouraging all Medicare beneficiaries to take advantage of the annual Open Enrollment period to make sure they have the best coverage available to meet their health care needs in 2011.

The Medicare Open Enrollment Period this year begins on November 15th and runs through December 31st. During the Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meet their needs.

"The Affordable Care Act will make Medicare stronger and more sustainable. There will be new benefits available to nearly every person with Medicare starting in January 2011, including free annual wellness visits and free recommended preventive services like mammograms and colonoscopies. Seniors who fall into the donut hole in 2011 will be eligible for a 50 percent discount on brand-name prescription drugs. These new benefits make this year's Medicare Open Enrollment Period especially important," said HHS Secretary Kathleen Sebelius. "Every year, the Medicare Open Enrollment Period gives Medicare beneficiaries a chance to evaluate their current plans and see what other options might be out there that serve their needs, especially if their health status has changed. Those enrolled in Medicare can think of the Open Enrollment Period as a yearly coverage "check-up." It is important for people with Medicare to look closely at their plan, look at the options available to them, consider their health status, and find what works for them."

"There's never been a better time for Medicare beneficiaries to check out their Medicare coverage," said CMS Administrator Donald Berwick, M.D. "With better plan choices available for 2011, Medicare beneficiaries can think of Open Enrollment as their yearly coverage 'check-up'."

"During Open Enrollment, AoA's national network of community-based organizations will work with seniors, individuals with disabilities and their caregivers across the country to help them understand the new benefits available under the Affordable Care

Act," said Kathy Greenlee, Assistant Secretary for Aging. "In addition, we urge seniors to protect themselves from potential fraud and identity theft. We know there are people who use this time to scam seniors and rip off Medicare. Seniors should protect their Medicare number the same way they do their Social Security number or credit cards."


Resources for Medicare Beneficiaries
People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new plan offerings, using many proven resources, including:

. Visiting www.medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder and Medicare Options Compare tools have been enhanced for an efficient review of plan choices. Multilingual Open Enrollment information and counseling is available.

. Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048.

. Reviewing the 2011 Medicare &You handbook. It is also accessible at www.medicare gov and has been mailed to the homes of people with Medicare benefits.

. Getting one-on-one counseling assistance from the local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:
o At http://www.medicare.gov/contacts/organization-search-criteria.aspx or
o On the back of the 2011 Medicare &You handbook or;
o By calling Medicare at 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048)
o Through a listing of national stand-alone prescription drug plans and state specific fact sheets can be found at: http://www.cms.hhs.gov/center/openenrollment.asp

Medicare beneficiaries who cannot meet the costs of prescription drugs may be eligible for additional resources. Based on eligibility for "extra help," some people Medicare will pay no more than $2.50 for each generic drug and no more than $6.30 for each name brand drug. The program, called Medicare's Limited Income Newly Eligible Transition (NET) Program, can also help pay for premiums and other out-of-pocket costs.

There is no cost to apply for this extra help. Medicare beneficiaries, family members, trusted counselors or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.

Protecting Against Fraud and Identity Theft

The new health care law also provides better tools to help fight waste, fraud and abuse to help protect Medicare. CMS offers tips to help beneficiaries protect themselves against fraud and identity theft during the Open Enrollment period. Medicare recommends thatpeople treat their Medicare number as they do their social security number and credit card information.

Beneficiaries should not give personal information to anyone arriving to their home uninvited or making unsolicited phone calls selling Medicare-related products or services. Beneficiaries who believe they are a victim of fraud or identity theft should contact 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048). More information is available at www.stopmedicarefraud.gov.

More information is available at www.healthcare.gov, a new web portal from the U.S. Department of Health and Human Services.

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Humana to Offer Savings and Broad Choice with 2011 Medicare Plans

(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) will offer a wide variety of Medicare Advantage (MA) and Prescription Drug Plans (PDP) to people with Medicare in 2011, including the new Humana Walmart-Preferred Rx Plan (PDP) that offers the nation’s lowest monthly premium in all 50 states and Washington, D.C.

Humana will offer people with Medicare choices that include MA plans with more benefits than Original Medicare, an affordable monthly premium, an extensive list of doctors in many areas, and predictable costs that are easy to budget.

The Annual Election Period when Medicare beneficiaries will select their Medicare coverage for 2011 runs from Nov. 15 through Dec. 31, 2010. In recent years, people with Medicare were allowed to change plans during the first three months of the year. Beginning in 2011, the January-to-March enrollment period has been eliminated.

“At a time when people are still coping with the impact of our challenging economy, especially senior citizens and disabled people living on a fixed income, it is critical to have medical and prescription-drug coverage that’s affordable,” said Tom Liston, senior vice president, senior products, and the leader of Humana’s Medicare organization. “Humana continues to offer a variety of choices across the country enabling Medicare beneficiaries to select a plan that meets their needs while receiving comprehensive benefits and value people have come to expect from Humana.”

Medicare Advantage Plans

Humana’s MA plans can help people get more out of their health care dollar. Most Humana MA plans:

* Offer additional benefits beyond Original Medicare
* Have copayments offering predictable costs that are easy to budget no matter which health care services are used
* Come with worldwide coverage for emergency care

With drug coverage, health-and-wellness offerings and disease-management programs also available with MA coverage, Humana MA plans remain an excellent value in 2011. Plans, benefits and premiums vary by state and county. Plans include local and regional PPO plans, as well as HMO and Private Fee-For-Service plans. Humana is committed to informing its members of the various benefits and savings options that are available to them for 2011. All Humana MA plans have annual out-of-pocket maximums in 2011, protecting beneficiaries against catastrophic costs.

