Seniors who take a close look at the Part D drug coverage offered by Medicare Advantage plans may reap handsome savings next year. Many Medicare HMO and PPO plans will continue to offer $0 monthly premiums and $0 deductibles with either complete or partial coverage throughout the "gap" or "donut hole" (when beneficiaries pay 100% of their drug bills until reaching $4,050 in out-of-pocket costs). HealthMetrix Research Inc. screened over 400 such Medicare Advantage plans to identify which ones offer the best Part D drug benefits in 2008.
The findings are based solely on estimated member out-of-pocket costs and do not compare drug formularies. According to HealthMetrix Research Inc. and MedicareNewsWatch.com president Alan Mittermaier, "The findings are favorable for seniors in most areas of the country who can enroll in $0 premium Medicare Advantage-Part D plans. For 2008, there are no $0 premium drug-only Part D plans available except for low-income seniors who qualify for premium subsidies. Beneficiaries currently enrolled in drug-only plans will see 17% premium increases on average effective January 1st. That is on top of premium increases for most Medigap supplemental insurance coverage.
Seniors who are willing to bundle their Medicare coverage by enrolling in a Medicare HMO or PPO plan can realize considerable savings in annual medical and drug expenses even with pre-existing medical conditions. The strategy and savings are similar to bundling auto, property and life insurance policies with a single insurer." Alan Mittermaier also notes that "what may not register with all seniors is that the same Medicare regulatory protections apply to enrollees in both drug-only and Medicare Advantage Part D plans with respect to required drug formulary lists and the rules for switching or dropping drugs. The reality is that drug-only Part D plan sponsors will manage their drug benefits just as aggressively as Medicare Advantage plans." The findings are from the HealthMetrix Research 2008 CostShare Report comparisons based on approved 2008 member copayments, deductibles and premiums that appear in the Medicare Options Compare database (http://www.medicare.gov/). HealthMetrix Research neither recommends nor endorses specific Medicare plans or products. Best 2008 Part D Benefit Values Among Medicare Advantage Plans Offering $0 Premium $0 Deductible with Gap Coverage
-- Aetna - Portland, ME -- Anthem - Richmond (VA), Toledo -- Blue Shield - Riverside County (CA) -- Care1st - San Bernardino, San Diego -- Central Health Plan - Los Angeles -- CIGNA -- Phoenix -- Citizens Choice Health Plan -- Orange County (CA) -- Coventry Health Care - Kansas City, Omaha -- Freedom Health - Naples -- GEMcare - Bakersfield -- HealthSpring - Birmingham, Chattanooga, Chicago, Houston, Memphis, Mobile, Montgomery, Nashville -- Health Plan of Nevada - Las Vegas, Reno -- Humana - Atlanta, Baton Rouge, Cincinnati, Columbus, Corpus Christi, Dayton, Des Moines, Louisville, Miami, Salt Lake City, Shreveport, Tucson -- Kaiser Permanente -- Denver -- Liberty Health Advantage -- Nassau County (NY) -- Lovelace Health Plan - Albuquerque, Santa Fe -- MD MedicareChoice - Bradenton, Ft. Lauderdale, Ft. Myers, Jacksonville, Orlando, Pensacola, Sarasota, St. Petersburg, Tampa, West Palm Beach -- Molina Healthcare - Houston, San Antonio -- Physicians Health Choice - El Paso -- Today's Health - Milwaukee -- Touchstone Health - New York City -- Unison Health Plan -- Pittsburgh -- WellCare - Akron-Canton, Cleveland, Dallas-Ft. Worth, Ft. Wayne, Indianapolis, New Orleans, St. Louis, South Bend, Essex-Hudson-Passaic- Union counties (NJ)
After a two-year moratorium mandated by the 2003 Medicare reform law, new Medicare local PPOs will re-enter the market starting January 1. With their provisions for out-of-network coverage, local PPOs will enhance the already fierce competition in the Medicare market. They could prove to be a popular alternative to private-fee-for-service (PFFS) plans, which have been plagued by provider access issues that resulted in heightened regulatory scrutiny, and to traditional HMO products. Local PPOs could enable MA organizations to boost their market share and/or profitability. Medicare plan sponsors and their partners need to determine now how to prepare for the market changes likely in 2008 with the return of local PPOs, and whether it makes sense to apply soon to offer new local PPOs in 2009.
Wednesday, October 31, 2007 1:00 - 2:30 Eastern time 12:00 - 1:30 Central time 11:00 - 12:30 Mountain time 10:00 - 11:30 Pacific time Sponsored by Atlantic Information Services, Inc., publisher of Health Plan Week, Medicare Advantage News and Drug Benefit News. Speakers Designed For Registration Prices How the Audioconference Works Written Materials
They’re back! And with the return of new local PPOs to the Medicare market starting on Jan. 1, sponsors of both existing and new local PPOs, as well as those offering other Medicare products, need a quick and accurate assessment of what the end of this two-year moratorium will mean for them. Sponsors and their partners must know what the future Medicare market will look like, and whether and how to capitalize on new emerging opportunities Medicare local PPOs offer. And they must keep in mind that the application deadline for 2009 entries is rapidly approaching.
To design effective strategies for your organization, you need to assess reimbursement rates, premiums, provider networks, medical management, benefit design, and a host of other key issues. You’ll need to know what your competitors are doing now — and what they are likely to do in the future. Medicare PPOs, with their advantages of greater choice and flexibility for beneficiaries — and potentially higher revenue streams for plans compared with HMOs — will work well for some market segments, but won’t work for others. So you’ll need tools that will permit you to assess beneficiary demand in your market. And you may need some tweaks in your marketing and member-services strategies to avoid some major pitfalls that lie ahead.
Join us on October 31 and hear two of the nation’s top Medicare managed care experts outline the details of effective strategies — and answer your questions — in such areas as:
Ways to determine how Medicare local PPOs will fare in particular markets
and in particular organizations. How to differentiate your Medicare products
from local PPOs — and your local PPOs from competitors’ PPO and other Medicare
Advantage (and supplemental insurance) products. How to alter your current
Medicare product mix for maximum results in a market that features new local
PPOs. Ways to segment your PPO market and focus your marketing messages.
Changes you may need in member services and retention strategies in light of
the re-emergence of local PPOs. Team-Wide Training at Its Best (and most cost-
and time-efficient). Gather your management team around the table on October
31 for one low single-participant price. And photocopy for each of them as
many copies of our printed materials as you need. Members throughout your
organization will get valuable strategies for dealing with the re-emergence of
Medicare local PPOs.
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