The Connecticut Consumer’s Guide to 2011 Medicare Advantage
The Annual Enrollment season for Medicare Advantage plans begins November 15. Over the next few weeks, health insurance companies will be communicating with seniors about their 2011 Medicare Advantage plan offerings. Whether you’re just turning 65 or you already have a Medicare plan, understanding the different options and choosing the right plan can be a daunting task.
Medicare is divided into three main categories – Original Medicare, which is managed by the federal government, and Medicare Advantage and Medicare supplement – or Medigap – plans, which are offered through private health insurance companies.
Original Medicare is composed of three sub-categories – Part A, which covers hospital expenses, Part B which covers doctors’ expenses, outpatient care and some other medical services not covered under Part A, and Part D, which covers prescription drugs. Costs vary for each of these. While Part A is usually provided with no monthly premium, Part B premiums are usually about $115 per month, except for higher-income individuals and Part D premiums range from $40-100 per month based on the drug plan you choose. There is a 20% coinsurance for Original Medicare and the current Part B deductible is $162.
In addition to enrolling in traditional Medicare, seniors may also choose to add benefits through Medicare Advantage or Medicare supplement plans. Since Original Medicare has deductibles and coinsurance, seniors may purchase a supplement plan to pay a portion or all of those out-of-pocket costs. Alternatively, they may opt to enroll in a Medicare Advantage plan – choosing between HMO, POS and PPO plan types. Typically Medicare Advantage plans offer more extensive benefits than Original Medicare, including annual physical exams and routine hearing and vision exams, at additional low monthly premiums, although they usually require physician and hospital copayments. Medicare Advantage plans typically include a Part D drug plan.
Is Medicare Advantage the Best Option for You…?
Choosing Between an HMO or PPO/POS Plan
HMO, POS and PPO plans differ primarily by cost and network, so it pays to invest time in deciding what you want and what you can pay when making your final decision. While HMOs may have the lowest monthly premiums, plan members may only be able to access care from their carriers’ network, except in the case of emergency care. And, while some Medicare HMO plans may have no monthly plan premium and include a Part D drug plan, it may have significant hospital and surgery copays. Often, the most popular Medicare Advantage HMO plans cost between $100-150 in monthly premiums and have low inpatient hospital copays.
For seniors who do not want to be restricted by a limited HMO network, such as those individuals who travel a lot, a Medicare PPO or POS plan might be a good alternative (PPO and POS plans are equivalent). While these plans often offer the same overall benefits as HMOs, higher monthly plan premiums and greater cost-sharing for out-of-network services allow greater flexibility in accessing health care. Seniors insured under a PPO/POS plan are not restricted by a network.
There are no private fee for service – or PFFS – plans available in 2011.
What’s Different from 2010
Seniors living in Connecticut will be able to choose from many Medicare Advantage plans, including 23 from the major carriers. The competitive landscape is much different than 2010, where Health Net, the largest and longest serving Advantage company in Connecticut, was purchased by United Healthcare. United introduced a plan to look like the popular Health Net Ruby II plan, and is automatically renewing Health Net members in a similar United plan. So seniors with Health Net in 2010 should carefully review their new United plan and network. United directories do not have Bridgeport and Greenwich hospitals as in-network, but United representatives say that those hospitals will join the network on January 1, 2011. One other big change in 2011 is that Aetna is currently under sanction by CMS and may not be eligible to sell plans during the annual enrollment period. However, existing Aetna members can renew into the plan.
ConnectiCare will be offering four HMO plans and two PPO/POS plans to residents in all Connecticut counties. Anthem is offering four HMOs for Fairfield, Hartford and New Haven counties, while United Healthcare is offering one PPO to residents in all Connecticut counties and an HMO only in New Haven County.
In 2010, HealthNet had one of the most popular HMO plans in Connecticut, prompting many ConnectiCare HMO members to switch carriers last year. However, it is worth noting that both the ConnectiCare networks do not extend outside of Connecticut for its Medicare Advantage members.
For residents in Fairfield, Hartford and New Haven counties, Anthem has a highly competitive plan options. ConnectiCare remains a strong choice, with its competitively priced POS plans. With moderately low physician and hospital copays, ConnectiCare’s POS plan also may be good options.
Or You May Consider a Medicare Supplement Plan?
Medicare supplement options may certainly be described as an alphabet soup of coverage, ranging from Plan A to Plan N. Like Medicare Advantage, Medicare supplement plans are sold by private insurers but these plans are primarily designed to help individuals fill payment gaps.
While these plans typically have higher monthly premiums, Medicare supplement plans pay your share of the costs of Medicare-covered services thus eliminating or reducing out-of-pocket payments, including co-insurance, deductibles and Part A and B premiums. These are separate from Medicare Advantage, employer- or union-sponsored group coverage, Veterans Administration benefits or TRICARE for military personnel and their families, so come with no value-added benefits. Enrollees would have to purchase a stand-alone Part D drug plan, as none are offered as part of these plans.
While many smaller insurers offer Medicare supplement plans in Connecticut, two plan options from major insurance carriers are worth considering based on their monthly premiums – UnitedHealthcare/AARP Plan N ($154/month) and United of Omaha Plan F ($219/month). Enrollees would have to purchase a stand-alone Part D drug plan, as they are not offered as part of supplement plans.
How Should I Decide?
With so many options available to seniors in Connecticut, it may be difficult to identify the one plan that is best for you. Earlier, we discussed price, which in the case of Medicare supplement plans, should guide your decision since benefits are identical. While some states do allow for different pricing based on age and gender, Connecticut does not.
For Medicare Advantage Plans, the quality and breadth of the physician and hospital networks, as well as value-added benefits, should also be taken into consideration. Are you sure your physician is in your plan’s network? Does your physician admit to hospitals that also are in the carrier’s network? For example, if your physician only admits to Norwalk Hospital in Fairfield County, it may be worth noting that only one health plan has Norwalk Hospital in its Medicare Advantage network. The size and quality of an insurer’s network is not critical for individuals purchasing Medicare supplement plans because there are no networks tied to these plans.
In addition to ensuring that your prescription medication is covered under a Part D or Medicare Advantage plan, you need to know what tier your health insurer has placed your drugs in, as different pricing tiers will impact your out-of-pocket costs.
Important Dates
- November 15 – Annual enrollment season begins
- December 31 – Annual enrollment season ends
Professionals Here to Help
For more information or to answer questions regarding specific plans, in addition to any concerns regarding Part D drug coverage, please visit www.medicaresolutions.com or www.healthplanone.com or call 1-877-270-0612.