Benefits with most Humana MA plans include:

* Care coordination and disease-management programs
* Affordable deductibles
* Affordable copayments
* 24-hour nurse hotline
* SmartSummary Rx benefits statement (available to both MA and PDP members)
* No-cost preventive services
* No-cost diabetic-monitoring supplies, including test strips, lancets and glucometers

Well-Being Benefits for Members

Humana is dedicated to supporting its Medicare members on their lifelong pursuit of well-being. As evidence of this commitment, most Humana MA members enjoy access to programs that encourage healthy behaviors such as gym memberships through SilverSneakers or Silver & Fit, and the WellDine Food Program, which delivers meals following a hospitalization. Over the long-term, these programs aid members in achieving a greater quality of life.

Prescription Drug Plans

In all 50 states, Washington, D.C. and Puerto Rico, Humana offers stand-alone PDPs, meaning they’re separate from Medicare medical coverage. Stand-alone PDPs enable people with Medicare to add drug coverage to their Original Medicare coverage.

New this year is the Humana Walmart-Preferred Rx Plan, which features a monthly premium of just $14.80, making it the lowest-premium plan available in all 50 states and Washington D.C. Copayments start at just $2 for preferred generic prescriptions filled at any Walmart, Sam’s Club or Neighborhood Market pharmacy. Copayments of $0 are available for many generic drugs filled via Humana’s home-delivery (mail-order) pharmacy, RightSource. Humana and Walmart estimate that the new co-branded plan will save members an average of more than $450 a year.

People with Medicare who prefer first-dollar coverage (no annual deductible) for preferred generics and a broader network of pharmacies should consider Humana’s Enhanced PDP Plan. With more than 62,000 pharmacies in Humana’s national pharmacy network, and $0 copayments for many generic drugs when using mail-order, this plan typically appeals to people who want that additional coverage.

Also New in 2011

In addition to the new Humana Walmart-Preferred Rx Plan (PDP), Humana is offering new MA plan options in multiple markets across the U.S. Here’s an overview of the various plan options Humana is offering for 2011:

* HMO plans in 27 states and Puerto Rico
* Local PPO plans in 39 states and Puerto Rico
* Regional PPO plans in 23 states (in 14 Medicare Advantage regions)
* Full−network Private Fee-for-Service (PFFS) plans in 34 states. All services are available in and out of network, taking full advantage of any Humana contracted discounts when the member uses in-network providers.
* Partial-network PFFS plans (networked for ancillary services only) in 28 states
* Non-network PFFS plans in 2 states
* PDP offerings approved for 2011 are statewide in 50 states, the District of Columbia and Puerto Rico and include the new nationwide PDP co-branded with Walmart.

For more information about Humana’s 2010 Medicare offerings, visit www.humana-medicare.com or call toll free 1-800-611-1481. TTY users call 1-877-833-4486.

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New report shows Affordable Care Act savings of $3,500 for Medicare beneficiaries

A new analysis issued today (November 4) by the U.S. Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher - as much as $12,300 over the next 10 years - for seniors and people with disabilities who have high prescription drug costs.

"The Affordable Care Act makes Medicare stronger and reduces the burden of health care costs on some of our most vulnerable citizens," said Secretary Kathleen Sebelius. "The law improves benefits for seniors and people with beneficiaries who rely on Medicare and ensures that Medicare will be there for current and future generations by extending the life of the Medicare Trust Fund. These benefits and savings are only possible with the continued implementation of the Affordable Care Act."

The analysis, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), shows that the Affordable Care Act helps lower costs for those on Medicare by slowing the growth of cost-sharing in Medicare. Closing the Part D coverage gap known as the "donut hole" will produce the greatest cost savings. Already, more than 1.8 million seniors and people with disabilities who have reached the donut hole in 2010 received a one-time $250 rebate check, and checks will continue to be distributed to those who enter the donut hole this year. Next year, people in the donut hole will receive 50 percent discounts on covered brand name Part D prescription drugs. Also starting next year, seniors and people with disabilities on Medicare will have access to a number of recommended preventive services and annual wellness visits at no additional cost.

Although all seniors and people with disabilities in Medicare are likely to see savings, the savings will be greatest for those with costly medical conditions or high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary with spending in the donut hole, estimated savings increase from $553 in 2011 to $2,217 in 2020.

"The savings that seniors and people with disabilities on Medicare are seeing are due to critical improvements the Affordable Care Act makes to Medicare," said Assistant Secretary for Planning and Evaluation, Sherry Glied. "Reducing waste, fraud and abuse, improving the quality of care beneficiaries receive, and making the program more efficient all contribute to lower cost increases across the system."

The full analysis is available at http://www.healthcare.gov/center/reports/affordablecareact.html.

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What Now, for Health Reform?

/PRNewswire/ -- The following is released by Lockton:

Human resource and benefits managers--and perhaps a lot of CEOs and CFOs--who in recent weeks had begun thinking seriously about the impact of federal health reform on their profitability, workforce structure and health plan viability, may have awoken Nov. 3 asking, "What now?"

What now, indeed. As Republican candidates in federal, state and local races swept into office in historic numbers, promising a change in the course of government, attention has centered on the impact of the election results and on the future of the federal health reform law.

The answer is: Don't expect much in the way of change. At least not yet.

Repeal is Not an Option...For Now

There was a never a chance that Republican mid-term victories, under the most optimistic of projections, would or could unravel the health reform law. Even had Republicans managed to capture control of the Senate in addition to their reclamation of the House, the health reform law was in no danger of repeal. Any attempt by Congress to do that would be vetoed by President Obama, and the Republicans lack the 67 Senate votes necessary to override a Presidential veto. Any serious attempt at repeal must await the results of the 2012 elections. Repeal will require the complete reversal of 2008: Republican control of the White House and both chambers of Congress.

