/PRNewswire/ -- Despite tight budgets, nearly all states maintained or made targeted expansions or improvements in their Medicaid and Children's Health Insurance Programs (CHIP) eligibility and enrollment rules in 2010, preserving the programs' ability to provide coverage to millions of low-income Americans who otherwise lack affordable options, according to a new survey released today by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU).
The 10th annual KCMU 50-state survey of Medicaid and CHIP eligibility rules, enrollment and renewal procedures and cost sharing practices, this year conducted with the Georgetown University Center for Children and Families, found that coverage policies held steady or in some cases expanded, particularly for low-income children. However, eligibility for their parents and other low-income adults continued to lag behind. The stability of such programs during a recession that has produced sharp increases in unemployment and declines in state tax revenues arises in large part from the temporary federal fiscal relief for Medicaid provided by the American Recovery and Reinvestment Act of 2009 (ARRA).
That enhanced federal assistance, which will end in July, was tied to requirements for states to maintain Medicaid coverage policies. To help provide a base for the future Medicaid expansion, the health reform law also requires states to maintain public coverage for adults until broader health reform goes into effect in 2014 and until 2019 for children. However, in the coming year states continue to face significant budget pressures as demand for the programs remains high and state revenues continue to be depressed amidst the slow economic recovery.
"Millions of American families have turned to Medicaid and CHIP as incomes have declined after losing jobs and the health insurance that often goes with them," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of the KCMU. "Keeping these programs stable and strong has helped protect children and avoid an even larger increase in the nation's 50 million uninsured, and will be key to ensuring the success of health reform implementation over the next few years."
Coverage Policies Held Steady or Expanded in 2010, Especially For Children
The survey found that 49 states, including D.C., held steady or made targeted improvements in their Medicaid and CHIP eligibility rules and enrollment procedures. A total of 13 states expanded eligibility, largely for children, and 14 states made improvements in enrollment and renewal procedures to reduce burdens on families and streamline administrative processes.
Without the enhanced federal funding and maintenance-of-effort requirements in the ARRA and health reform laws, it is likely that more states would have made cutbacks in coverage to cope with budget pressures. Two states -- Arizona and New Jersey -- did make reductions that were not subject to the requirements in the laws.
Coverage for Low-Income Adults Continues to Lag Behind
The survey finds that as of January 1, 2011, 25 states, including D.C., cover children in families with incomes at least up to 250 percent of the federal poverty level ($45,775 for a family of three in 2010), continuing a decade of progress in covering children. However, coverage for their parents lags behind. The median Medicaid eligibility threshold for parents nationally remains at 64 percent of the federal poverty level, and 16 states limit eligibility for parents to those in families that earn below 50 percent of the federal poverty level ($9,155 for a family of three in 2010).
Until health reform passed, states could not cover adults without dependent children in Medicaid programs without a waiver. The new law ends the historic exclusion of these adults through a Medicaid eligibility expansion to a national floor of 133 percent of the federal poverty level ($24,352 for a family of three and $14,404 for an individual in 2010). Although the law won't take full effect until 2014, last year Connecticut and D.C. took advantage of the new option to begin covering these adults by moving into Medicaid low-income adults whom they had previously covered only with state and local dollars. Also, California received approval for a waiver to continue and expand county initiatives that cover low-income adults. A few other states, including Minnesota, also have pending plans to take advantage of the new option to provide Medicaid coverage to adults. Even with these efforts, as of January 1, only seven states (Arizona, Connecticut, Delaware, D.C., Hawaii, New York and Vermont) provided Medicaid or Medicaid-equivalent benefits to adults without dependent children.
In the absence of further expansions over the next couple of years, most uninsured, low-income adults will remain unable to qualify for Medicaid until health reform goes into effect in 2014.
