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2009 Medicare Information

Companies we represent

The ABCs-And D-Of Medicare

It's as simple as ABC: If you or someone you care for is a senior citizen, it may pay to learn the Medicare alphabet. Knowing how the different parts of the program work could mean more money saved and possibly even better care. Medicare Parts A and B have been around since the beginning of Medicare in the 1960s. Part A covers hospital visits, skilled nursing facilities and some home health care. Part B covers doctor visits, outpatient visits and durable medical equipment. Together, Parts A and B are referred to as "traditional" fee-for-service (FFS) Medicare, or sometimes as "Original Medicare." It is estimated that FFS Medicare only covers about 50 percent of the health care costs incurred by beneficiaries. That is why some people who choose FFS Medicare also obtain a Medicare Supplemental plan. This type of health insurance is also known as Medigap coverage. Medigap plans do just that-cover the "gaps" that FFS Medicare does not cover. However, Medigap plans can be extremely costly. As a result, many seniors are attracted to the broader coverage and more predictable costs of Medicare Part C, commonly called Medicare Advantage. Extra Benefits Medicare Advantage plans may offer extra benefits such as vision and hearing coverage, annual physicals and worldwide emergency coverage and many also include coverage for medications. These plans help with your coordination of care across the provider spectrum. Explains Scott R. Kelly, chief government programs officer, Health Net, Inc., "With the wide array of Medicare options, you have the ability to customize your coverage to really meet your needs." He offers another alphabetical aid, saying, "In reviewing your options, the most important factors are often the 4 Cs-Cost, Customer Service, Convenience and Coverage." Part D is prescription drug coverage, which started in early 2006 and has turned out to be more popular than expected. Both Part D and Medicare Advantage plans are offered through private health care companies, either as separate options or together in one plan. Some of the plans do not have premiums while others do have monthly fees. Those plans can vary depending on where you live and the services covered. Dates To Keep In Mind In addition to the Medicare alphabet, there are some numbers you should keep in mind as well. You are eligible to join Medicare on the first day of the month in which you turn 65. Once you are on Medicare, you can change your Medicare Advantage or prescription drug plan each year during the Annual Election Period, which runs from November 15 to December 31. During this period, you can pick any plan that is offered in your area. Most beneficiaries can choose between dozens of plans. For more information, please go to www.medicare.gov or call us at (800) 547-1567. Many seniors are attracted to the broader coverage of Medicare Part C, called Medicare Advantage.

Co-Pays and Deductibles

PRESCRIPTION DRUG ALERT!!!
Medicare beneficiaries, their advocates and other helpers cannot be assured that the information provided to them on the Plan Finder is accurate. They need to drill as deeply as possible into the Plan Finder tool to ascertain whether reference-based pricing and other utilization management tools apply to their prescriptions. The initial screen from the Plan Finder does not provide detailed information about new pricing schemes that increase the cost of certain brand name drugs substantially.  As a result, unwary beneficiaries may find themselves paying significantly more for their brand name prescriptions than they were led to believe by the Plan Finder.

In July 2008 CMS issued new guidance that allows drug plans to use "reference-based pricing" for certain formulary drugs, generally brand name drugs with a generic equivalent. Under a reference-based pricing system, the beneficiary pays the tiered cost sharing amount plus an additional amount that supplements the cost-sharing. The additional amount, sometimes referred to as a "product selection penalty," is calculated as the difference between the full price of the brand name drug and the full price of its generic equivalent. Advocates report that at least three national Part D plan sponsors, HealthNet, SilverScript, and Sterling, use reference based pricing in their formularies.

2009 Annual Election Period (AEP) is Open!
AEP marketing started October 1. Medicare information first became available on October 8, 2008 but not all data has been loaded yet. Do not send in applications before November 15! The Medicare AEP is starts November 15 and ends on December 31, 2008. All choices made during that time will have an effective date of January 1, 2009.

What's New?
Medicare Advantage Plans May Limit Coverage
In 2009 many plans that offered full coverage for their "Out of pocket limits" no longer do so. It is important to look at the plan comparisons and look for which type of out of pocket limit is a part of the coverage. These are the types we have found so far:

1.  "All plan services covered by the out of pocket limit."
2. "All Medicare services covered under the out-of-pocket limit"
3. "Not all plan services are covered under the out-of-pocket limit."
4. "...only Medicare-covered services will count toward your yearly deductible."

Non-covered items, especially those expressed as a percentage, could result in some very large out of pocket expenses with no limit.

NEW - Changes to 2009 SecureHorizons® Private Fee For Service Plans 
Office visit co-pays no longer will apply toward the out-of-pocket maximum. (In 2008, all services covered by Medicare, including office visit co-pays, were applied to the out-of-pocket maximum.) This change brings the Private Fee for Service plans in line with the SecureHorizons HMO/PPO plans, which have always excluded office visit co-pays from the out-of-pocket maximum. The complete list of services that apply to the 2009 private fee for service, out-of-pocket maximums are: 
Abdominal aortic aneurysm screening
Ambulance services
Cardiovascular disease testing
Dialysis (kidney)
Durable medical equipment and related supplies
Emergency care
Inpatient hospital care
Inpatient mental health care
Medicare Part B prescription drugs
Outpatient diagnostic tests and therapeutic services and supplies
Outpatient rehabilitation services
Outpatient surgery (including services provided at ambulatory surgical centers)
Partial hospitalization (described under outpatient mental health care)
Prosthetic devices and related supplies 
Skilled nursing facility care  
Not covered in the out of pocket limit are, among other things, Part B chemotherapy treatment which could be very expensive.

Part B Premiums Increase for People Earning Higher Incomes

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