If the GOP cannot now outright behead the law, can they strangle it by denying it funding? To be sure, the funding issue is the law's weak underbelly. The law requires federal funding of more than 100 key components of the bill, most notably grants to states to establish insurance exchanges by 2014, and of course the $500 billion necessary to provide subsidies toward individuals' purchases of insurance in the exchanges. Federal taxpayers are also picking up, for the first several years, all or nearly all of the additional Medicaid expenses associated with the expansion of Medicaid eligibility.

Risky Business

But holding up the federal budget - threatening the shutdown of the government - is risky business. Many voters are weary of partisanship and are looking for Congress to make something good happen. Republicans must remember that according to a number of exit polls, voters identified the economy as their main concern, by a wide margin (about 62% of voters picked the economy as their primary issue; only 18% cited the health reform law). The American electorate wants results.

The new makeup of the Congress doesn't bode well in that regard. Among the many Democrats swept out of the House are a significant number of self-styled moderates, known as "Blue Dogs." This purging of Democratic moderates means we'll now have in the Congress, particularly on the Democratic side of the aisle, a caucus whose center of gravity is a fair bit farther left than before. Throw in a Republican majority infused with new blood drawn from the mid- to far-right, and you have all the makings of political gridlock.

What's in Store?

So what will happen, then? Our best guess, for the short term, is that Republicans in the House will pass a symbolic bill repealing the health reform law, a bill that will go nowhere in the Senate. Again, here the Republicans must be prudent. Voters, particularly those in the all-important political center, are likely to have little tolerance for symbolic gestures while the nation's economy festers. For the same reason, if Republicans allow themselves to become bogged down over fringe issues, they will have misread the lessons of the election results.

Some nibbling around the soft edges of the health reform bill is likely. The business community is rightly aghast at the new Form 1099 reporting requirement appended to the law. The requirement compels businesses to issue a Form 1099 to every vendor - from copy repairmen to bartenders - to whom the company pays $600 or more during a year. House Republicans will move swiftly to repeal that provision, and will likely attract enough Senate Democrats - spooked by the election bloodletting - to get it done.

There is talk of attempting to do even more, perhaps repealing the "Individual Mandate" (the provision that compels nearly all Americans to have minimum health coverage by 2014 or face a modest penalty) or the "Free Rider Surcharge"(the penalty employers will pay beginning in 2014 if they fail to offer affordable coverage to full-time employees who instead obtain subsidized coverage in the insurance exchanges).

Such actions, like the health reform bill itself, may have unintended consequences. The health reform law requires insurers to issue policies to all applicants, without pre-existing condition restrictions. That works only if the nation gets everyone in the risk pool. Otherwise, people will simply wait to buy insurance until they get sick. Removing the individual mandate without relieving carriers of the obligation to issue a policy to all applicants, without restrictions, makes it even more difficult for private insurance companies to survive.

Business has many reasons to oppose the Free Rider Surcharge. But if the insurance exchange concept survives until 2014, and employers find then that their employees have another, taxpayer-subsidized option for health coverage available, and no surcharge binding the employers to their existing group health plans, a great many more employers may simply terminate their group coverage. That will improve employers' bottom lines (although many employees will fare worse in the exchanges), but not the nation's.

The Congressional Budget Office, when estimating the first decade's cost of the bill at $1 trillion, assumed only about 4-5 million Americans (net) who have group insurance today will lose it by 2019, as a result of the health reform law. A recent study suggests that the cost of federal subsidies in the insurance exchanges rises about $300 billion for every additional six million Americans who seek exchange-based coverage. If the 4-5 million estimate balloons to 40-50 million, the first decade's cost of the program leaps to $2.5 - $3 trillion, a number that is simply not sustainable.

Stay the Course

So we shall see. Experienced political pundits say that prognostications based on mid-term election results are almost always wrong. In other words, we should not read too much into the results, although there is still much to make of them. Our advice to employers who are beginning to assess the impact of health reform and chart a course to address the issues it poses, is to "stay the course." There is still much to do, and health reform isn't going anywhere, at least not for a while.

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Our Nation's Veterans Have Options for Health Care Coverage

/PRNewswire/ -- As the nation pauses to honor its veterans on Nov. 11 for their patriotism, love of country, and willingness to serve and sacrifice for the common good, Blue Cross and Blue Shield of Georgia (BCBSGA) wants our veterans to be taken care of, especially when it comes to their health. Those who have served their country through the United States military have several options surrounding their health care coverage.

Qualifying veterans receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. "Many veterans don't know about their Medicare rights," said Krista Bowers, president of senior business at BCBSGA's parent company. "Most have earned access to the Medicare system, just as they've earned their VA benefits. They shouldn't lose the opportunity, especially since some of these benefits may be offered at an affordable or no cost."

"VA and Medicare offer different, yet valuable, benefits to veterans," stated Morgan Kendrick, President of BCBSGA.

Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services as long as they stay within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department of Veterans Affairs website, there are more than eight million people covered by the VA Health Care System.

Medicare has four parts – A, B, C and D. Part A covers inpatient services, including hospital, skilled nursing facility, home health and hospice care. Part B covers outpatient medical services, such as doctor visits, preventive care and durable medical equipment. Part C, also known as Medicare Advantage (MA), combines Parts A and B into one plan that is run by a private insurance company, like Blue Cross and Blue Shield of Georgia, rather than the government. These plans may also include Part D, which is drug coverage.

Most people, including veterans, don't pay a premium for Part A. In most cases, these costs have been covered by payroll taxes. In contrast, Part B generally requires a monthly payment. Some companies offer Medicare Advantage plans (Part C) that cover everything included in Parts A and B, and more, including preventative services, at no additional cost. These are known as "zero premium plans." Some of these plans could also include dental, vision and hearing coverage. Other plans provide the same services, but require a monthly premium.

Enrollment processes and eligibility differ for VA and Medicare. Veterans can choose to participate in one program or the other or both. Enrollment in a Medicare plan does not affect an individual's VA eligibility.