States are Incorporating Technology into Their Programs, but Have More Work Ahead
The survey finds that states continue to adopt technology to modernize their programs. Many of these improvements have helped to reduce barriers to enrollment and renewal for families, while also streamlining administrative processes and achieving administrative efficiencies. For example, about half of the states (29) took advantage of a new option to rely on an electronic data match with the Social Security Administration to more efficiently and accurately verify citizenship status of applicants for Medicaid and CHIP. The survey also found states making progress in using electronic data matches to verify other aspects of eligibility.
Yet states still have a significant amount of work to do, the survey finds. The new health reform law calls upon states to implement an integrated, web-based, technology-driven enrollment process for Medicaid, CHIP, and coverage in the new health insurance Exchanges. While all states make their Medicaid application available online, only slightly more than half (29) allow for the application to be electronically submitted with an electronic signature and most of these still require families to submit paper documentation via mail or fax. In light of a rule proposed by the Administration at the end of 2010 to provide states with a 90% federal matching rate to prepare their Medicaid eligibility systems for health reform, new grant funding, and the likelihood of additional guidance and funding opportunities in the months ahead, more activity in this area is expected in the coming year.
Today's report, Holding Steady, Looking Ahead: Annual Findings of a 50-State Survey of Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in Medicaid and CHIP, 2010-2011, and related materials from today's public briefing on the survey findings, are available online at: http://www.kff.org/medicaid/Medicaid-CHIP-Coverage-Recession-Health-Reform.cfm. In addition, an archived webcast of a public briefing will be available on the website after 4 p.m. ET today.
The Kaiser Family Foundation is a non-profit private operating foundation, based in Menlo Park, California, dedicated to producing and communicating the best possible information and analysis on health issues.
The Kaiser Commission on Medicaid and the Uninsured provides information and analysis on health care coverage and access for the low-income population, with a special focus on Medicaid's role and coverage of the uninsured. Begun in 1991 and based in the Kaiser Family Foundation's Washington, D.C. office, the Commission is the largest operating program of the Foundation. The Commission's work is conducted by Foundation staff under the guidance of a bipartisan group of national leaders and experts in health care and public policy.
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Showing posts with label enrollment. Show all posts
Showing posts with label enrollment. Show all posts
Tuesday, January 11, 2011
Monday, November 15, 2010
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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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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Friday, October 29, 2010
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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"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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Wednesday, October 13, 2010
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).
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).
Thursday, October 07, 2010
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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“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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Tuesday, October 05, 2010
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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"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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Sunday, July 04, 2010
HHS Secretary Sebelius Announces New Pre-Existing Condition Insurance Plan
The U.S. Department of Health and Human Services (HHS) announced on July 1 the establishment of a new Pre-existing Condition Insurance Plan (PCIP) that will offer coverage to uninsured Americans who have been unable to obtain health coverage because of a pre-existing health condition.
The Pre-Existing Condition Insurance Plan, which will be administered either by a state or by the Department of Health and Human Services, will provide a new health coverage option for Americans who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are a U.S. citizen or are residing in the United States legally.
Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive Exchanges. In 2014, Members of Congress will also purchase their insurance through Exchanges.
“For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” said Secretary Kathleen Sebelius. “Today, the Pre-Existing Condition Insurance Plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.”
The Affordable Care Act provides $5 billion in federal funding to support Pre-Existing Condition Insurance Plans in every state. Some states have requested that the U.S. Department of Health and Human Services run their Pre-Existing Condition Insurance Plan. Other states have requested that they run the program themselves. For more information about how the plan is being administered where you live, please visit HHS’ new consumer website, www.HealthCare.gov.
“Health coverage for Americans with pre-existing conditions has historically been unobtainable or failed to cover the very conditions for which they need medical care,” said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight (OCIIO) which is overseeing the program. “The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage at a reasonable cost. We modeled the program on the highly successful Children’s Health Insurance Program, also known as CHIP, so states would have maximum flexibility to meet the needs of their citizens.”
