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Is Medicare Advantage still a good choice?

Created date

September 20th, 2011

For many Medicare beneficiaries, a Medicare Advantage plan has become an attractive option for health care coverage. According to the Henry J. Kaiser Family Foundation, 11.8 million (nearly one out of every four Medicare beneficiaries) are enrolled in Medicare Advantage plans. These plans are formed when health insurance companies contract with Medicare to provide health benefits to Medicare beneficiaries, with the idea that private companies may often enhance basic Medicare benefits with preventive care options and other services to better manage people s health care. These private insurance companies are Medicare-approved and under contract with Medicare. Also known as Part C of Medicare, a Medicare Advantage plan includes both Part A (hospital) and Part B (medical) coverage and usually provides other benefits like prescription drugs. These plans always cover emergency and urgent care and must include all the services that Original Medicare covers. Typically, Medicare Advantage plans may offer additional coverage such as vision, hearing, dental, or health and wellness programs. In addition, these plans often provide care coordination or the organization of health care services between different providers. According to the official U.S. government website for Medicare, most Medicare Advantage plans have lower co-payments than in the Original Medicare Plan. Out-of-pocket costs with Medicare Advantage plans, however, can depend on many factors including individual medical needs and the particular plan so it s important to thoroughly understand a plan s details before joining. The Medicare Advantage 2011 Data Spotlight prepared by the Henry J. Kaiser Family Foundation reports that premiums will, on average, increase by about 5% this year, as opposed to an average 22% increase from 2009-2010. Some plans will have no change in their premiums and some will actually decrease for 2011. Erickson Advantage members had no premium increases last year, says Penny Folden, vice president of sales and service for Erickson Advantage. Erickson Advantage is a Medicare Advantage plan exclusively for residents of Erickson Living communities.

Health care reform changes that may affect you

The Affordable Care Act (ACA) of 2010 requires Medicare Advantage plans to limit beneficiaries out-of-pocket expenses. In addition, 53% of plans will offer some coverage in the prescription drug coverage gap (the Medicare Part D doughnut hole ). Enrollees in these plans will receive a 50% discount on brand-name drugs, and additional coverage of generics will be phased in gradually. The ACA originally called for a $145 billion cut to Medicare Advantage plans. As a result, beneficiaries were expected to receive fewer services and higher out-of-pocket costs. Now the U.S. Health and Human Services Department will instead award $6.7 billion to plans as quality bonuses. This policy change may head off service cuts, at least for the short term, Folden says. The goal of this cash infusion is to help plans be more efficient and ultimately save money for everyone. The quality bonus payments are based on factors such as how well doctors manage chronic diseases and if their patients health is improving over time, says Daniel Feirtag, M.D., vice president, Erickson Advantage medical director. They also look at whether a particular plan has a substantial amount of complaints from patients. In the 2010 National Benchmark Comparison of Health Plans, Erickson Advantage scored 10 to 15 points higher than the competition on questions regarding overall member satisfaction with the health plan, overall value of the plan, likelihood of a member to recommend Erickson Advantage to others, and likelihood to continue current coverage, Folden says. Our member service representatives, nurse care coordinators, and health insurance resource managers at each Erickson Living community also received strong satisfaction scores. According to our member satisfaction survey, 92% of Erickson Advantage members say they are likely to continue their coverage, Folden adds.

Get a head start

Review your health plan options now because you can enroll earlier this year. Medicare s Annual Election Period begins on October 15, 2011, and runs through December 7, 2011, Folden says. According to the Henry J. Kaiser Family Foundation, the average Medicare beneficiary in 2011 has 24 Medicare Advantage plans available in their area. Whether or not you are satisfied with your current coverage, it can be beneficial to check out alternatives and compare options. Erickson Living residents can visit their on-site Erickson Advantage licensed sales agent who can assist in comparing the costs and benefits of different plans. Outside of Erickson Living communities, Medicare beneficiaries can get in touch with their local Senior Health Insurance Assistance Program (SHIP) office. To find your local SHIP office, contact your state s Department of Aging or Insurance Administration. Erickson Advantage ' is insured through UnitedHealthcare Insurance Company and its affiliated companies, a Medicare Advantage organization with a Medicare contract.H5652_110817_114458 File & Use 08302011.