On its website the VA recommends veterans not decline Medicare based solely on their VA coverage. The VA says there is no guarantee funds will continue to be appropriated for medical care for all enrollment priority groups. This could leave some veterans, especially those enrolled in one of the lower priority groups, with no access to care. For this reason, having a secondary source of coverage, like Medicare, may be in a veteran's best interest, the VA says.

Additionally, people who decline Medicare Part B when they are first eligible to receive it face substantial financial penalties if they decide to enroll later. The initial enrollment period typically occurs in the three months before the person's 65th birthday, their birthday month and the three subsequent months. There is no similar penalty for veterans who delay Part D enrollment because the VA's drug coverage is deemed equal to or better than Medicare.

Other benefits of Medicare for veterans include having access to doctors, hospitals and pharmacies outside the VA network and potentially having a larger list of covered drugs. Wider access could be important in case of an emergency or if a veteran needs a second opinion or specialized care.

There are additional benefits to having a Medicare Advantage plan. These advantages vary by insurer, but may include some or all of the following:

* Limits to total out-of-pocket costs
* Fitness programs, such as free gym memberships
* Preventive dental and vision care
* Programs that help people with chronic diseases, such as diabetes and asthma.
* Discounts on non-covered health-related products
* Chiropractic and podiatry services


It's important to remember that Medicare cannot generally pay for the same service paid for by the Department of Veterans Affairs (VA). Similarly, the VA generally cannot pay for the same service paid for by Medicare

"Obviously, this can get very complicated," said Kendrick. "There are many things for veterans to consider when selecting health care, including premiums, copayments and access. At Blue Cross and Blue Shield of Georgia we provide health benefits to many veterans and are happy to answer their questions to help them understand their options. After all, they deserve the absolute best health care coverage they can get."

For more information about veterans and Medicare, visit the Department of Veterans Affairs Web site at http://www4.va.gov/healtheligibility/ and click on " Medicare Information for Veterans ."

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Open Enrollment Goes Virtual: Blue Cross and Blue Shield of Georgia Launches Virtual Open Enrollment Center, Allowing Companies to More Easily Engage Employees

/PRNewswire/ -- For medium and large organizations, providing employees with complete, comprehensive and consistent information during open enrollment can be challenging. To help businesses reach and engage their employees more easily, Blue Cross and Blue Shield of Georgia (BCBSGA) has launched a Virtual Open Enrollment center, an easy to use, easy to understand interactive 3-D environment, which can be found at: http://tinyurl.com/23hkhqg.

"The virtual enrollment center is another way that Blue Cross and Blue Shield of Georgia is delivering the best value to our customers and the members we serve," said Morgan Kendrick, President, BCBSGA. "Many businesses tell us they want to improve their systems to more effectively and efficiently communicate important benefit information to their employees. The BCBSGA virtual open enrollment center, designed with input from businesses, was created to meet this need. Ultimately, we believe this will help individuals make the best benefit choices to fit their unique circumstances."

With the virtual enrollment center, employees can access benefits information at their convenience in a single intuitive and interactive location. Upon entering the site, a user will see a 3-D design with their company's logo and a video spokesperson delivering personalized messages. The center has scrolling marquees providing up to date messaging. The user can easily find enrollment information through simple key word searches. In addition, the virtual enrollment center has a content library, housing enrollment materials, documents that can be downloaded, and web links to additional information such as health plan details, provider lists, prescription information and other available health programs.

This is also a valuable resource for human resource departments as they can easily maintain and publish content. The virtual enrollment center gives them the ability to efficiently reach all employees, increase visibility within the organization, track the number of visitors and monitor the usage.

"BCBSGA's virtual open enrollment center has been a great resource for our business and our employees," said Hazel Davis, manager, health and welfare plans for Albemarle Corporation. "We began using this new system last week and already our employee engagement has increased, and the employee feedback has been overwhelmingly positive. Our employees are able to access the center at their convenience, helping them to more effectively select the best benefits for themselves and their families. We have been looking for a way to increase employee engagement and Blue Cross and Blue Shield of Georgia's virtual open enrollment center has been a perfect solution."

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HHS announces nearly 700 additional employers and unions to receive help providing health coverage to early retirees and their families

Nearly 3,600 employers and unions approved to participate in the Affordable Care Act's Early Retiree Reinsurance Program to date; applications still being accepted

The U.S. Department of Health and Human Services (HHS) today released a list of additional employers and unions accepted into the Affordable Care Act's Early Retiree Reinsurance Program. Nearly 700 additional large and small businesses, state and local governments, educational institutions, non-profit organizations, and unions have been accepted into the program, which reimburses employers for a portion of the cost of health benefits for early retirees' and their families. Today's announcement brings the total number of organizations participating in the program to nearly 3,600.

"By helping employers and unions continue to offer coverage for early retirees, we're helping them compete -- while providing a measure of certainty and security for their former workers at a time when it could not be more important," said Secretary Kathleen Sebelius. "The Early Retiree Reinsurance Program seeks to shore up the financial foothold for employers and unions who want to provide coverage to their retirees."

Created by the Affordable Care Act as another bridge to the new health insurance exchanges in 2014, the Early Retiree Reinsurance Program provides $5 billion in financial assistance to employers and unions, to help them maintain coverage for early retirees ages 55 and older who are not yet eligible for Medicare. Businesses and other employers and unions that are accepted into the program will receive reimbursement for a portion of the costs of health benefits for their early retirees and their spouses, surviving spouses, and dependents. Savings may be used to reduce employer or union health care costs, provide premium or out-of-pocket relief to workers, retirees, and their families, or both. The program ends on January 1, 2014, when the state-based health insurance exchanges will be up and running.