In order to give states the flexibility to best meet their needs, HHS provided states with the option of running the Pre-Existing Condition Insurance Plan themselves or having HHS run the plan. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs.
Starting today, the national Pre-Existing Condition Insurance Plan will be open to applicants in the 21 states where HHS is operating the program.
All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of the summer, with many beginning enrollment today.
“The Pre-Existing Condition Insurance Plan is an important next step in the overall implementation of the Affordable Care Act,” said Richard Popper, Director of Insurance Programs at OCIIO. “We have been working closely with the states and other stakeholders to make sure this program reaches uninsured Americans struggling to find coverage due to a pre-existing condition.”
The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Pre-Existing Condition Insurance Plan does not base eligibility on income and does not charge a higher premium because of a medical condition. Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.
Like the popular Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan provides states flexibility in how they run their program as long as basic requirements are met. Federal law establishes general eligibility, but state programs can vary on cost, benefits, and determination of pre-existing condition. Funding for states is based on the same allocation formula as CHIP, and it will be reallocated if unspent by the states. Unlike CHIP, there is no state matching requirement and the federal government will cover the entire cost of the Pre-Existing Condition Plan. While it took more than 6 months for a small number of states to establish their CHIP programs, we anticipate that every state will begin enrolling individuals in the Pre-Existing Condition Plan by the end of August.
Information on how to apply for the Pre-Existing Condition Insurance Plan is available at www.HealthCare.gov. Americans who live in a state where the U.S. Department of Health and Human Services is running the Pre-Existing Condition Plan will be linked directly to the federal application page. Those living in states running their own programs will also find information on how and where to apply on www.HealthCare.gov.
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The Pre-Existing Condition Insurance Plan, which will be administered either by a state or by the Department of Health and Human Services, will provide a new health coverage option for Americans who have been uninsured for at least six months, have been unable to get health coverage because of a health condition, and are a U.S. citizen or are residing in the United States legally.
Created under the Affordable Care Act, the Pre-Existing Condition Insurance Plan is a transitional program until 2014, when insurers will be banned from discriminating against adults with pre-existing conditions, and individuals and small businesses will have access to more affordable private insurance choices through new competitive Exchanges. In 2014, Members of Congress will also purchase their insurance through Exchanges.
“For too long, Americans with pre-existing conditions have been locked out of our health insurance market,” said Secretary Kathleen Sebelius. “Today, the Pre-Existing Condition Insurance Plan gives them a new option – the same insurance coverage as a healthy individual if they’ve been uninsured for at least six months because of a medical condition. This program will provide people the help they need as the nation transitions to a more competitive and fair market place in 2014.”
The Affordable Care Act provides $5 billion in federal funding to support Pre-Existing Condition Insurance Plans in every state. Some states have requested that the U.S. Department of Health and Human Services run their Pre-Existing Condition Insurance Plan. Other states have requested that they run the program themselves. For more information about how the plan is being administered where you live, please visit HHS’ new consumer website, www.HealthCare.gov.
“Health coverage for Americans with pre-existing conditions has historically been unobtainable or failed to cover the very conditions for which they need medical care,” said Jay Angoff, Director of the Office of Consumer Information and Insurance Oversight (OCIIO) which is overseeing the program. “The Pre-Existing Condition Insurance Plan is designed to address these challenges by offering comprehensive coverage at a reasonable cost. We modeled the program on the highly successful Children’s Health Insurance Program, also known as CHIP, so states would have maximum flexibility to meet the needs of their citizens.”
In order to give states the flexibility to best meet their needs, HHS provided states with the option of running the Pre-Existing Condition Insurance Plan themselves or having HHS run the plan. Twenty-one states have elected to have HHS administer the plans, while 29 states and the District of Columbia have chosen to run their own programs.
Starting today, the national Pre-Existing Condition Insurance Plan will be open to applicants in the 21 states where HHS is operating the program.