HHS' Office of Consumer Information and Insurance Oversight has approved nearly 3,600 employer and union plans, representing a broad range of employers and unions from all 50 states and the District of Columbia, for participation in the Early Retiree Reinsurance Program, with more applications being reviewed every day. HHS has set up a website, www.ERRP.gov, where sponsors can begin submitting information today to qualify early retirees, spouses, surviving spouses, and dependents for claims reimbursements.

Employers and unions interested in the Early Retiree Reinsurance Program should visit www.ERRP.gov or call 1-877-574-3777 or 877-574-ERRP. Employers and unions can find the application form and application instructions, as well as other relevant guidance and regulations from HHS, online.

More information about the Early Retiree Reinsurance Program, a full alphabetical list of participants, and an interactive map displaying participants by state is available online. This list is updated regularly. To find this information, please visit:
http://www.healthcare.gov/news/factsheets/early_retiree_reinsurance_program.html.

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Medicare Open Enrollment Starts November 15th

The GeorgiaCares State Health Insurance Assistance Program (SHIP) is helping Medicare recipients make informed decisions about which prescription drug and Advantage plan options are best for them. Beginning on October 15, consumers can compare available plans by visiting www.Medicare.gov. They may also call GeorgiaCares toll-free at 1-800-669-8387 for personalized assistance.

Open enrollment for Medicare Part C and D begins November 15, and recipients will have until December 31, 2010, to make their choices. With so many options available, choosing the right one is important. This is the first year that there will be one election period for both Part C and D plans. After this time, plan changes can be made during the annual Disenrollment Period of January 1 - February 15th of each year. During the Disenrollment Period, beneficiaries will only be allowed to leave a Medicare Part C plan and return to Original Medicare (Parts A and B) with the option of choosing a prescription drug plan.

“The GeorgiaCares SHIP network provides one-on-one assistance, so that callers can get personalized help as they compare their options and decide on which plans best meet their needs,” said Dr. James J. Bulot, director of the DHS Division of Aging Services.

GeorgiaCares SHIP counselors are available through the statewide network of Area Agencies on Aging and will provide community education sessions and answer hotline calls to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.

GeorgiaCares SHIP and the Centers for Medicare and Medicaid Services (CMS) advise people who wish to make a change to do so as close as possible to the November 15 opening date to ensure their coverage will be available on January 1, 2011. Companies began marketing their plans on October 1.

GeorgiaCares SHIP services are free and also assist Medicare beneficiaries on Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, resolution to billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.

GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who do not want to make a change can remain in their plan from 2010.

Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.

For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).

Oxendine: Choose Carefully During Open Enrollment

Insurance Commissioner John W. Oxendine urges consumers who are part of a group health plan to be prepared to make the right choices during health insurance open enrollment.

“It's the time of year when many companies across the country hold open enrollment periods for their group health insurance plans,” Oxendine said. “Consider the options carefully to be sure you and your family are properly covered.”

Open enrollment refers to the period of time during which all members of your group health insurance plan have the opportunity to enroll in certain benefit programs. During this period, insurance carriers are required to accept all applicants of the group without underwriting or evidence of insurability. Open enrollment is generally only held once a year, so if you miss it, you likely will not be able to enroll in your employer-sponsored health insurance program until next year. Certain exceptions apply for new employees or employees with life-changing events.

Make sure to check with your human resources department to see when your company’s open enrollment period begins and ends, and when your policy goes into effect.

There are many different types of major medical plans typically offered by employers. For help understanding the fundamental differences between preferred provider organizations (PPO), health maintenance organizations (HMO), point of service plans (POS) or indemnity plans, visit our website at www.oci.ga.gov/publicInformation/healthInsuranceFAQ.aspx.

Before making a choice:
Check to see if your current physicians and area hospitals are in the plan’s network. Using network providers generally will save money on your health care.
Check to see if spouses or dependents are covered. Some plans will cover spouses and other dependents, while other plans will not.
Read all of the plan materials thoroughly. Doing so will tell you what your rights and responsibilities are under each plan.
Review any pre-existing condition exclusions and prior authorization requirements in the plan materials.
If you take prescription medications, check them against the list of approved drugs in each plan booklet.
If any part of a plan is unclear to you, ask for help from your human resources department or the insurance carrier.

If you are not satisfied with the answers to your questions, contact Oxendine’s Consumer Services Division for help and advice at 1-800-656-2298.

In this uncertain market, it’s important to carefully evaluate your healthcare costs when making your annual enrollment decisions. While one option might have high monthly premiums and a low deductible, and another might have a low premium but more out-of-pocket expenses, it could be misleading which plan is best for you until you do the figures.

To pick the best coverage, first calculate your healthcare costs from recent years and try to estimate what your costs might be for the coming year. Don’t forget to include the cost of doctor’s visits, daily medications and any procedures you might be planning.

Next, make a list of the premiums, out-of-pocket expenses and benefits under each plan. Co-payments, deductibles and additional charges for wellness care or specialists (e.g. chiropractic care, cosmetic surgery, etc.) are examples of out-of-pocket expenses that you are responsible to pay. Remember, if you use a medical provider that is out-of-network, you will generally pay more out-of-pocket expenses. Include these fees in your calculations.

Finally, decide how much you can afford to pay. Other things to keep in mind:
Check for any annual limits and prior authorization requirements.
Some prescription medications have higher co-payments than others and they might vary from plan to plan. Mail-order options might be available for maintenance drugs at a lower cost to you.
If your dependents have health insurance coverage through their employer, school or the Veteran’s Administration, compare their costs and benefits to the family plans you are considering to ensure that you choose the best plan for every member of your family. Make the same type of comparisons for any dental or vision care plans that you are offered.

Once enrolled in a health plan, you will not be able to make changes until the next open enrollment period, unless there is a life changing event such as divorce, a job change, marriage or the birth or adoption of a baby.

If you do not receive insurance cards and/or enrollment information, contact your HR administrator, or call the insurance company.

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How health care reform affects your Medicare enrollment

(ARA) - Health care legislation passed earlier this year may make Medicare annual enrollment season particularly challenging for the millions of baby boomers aging into Medicare and for seniors already enrolled who are considering different coverage for 2011. Annual enrollment runs from Nov. 15 to Dec. 31, allowing people to select their Medicare coverage for 2011.

"Choosing a Medicare plan can be overwhelming in any year," says Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor, a Medicare plan selection service for people with disabilities and those 65 and older. "However, this year there are not only the usual changes, such as premium and coverage changes, you also need to understand how the Patient Protection and Affordable Care Act may affect your 2011 Medicare coverage."

According to Muralidharan, the most important ways the new health care legislation will affect Medicare beneficiaries for 2011 include:

* Prescription drug costs should be lower in the "doughnut hole." For 2011, Medicare beneficiaries will receive a 50 percent discount for the cost of brand-name prescription drugs and a 7 percent discount for generic drugs they are taking while in the prescription drug doughnut hole.

* Medicare Part B (medical insurance) will fully cover preventive care. Beginning in 2011, Medicare beneficiaries will no longer have to pay deductibles or co-pays for preventive services that fall under U.S. Preventive Service Task Force guidelines, such as an annual wellness exam.

* More beneficiaries may have higher costs for Medicare Part B and Part D (prescription drug) coverage. The Part B income threshold freezes at the 2010 levels through 2019. As a result, individuals with modified adjusted gross income (income) exceeding $85,000 and married couples with income exceeding $170,000 will have to pay higher premiums. Because this will not adjust with inflation, it's likely more people over time will be subject to higher premiums. In addition, the law reduces the Medicare Part D premium subsidy for individuals with incomes above these levels.

* Opportunities to change coverage after the annual enrollment period will be more limited. Historically, an open enrollment period ran from Jan. 1 through March 31, immediately after annual enrollment ended. During open enrollment, people were able to switch from their existing Medicare plans to similar Medicare coverage, choosing from "like to like" options.

Now, open enrollment has been replaced with a shorter annual disenrollment period, which runs from Jan. 1 through Feb. 14. During this period, the only change that can be made is to disenroll from a Medicare Advantage plan in order to enroll in traditional Medicare and join a Medicare Part D plan. Other selections will not be available to consumers.

"It's easy to get confused over the various Medicare enrollment periods," Muralidharan says. "However, it's now more important than ever to look at annual enrollment as your main opportunity to choose your coverage."

Reasons to review your medicare coverage

Changes brought on by health care reform are just one reason people should evaluate their Medicare coverage. Each year, individuals with Medicare should consider different health care coverage if they experience any of the following:

* Your health situation has changed in the past year.

* Your provider situation has changed (for example, you hospital or physician left your plan).

* Your coverage has changed (for example, certain drugs, procedures or conditions are no longer covered).

* Your plan premiums and/or co-payments have increased.

* You have moved to a new location.

* Your current plan no longer will be available.

Additionally, people now turning 65 and becoming Medicare-eligible for the first time should carefully review their options - and make certain they follow the enrollment guidelines. Failing to do so can trigger costly penalties and may mean certain coverage is unavailable in the future.

"The choices you make about your Medicare coverage can have a significant effect on your health care and your finances," says Muralidharan. "If you are uncertain about which Medicare plans are available to you, or which would best meet your needs, seek help before enrolling." More information on Medicare plan selection assistance is available at Medicare.Allsup.com or (888) 271-1173.


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Care Improvement Plus Releases 2011 Medicare Health Plan Benefits for Georgia

/PRNewswire/ -- Care Improvement Plus, operator of the largest special needs plan in Georgia, is standing by its commitment to serve chronically ill and underserved Medicare beneficiaries with the release of its 2011 Medicare health plan benefits in preparation for the upcoming Medicare annual election period, which begins November 15th.

"At a time when there is concern over unpredictable change in healthcare, Care Improvement Plus remains committed to our members and the underserved Medicare beneficiaries of Georgia," said Frederick C. Dunlap, chairman and chief executive officer of XLHealth, which owns and operates Care Improvement Plus. "For 2011, we are continuing to build upon our innovative model of care, providing specialized services that go well beyond what Original Medicare and most Medicare Advantage plans offer -- improving quality of care and controlling healthcare costs."

The details of Care Improvement Plus' 2011 Medicare health plan benefits include stable plan premiums with $0 options, and the continuation of valuable additional benefits and services, such as:

* Vision, dental, transportation, and Over-The-Counter benefits
* Care management program including nurse coaching and a 24-7 nurse hotline
* Free annual in-home health assessments with a licensed practitioner
* Personalized counseling sessions with plan pharmacists
* Assistance with accessing social support services
* An open access provider network with no referral required for Medicare-covered services
* $0 copays for important preventive care services


Beneficiaries with chronic conditions such as diabetes and heart failure complex healthcare needs requiring a patient-centered focus, making Care Improvement Plus an important option for more than 1,218,887 eligible Georgians to consider.

"During a time when some Medicare Advantage companies are either discontinuing or reducing their coverage, we will continue to serve Georgia Medicare beneficiaries with stability in cost and benefits," continues Dunlap.

Care Improvement Plus will open enrollment on November 15, 2010 for services effective January 1, 2011. Those interested in learning more about Care Improvement Plus may call 1-800-711-1656, or visit www.careimprovementplus.com for more information.

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Affordable Care Act gives consumers new tools, makes health insurance market more transparent

The U.S. Department of Health and Human Services (HHS) today announced that new information and tools have been added to HHS' consumer website www.healthcare.gov that will make the health insurance market more transparent, increase competition and help lower costs for individuals.

For the first time ever, price estimates for private insurance policies are available, allowing consumers to easily compare health insurance plans - putting consumers, not their insurance companies, in charge by providing one-stop shopping and taking the guesswork and confusion out of buying insurance.