All states which are operating their own Pre-Existing Condition Insurance Plans will begin enrollment by the end of the summer, with many beginning enrollment today.
“The Pre-Existing Condition Insurance Plan is an important next step in the overall implementation of the Affordable Care Act,” said Richard Popper, Director of Insurance Programs at OCIIO. “We have been working closely with the states and other stakeholders to make sure this program reaches uninsured Americans struggling to find coverage due to a pre-existing condition.”
The Pre-Existing Condition Insurance Plan will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. The Pre-Existing Condition Insurance Plan does not base eligibility on income and does not charge a higher premium because of a medical condition. Participants will pay a premium that is not more than the standard individual health insurance premium in their state for insurance that covers major medical and prescription drug expenses with some cost-sharing.
Like the popular Children’s Health Insurance Program (CHIP), the Pre-Existing Condition Plan provides states flexibility in how they run their program as long as basic requirements are met. Federal law establishes general eligibility, but state programs can vary on cost, benefits, and determination of pre-existing condition. Funding for states is based on the same allocation formula as CHIP, and it will be reallocated if unspent by the states. Unlike CHIP, there is no state matching requirement and the federal government will cover the entire cost of the Pre-Existing Condition Plan. While it took more than 6 months for a small number of states to establish their CHIP programs, we anticipate that every state will begin enrolling individuals in the Pre-Existing Condition Plan by the end of August.
Information on how to apply for the Pre-Existing Condition Insurance Plan is available at www.HealthCare.gov. Americans who live in a state where the U.S. Department of Health and Human Services is running the Pre-Existing Condition Plan will be linked directly to the federal application page. Those living in states running their own programs will also find information on how and where to apply on www.HealthCare.gov.
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Friday, December 04, 2009
Medicare Open Enrollment Begins: Now Is The Time To Review Your Plan
(NAPSI)-You may know that new Medicare prescription drug and health plan choices are offered each year. Medicare's Open Enrollment Period runs through December 31.
Open Enrollment is your chance to review your current plan-including your Original Medicare coverage-compare it with your other options and make sure you're getting the best available coverage for your health care needs.
Your current health plan may have changed its cost or coverage for 2010, or maybe you'd like a plan with a lower deductible.
If you've had any changes in your health, it's particularly important for you to double-check your coverage during Open Enrollment so you can make sure that any new treatments or drugs are covered by your plan.
Since coverage varies by plan, know what's important for you. For example, make a list of the drugs you take so you can make sure they're covered by the plans you're considering.
If you are in Original Medicare and don't have prescription drug coverage, you can join a Medicare drug plan during Open Enrollment.
Medicare has several ways to get you the help you need to find a plan that works for you.
• Visit www.medicare.gov, where you can get a personalized comparison of the costs and coverage of the plans available in your area.
• Call 1-800-MEDICARE (1-800-633-4227) to find out more about your coverage options. TTY users should call 1-877-486-2048. Medicare customer service representatives are available 24 hours a day, seven days a week with multiple language options and resources for people with disabilities.
• Watch your mailbox for the 2010 "Medicare & You" handbook. The handbook is mailed to all Medicare households each fall and includes a listing of all plans in your area. This handbook is also conveniently available online at www.medicare.gov.
• Meet one on one with a trained expert for personalized assistance. Call 1-800-MEDICARE or visit www.medicare.gov to find a Medicare specialist in your area. Select "Find Helpful Phone Numbers and Websites."
Important Medicare Enrollment Dates:
Dec. 31: Open Enrollment ends. Last day to join or change your Medicare drug plan.
Jan. 1: Your new plan coverage begins.
This message is brought to you by the U.S. Department of Health & Human Services.
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Open Enrollment is your chance to review your current plan-including your Original Medicare coverage-compare it with your other options and make sure you're getting the best available coverage for your health care needs.
Your current health plan may have changed its cost or coverage for 2010, or maybe you'd like a plan with a lower deductible.