To help consumers make more informed choices, the site includes new information including two notable metrics never before made public:
* Insurance providers are required to provide the percentage of people who applied for insurance and were denied coverage.

* Insurance companies are required to provide the percentage of applicants who were charged higher premiums because of their health status.

"Millions of Americas have already logged-on to www.HealthCare.gov's Insurance Finder to see what health coverage options are available to them," said Secretary Kathleen Sebelius. "This already unprecedented ability to search and compare coverage options is getting better with the new benefits and price information now available. These changes will help Americans find coverage that meets their needs and that gives them value for their dollars now."

Created under the Affordable Care Act, www.HealthCare.gov was launched July 1, 2010, and is the first website of its kind to bring information and links to health insurance plans into one place to make it easy for consumers to learn about and compare their insurance choices. HHS' Office of Consumer Information and Insurance Oversight (OCIIO) worked to define and collect detailed benefits and premium rating information from insurers across the country, and starting October 1, 2010, consumers will also be able to find information about health insurance options such as:
* Monthly premium estimates;
* Cost-sharing information, including annual deductibles and out-of-pocket limits;
* Major categories of services covered;
* Consumer's share of cost for these services;
* Percent of people in the plan who pay more than the base premium estimate due to their health status; and
* Percent of people denied coverage from a health plan;

More than 225 insurance companies have provided information about their individual and family plans for more than 4,400 policies, including policies in every state and the District of Columbia. Consumers can search for and compare information on plans available to them based on their age, gender, family size, tobacco use and location.

"We applaud the insurance companies that have provided us this information about their products. Together, we are improving competition in the insurance marketplace," said Jay Angoff, director of the Office for Consumer Information and Insurance Oversight. "This type of transparent competition is critical to improving quality of coverage and lowering costs for consumers."

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Statement on the application of medical loss ratio standards to certain health plans under the Affordable Care Act

Jay Angoff, director of the Office of Consumer Information and Insurance Oversight, within the U.S. Department of Health and Human Services (HHS) released the following statement September 30, regarding the application of medical loss ratio standards to certain health plans under the Affordable Care Act:

"As many employers and insurers consider health insurance options for 2011, one question that has been raised is the applicability of provisions of the Affordable Care Act to health plans and coverage with special circumstances. HHS remains committed to implementing the law in a way that minimizes disruption to coverage that is available today while also ensuring that consumers receive the benefits the Act provides.

"For example, pursuant to the Affordable Care Act and our regulations, HHS recently announced an expedited process for plans to apply for a waiver from the requirement in the Affordable Care Act establishing minimum annual limits where such limits would result in decreased access or increased premiums. HHS has approved dozens of these waiver requests, most often filed by so-called "mini-med" plans, and in doing so, has ensured the continuation of health coverage for workers and their families. Complete waiver applications were generally processed in 48 hours.

"More recently, the issue of the applicability of the medical loss ratio requirements to plans such as mini-med plans has come up. HHS has not yet issued regulations implementing the medical loss ratio requirements because the Affordable Care Act tasks the National Association of Insurance Commissioners (NAIC) with first making recommendations to the Secretary.

"Although the NAIC is close to completing its work, we understand that some employers must soon make decisions regarding coverage options for 2011. As such, we fully intend to exercise her discretion under the new law to address the special circumstances of mini-med plans in the medical loss ratio calculations. According to the Affordable Care Act, medical loss ratio "methodologies shall be designed to take into account the special circumstance of smaller plans, different types of plans, and newer plans." We recognize that mini-med plans are often characterized by a relatively high expense structure relative to the lower premiums charged for these types of policies. We intend to address these and other special circumstances in forthcoming regulations."

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Humana and Walmart Announce Innovative Medicare Part D Prescription Drug Plan with Lowest National Monthly Premium Offered in all 50 States and D.C.¹

(BUSINESS WIRE)--Today, Humana Inc. (NYSE: HUM) announced an innovative Medicare Part D prescription drug plan, co-branded with Wal-Mart Stores, Inc. (NYSE: WMT) or (“Walmart”), that can provide significant savings on monthly plan premiums and prescription medicine copayments and cost-shares for Medicare beneficiaries, including seniors and people with disabilities.

The Humana Walmart-Preferred Rx Plan (PDP) offers one low national monthly plan premium of $14.80 – according to CMS¹, the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C. This new co-branded prescription drug plan can save a typical Medicare Part D beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) an estimated average of more than $450² in 2011 on plan premiums and prescription medication copayments and cost-shares when compared with the average total costs for a Part D prescription drug plan in 2010. With nearly 18 million Americans relying on Medicare Part D for their prescriptions³, the Humana Walmart-Preferred Rx Plan (PDP) provides an affordable prescription solution for those who need it most.

“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”

“We know every dollar counts, especially when you live on a fixed income. We believe no one should have to choose between buying their groceries or their medications,” said John Agwunobi, M.D., president of Walmart’s Health and Wellness division. “Financial health is a fundamental part of a person’s well-being. At Walmart, the customer is always front and center, and that is why we are committed to doing everything we can to ensure seniors have access to the medications they need at a price they can afford.”

Humana Walmart-Preferred Rx Plan (PDP): Benefits and Details

* One low monthly rate nationwide. The monthly plan premium is less than $15 a month for everyone, regardless of where they live.
-According to CMS, the $14.80 monthly plan premium is the lowest national plan premium in 2011 for a standalone Medicare Part D prescription drug plan offered in all 50 states and Washington, D.C.1
-The Humana Walmart-Preferred Rx Plan (PDP) offers a monthly plan premium of $14.80, which is less than half the weighted 2010 national average for Medicare Part D prescription drug plans’ monthly plan premiums⁴.

* Low copayments when plan members use preferred pharmacies like Walmart, Neighborhood Market or Sam’s Club pharmacies:
-In-store copayments (at preferred pharmacies) on generic prescriptions start as low as $2 when plan members use preferred pharmacies.
-Copayments as low as $0 for generic prescriptions filled via Humana’s RightSource home-delivery prescription service.

* A broad competitive formulary comparable to other plans, with a list of prescription drugs included in the plan available at humana-medicare.com.

How to Enroll in the Plan: Call, Click or Go

Information on the plan is available starting today; annual enrollment for Medicare plans begins Monday, Nov. 15, 2010, and continues through Dec. 31, 2010. To get more information on the Humana Walmart-Preferred Rx Plan (PDP) and to learn more about these savings:

* Call Humana to enroll at 1-800-899-0441. For TTY, call 711, 8 a.m. to 8 p.m., seven days a week.
* Click on humana-medicare.com or medicare.gov to enroll.
* Click on walmart.com/rxplan or samsclub.com/rxplan for additional plan details and links to enroll.
* Visit a Walmart store to speak to a Humana representative.
o Informational kiosks, including many staffed by Humana representatives, are available in approximately 3,000 Walmart stores across the country. Medicare beneficiaries can click on “Find a Location Near You” at walmart.com/rxplan to locate an on-site Humana representative.

Medicare Part D Background

Medicare Part D is the prescription drug program supported by the federal government. According to the Kaiser Family Foundation, nearly 18 million people are currently enrolled in a standalone Part D plan3 and Families USA reports that seniors generate one-third of all prescriptions filled in the United States⁵.




References

1 “Centers for Medicare & Medicaid Services.” Click on the “2011 Drug Plan Information - State Fact Sheets” under “Spotlights.” September 2010. http://www.cms.gov/center/openenrollment.asp

2 Savings estimate is based on a comparison between 1) the projected average nationwide out-of-pocket costs for the 2011 benefit year for the average Medicare beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) and fills their prescriptions in-store at preferred pharmacies like Walmart, Sam's Club, and Neighborhood Market pharmacies, and 2) the projected average nationwide out-of-pocket costs for the 2010 benefit year for the average Medicare beneficiary. Calculations based in part on industry average PDP premium and benefit information from the “Medicare Part D 2010 Spotlight, Medicare Prescription Drug Plans in 2010 and Key Changes over Five Years”, an independent review and analysis of CMS data by the Kaiser Family Foundation (September 2010). Actual savings may vary. For some beneficiaries, actual out-of-pocket costs may be more. Savings estimate may be updated when 2011 benefit year data becomes publicly available.

3 “The Henry J. Kaiser Family Foundation.” Medicare: A Primer. Chart: Prescription Drug Coverage Among Medicare Beneficiaries, 2010, Page 8. April 2010. http://www.kff.org/medicare/upload/7615-03.pdf

4 “The Henry J. Kaiser Family Foundation.” Medicare Part D 2010 Data Spotlight. Chart: Exhibit 2: Weighted Monthly PDP Premiums, 2006-2010, Page 9. September 2010. http://www.kff.org/medicare/8096.cfm

5 “Families USA.” Cost Overdose: Growth in Drug Spending for the Elderly, 1992 – 2010; Figure 1: Seniors Consume a Disproportionate Share of Drug Expenses, Page 2. July 2000.

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Forty-eight states receive new resources to build competitive health insurance marketplaces

The U.S. Department of Health and Human Services (HHS) today awarded nearly $49 million to help 48 states and the District of Columbia plan for the establishment of health insurance exchanges. A key part of the Affordable Care Act, starting in 2014, health insurance exchanges - new, competitive, consumer-centered private health insurance marketplaces - will put greater control and greater choice in the hands of individuals and small businesses.

"Today, too many individuals and small businesses are on their own in dealing with insurance companies. They pay higher costs than Americans who get their insurance through big companies or other large employers because they can't pool their costs or spread the risk," said Secretary Kathleen Sebelius. "That's why the Affordable Care Act helps states create exchanges, so individuals and small businesses can band together, have the same purchasing power as those big employers, and get a fairer deal when it comes to their health care. Today, we're providing critical resources to help states take the first step toward creating these competitive marketplaces."

The state-based exchanges will make purchasing health insurance easier by providing eligible consumers and businesses with "one-stop-shopping" where they can compare and purchase health insurance coverage. Americans will have the same health care choices as members of Congress - who will also purchase coverage through the exchanges. Individuals and families purchasing health insurance through exchanges may also qualify for tax credits and reduced cost-sharing depending on their income.

These grants of up to $1 million each will give states the resources they need to conduct the research and planning needed to build a better health insurance marketplace and determine how their exchanges will be operated and governed, including:
. Assessing current information technology (IT) systems and infrastructure and determining new requirements.
. Developing partnerships with community organizations to gain public input into the exchange planning process.
. Planning for consumer call centers to answer questions from their residents.
. Determining the statutory rules needed to build the exchanges.
. Hiring key staff and determining ongoing staffing needs.
. Planning the coordination of eligibility and enrollment systems across Medicaid, the Children's Health Insurance Program (CHIP), and the exchanges.
. Developing performance metrics, milestones and ongoing evaluation.

Although state exchanges are not required to be operational until 2014, these planning grants begin the path toward 2014 when health insurance exchanges will take what is now a very complicated and confusing process and turn it into a simple, easy to navigate experience that benefits consumers, not insurance companies.

The Department of Health and Human Services is working closely with states in implementing the Affordable Care Act. This is just the first round of state planning and establishment grants, which are one of several resources available to states to help with implementation of the Affordable Care Act. Already, 46 states have received resources from the Affordable Care Act to help improve the oversight of proposed health insurance premium increases, take action against insurers seeking unreasonable rate hikes, and ensure consumers receive value for their premium dollars. To learn more about the Affordable Care Act please visit www.HealthCare.gov.

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