If you've had any changes in your health, it's particularly important for you to double-check your coverage during Open Enrollment so you can make sure that any new treatments or drugs are covered by your plan.
Since coverage varies by plan, know what's important for you. For example, make a list of the drugs you take so you can make sure they're covered by the plans you're considering.
If you are in Original Medicare and don't have prescription drug coverage, you can join a Medicare drug plan during Open Enrollment.
Medicare has several ways to get you the help you need to find a plan that works for you.
• Visit www.medicare.gov, where you can get a personalized comparison of the costs and coverage of the plans available in your area.
• Call 1-800-MEDICARE (1-800-633-4227) to find out more about your coverage options. TTY users should call 1-877-486-2048. Medicare customer service representatives are available 24 hours a day, seven days a week with multiple language options and resources for people with disabilities.
• Watch your mailbox for the 2010 "Medicare & You" handbook. The handbook is mailed to all Medicare households each fall and includes a listing of all plans in your area. This handbook is also conveniently available online at www.medicare.gov.
• Meet one on one with a trained expert for personalized assistance. Call 1-800-MEDICARE or visit www.medicare.gov to find a Medicare specialist in your area. Select "Find Helpful Phone Numbers and Websites."
Important Medicare Enrollment Dates:
Dec. 31: Open Enrollment ends. Last day to join or change your Medicare drug plan.
Jan. 1: Your new plan coverage begins.
This message is brought to you by the U.S. Department of Health & Human Services.
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Thursday, November 12, 2009
New CVS/pharmacy Data Reveals Older Americans Could Save an Average of $612 Annually by Switching Medicare Part D Plans
/PRNewswire/ -- With the Annual Enrollment Period for Medicare Part D beginning on November 15, CVS/pharmacy and the National Council on Aging (NCOA) are urging older adults and their caregivers to review their Medicare Part D options in order to find the lowest cost plan that meets their needs.
Confusion around the number and variety of prescription drug plans often becomes a barrier to identifying and selecting the most cost effective plan. Free online tools like the CVS/pharmacy Medicare Part D Savings Calculator at www.cvs.com/medicare simplifies the comparison process, helping seniors more readily identify the plan with the lowest overall costs.
"Plan review can seem cumbersome, but completing a plan comparison each year is an essential step toward saving," said Fernando Gonzalez, R.Ph at CVS/pharmacy. "Tools like the Medicare Part D Calculator are designed to simplify the process to help older adults and their caregivers select a plan that provides them with the greatest value and peace of mind."
A CVS/pharmacy analysis of more than 10,000 older Americans using the Medicare Part D Savings Calculator last year revealed plan participants could save an average of $612 in annual drug costs just by switching to their optimal Medicare Part D plan.(1)
"This data underscores the importance for older adults and their caregivers to review Medicare Part D plans each year," said Wendy Zenker, Vice President of the NCOA Benefits Access Group. "With the number of changes to Part D plans from year to year, Medicare beneficiaries can expect to see significant savings and receive better coverage, if they compare and shop around."
To that end, CVS/pharmacy today launches a campaign with the goal of helping millions of seniors and their caregivers realize savings on 2010 prescription costs through education and assistance in Medicare Part D plan comparison. Starting November 12, CVS/pharmacy and the NCOA are offering Medicare Part D educational events throughout Annual Enrollment period at senior centers across the country.
Consumers can also go online at CVS.com/medicare to use the free Medicare Part D Savings Calculator. And, CVS pharmacists will be available throughout the enrollment period to provide plan comparisons in stores for those who would like assistance.(2)
Remembering the Three Cs: Cost, Coverage and Convenience
CVS/pharmacy and NCOA recommend considering three factors when evaluating plans:
-- Cost - What is the plan deductible, monthly premium and prescription
co-pay for the prescriptions you regularly take? Evaluate the total
cost and not just the co-pays. And, identify in advance if you fall
into the doughnut hole.
-- Coverage - Are the prescription medications you regularly take covered
in the plan? Are there restrictions such as prior authorization? Each
year insurance plans change, including premiums, co-pays, and the list
of covered drugs. Your own prescription needs change as well.
-- Convenience - Can you fill the prescription at the pharmacy of your
choice?
Before starting the plan selection process, older Americans should review their current medications with their pharmacist. Often, prescription costs can be lowered by switching to a generic alternative, consolidating pills or by switching to an over the counter alternative. Having these changes in place before selecting a plan can help in choosing the most affordable option and potentially avoiding the doughnut hole -- the gap in coverage if your prescription costs reach $2,830.
-----
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Confusion around the number and variety of prescription drug plans often becomes a barrier to identifying and selecting the most cost effective plan. Free online tools like the CVS/pharmacy Medicare Part D Savings Calculator at www.cvs.com/medicare simplifies the comparison process, helping seniors more readily identify the plan with the lowest overall costs.
"Plan review can seem cumbersome, but completing a plan comparison each year is an essential step toward saving," said Fernando Gonzalez, R.Ph at CVS/pharmacy. "Tools like the Medicare Part D Calculator are designed to simplify the process to help older adults and their caregivers select a plan that provides them with the greatest value and peace of mind."
A CVS/pharmacy analysis of more than 10,000 older Americans using the Medicare Part D Savings Calculator last year revealed plan participants could save an average of $612 in annual drug costs just by switching to their optimal Medicare Part D plan.(1)
"This data underscores the importance for older adults and their caregivers to review Medicare Part D plans each year," said Wendy Zenker, Vice President of the NCOA Benefits Access Group. "With the number of changes to Part D plans from year to year, Medicare beneficiaries can expect to see significant savings and receive better coverage, if they compare and shop around."
To that end, CVS/pharmacy today launches a campaign with the goal of helping millions of seniors and their caregivers realize savings on 2010 prescription costs through education and assistance in Medicare Part D plan comparison. Starting November 12, CVS/pharmacy and the NCOA are offering Medicare Part D educational events throughout Annual Enrollment period at senior centers across the country.
Consumers can also go online at CVS.com/medicare to use the free Medicare Part D Savings Calculator. And, CVS pharmacists will be available throughout the enrollment period to provide plan comparisons in stores for those who would like assistance.(2)
Remembering the Three Cs: Cost, Coverage and Convenience
CVS/pharmacy and NCOA recommend considering three factors when evaluating plans:
-- Cost - What is the plan deductible, monthly premium and prescription
co-pay for the prescriptions you regularly take? Evaluate the total
cost and not just the co-pays. And, identify in advance if you fall
into the doughnut hole.
-- Coverage - Are the prescription medications you regularly take covered
in the plan? Are there restrictions such as prior authorization? Each
year insurance plans change, including premiums, co-pays, and the list
of covered drugs. Your own prescription needs change as well.
-- Convenience - Can you fill the prescription at the pharmacy of your
choice?
Before starting the plan selection process, older Americans should review their current medications with their pharmacist. Often, prescription costs can be lowered by switching to a generic alternative, consolidating pills or by switching to an over the counter alternative. Having these changes in place before selecting a plan can help in choosing the most affordable option and potentially avoiding the doughnut hole -- the gap in coverage if your prescription costs reach $2,830.
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Wednesday, October 28, 2009
Selecting Medicare Coverage: Four Considerations to Help Seniors Choose
/PRNewswire/ -- Open enrollment, the six-week period during which seniors can select healthcare coverage for 2010, begins Nov. 15. Health plans have begun sharing their costs and coverage, but making a choice can be a daunting task. Here are four considerations to help Medicare-eligible seniors select which Medicare coverage best meets their individual needs:
1. Understand the A, B, C and Ds of Medicare. There are four primary parts
to Medicare. Parts A and B cover hospital and medical expenses,
respectively. Parts C and D provide benefit and prescription drug
coverage through health insurance companies that are approved by
Medicare. Medicare Advantage plans include all of the coverage offered
by Parts A and B and can include prescription drug coverage under Part
D.
2. Compare costs. Premiums can range for $0 to hundreds of dollars per
month, depending upon the type of organization (nonprofit or
for-profit) and the type of coverage. Total plan costs include
premiums, co-payments and deductibles for everything from preventive
care to hospitalization.
3. Compare benefits and doctors. Does the plan have a large network of
doctors and specialists for you to choose from? Is your doctor and
preferred hospital in that network? Does the plan cover your
prescription medications?
4. Compare quality. Call the customer service number for the plans you're
considering. Does a live person answer the phone? Are they friendly,
helpful and knowledgeable? Does the plan offer value-added programs
that help you maintain or improve your health and independence? Does
the plan offer services to help your loved ones take care of you if
needed? Will the plan coordinate your care between doctors and
specialists?
Selecting Medicare coverage is an important decision, especially since Medicare rules indicate that members must maintain the coverage they've chosen for an entire year. Seniors currently enrolled in Medicare Advantage plans will soon receive letters from their health plans explaining any changes in coverage for 2010. "We recommend that people read this letter thoroughly to avoid any surprises in the coming year," said Tom Lescault, president of SCAN Health Plan Arizona. "Changes in government funding has forced many health plans to reduce benefits or increase costs. People need to make sure they are able to make informed decisions during open enrollment."
As part of an ongoing commitment to improving the lives of seniors, SCAN Health Plan Arizona is an exclusive sponsor of "Healthy Tips for Successful Aging" with ABC 15. Each week, the station airs 30-second health tips provided by SCAN. The health plan also is the exclusive studio sponsor for KOY radio and co-hosts "Senior Focus," a broadcast dedicated to senior-related issues.
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1. Understand the A, B, C and Ds of Medicare. There are four primary parts
to Medicare. Parts A and B cover hospital and medical expenses,
respectively. Parts C and D provide benefit and prescription drug
coverage through health insurance companies that are approved by
Medicare. Medicare Advantage plans include all of the coverage offered
by Parts A and B and can include prescription drug coverage under Part
D.
2. Compare costs. Premiums can range for $0 to hundreds of dollars per
month, depending upon the type of organization (nonprofit or
for-profit) and the type of coverage. Total plan costs include
premiums, co-payments and deductibles for everything from preventive
care to hospitalization.
3. Compare benefits and doctors. Does the plan have a large network of
doctors and specialists for you to choose from? Is your doctor and
preferred hospital in that network? Does the plan cover your
prescription medications?
4. Compare quality. Call the customer service number for the plans you're
considering. Does a live person answer the phone? Are they friendly,
helpful and knowledgeable? Does the plan offer value-added programs
that help you maintain or improve your health and independence? Does
the plan offer services to help your loved ones take care of you if
needed? Will the plan coordinate your care between doctors and
specialists?
Selecting Medicare coverage is an important decision, especially since Medicare rules indicate that members must maintain the coverage they've chosen for an entire year. Seniors currently enrolled in Medicare Advantage plans will soon receive letters from their health plans explaining any changes in coverage for 2010. "We recommend that people read this letter thoroughly to avoid any surprises in the coming year," said Tom Lescault, president of SCAN Health Plan Arizona. "Changes in government funding has forced many health plans to reduce benefits or increase costs. People need to make sure they are able to make informed decisions during open enrollment."
As part of an ongoing commitment to improving the lives of seniors, SCAN Health Plan Arizona is an exclusive sponsor of "Healthy Tips for Successful Aging" with ABC 15. Each week, the station airs 30-second health tips provided by SCAN. The health plan also is the exclusive studio sponsor for KOY radio and co-hosts "Senior Focus," a broadcast dedicated to senior-related issues.
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