Archive for the ‘Miscellaneous’ Category

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Medicare expands drug coverage for cancer patients

Wednesday, January 28th, 2009

Even without the approval of the Food and Drug Administration, Medicare has expanded its coverage of drugs for cancer treatment. The push for these drugs have mostly come from doctors who believe these treatments, known as off-label uses are essential for the treatment of cancer in patients. These drugs are the most up-to-date care. Though the drugs have limited evidence that they are effective, doctors are using them on critical patients as a last hope.

People and doctors for the drug changes in the Medicare rules believe that the spending is worth it because if the drugs work, it can enhance the understanding of which drugs work and which don’t against various forms of cancer. Opponents of the changes believe that it is a waste of money and can expose people to side effects that are not known and not approved by the FDA. They also believe that doctors are using patients as guinea pigs for unproved drugs and therapies.

Medicare officials have also canceled an analysis of the costs of these changes so predictions of the amount being spent on these drugs are hard to determine. One of the products called Gemzar, costs $2,500 to $5,000 a month. The new rules can guarantee Medicare to use the drugs for many types of cancer even though the FDA has only approved it for use on 4 types of cancer.

A spokesman for the Pharmaceutical Research and Manufacturers of America said the new rules ensured “that cancer patients have access to the treatments they need.” Like this man, doctors think that they need greater flexibility since getting a drug approved can take years. Some of these people don’t have years to spare and are willing to try any drug that may help them.

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Medicare Buzz Words Everyone Should Know

Friday, January 16th, 2009

Medicare, like standard health insurance can be very confusing, especially if you don’t know what half the words mean.

  • Part A: Hospital insurance- helps pay for hospice care, inpatient hospital care, and skilled nursing facility care. Individuals are entitled to Part A if they contributed payroll taxes for 10 years or more while they worked.
  • Part B: Supplementary Medical Insurance- helps pay for physician services, outpatient care, preventive services, x-rays, diagnostic tests, and mental health services. It is funded primarily by premiums.
  • Part C: Medicare Advantage- provides care through managed care plans. Plan C provides Parts A, B, and D benefits.
  • Part D: Prescription drug plan- enrollment is voluntary and is provided by private prescription drug plans or Medicare Advantage prescription drug plans.
  • Medigap- refers to private supplemental health insurance plans sold to Medicare beneficiaries. It covers medical expenses that may not be covered by the Original Medicare plan.
  • Original Medicare- a fee-for-service plan that covers many health care services and drugs but doesn’t pay for all health care costs. There are costs such as coinsurance, copayments, and deductibles that you must pay. It includes Medicare Part A and Medicare Part B.
  • Monthly premium- a monthly payment to Medicare, an insurance company, health care plan or drug plan for health coverage.
  • Annual deductible- The amount you pay for medical services and prescriptions before your health insurance plan or Medicare plan kicks in and begins to pay.
  • Coinsurance- The amount you may be required to pay for services after you pay any deductibles.
  • Copayment- an amount you pay for services such as a doctor’s visit or specialist visits regardless of whether you have fully paid your deductible.

These are just some of the terms you should be familiar with when you are dealing with your Medicare plan or when you are choosing a Supplemental Medicare plan. They can help you to better understand the process and make an informed decision about the right plan to choose. Other ways to stay informed is to talk to your health insurance representative or carrier and stay current with insurance news.

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Some beneficiaries still have time to switch their Medicare coverage

Tuesday, January 13th, 2009

Even though the annual Medicare enrollment period ended on December 31st, some Medicare Advantage beneficiaries may still be able to switch their coverage during the current enrollment period which extends until March 31st. Under certain circumstances, beneficiaries can change their plan by March 31 if they do not think the plan they chose fits their needs.

Of course there are some disadvantages. If, as of December 31 you have prescription drug coverage, you must continue to keep the coverage. If you did not have prescription drug coverage, you cannot add it to your plan.

The main reason why individuals may want to buy supplemental Medicare coverage is because Original Medicare offers limited coverage. Adding a supplemental plan, also add extra benefits, especially for those individuals with disabilities and pre-existing conditions. Medicare Advantage plans are required to cover any individual with pre-existing conditions.

Once the current enrollment is closed on March 31, beneficiaries have limited options to switching their coverage. There are only a few reasons that an individual may be able to change their plan. These specific reasons include:

  • Turning 65 after the open enrollment period is closed
  • As determined by the Social Security Administration, any individual can join a plan three months before or after their 25th month of disability
  • Permanent home change is grounds for switching plans. If you move out of your plan’s service area, you’re eligible to switch plans.
  • If an individual move into or out of a nursing home, they can enroll in a new plan anytime during the specified year.

So if for any reason, you would like to switch your plan to best fit your needs, you still have time. Make sure you call your health insurance provider immediately to get the most out of your insurance.

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Why choose a Health Net Medicare plan over its competitors’ plans?

Thursday, December 18th, 2008

Health Net is among the nation’s largest publicly traded managed health care companies. They provide health benefits to approximately 6.7 million individuals across the country through group, individual, Medicare, Medicaid and TRICARE and Veterans Affairs programs. They are the largest provider of Medicare Advantage plans in Connecticut and they have been serving Medicare Beneficiaries in Connecticut for 25 years offering their plans in all 8 counties.

Last year they introduced their “Take Care” program which features dedicated health care advocates for its Medicare members. It’s their dedication to the community that sets them apart from other health care companies. The “Take Care” Program offers access to Decision PowerSM, a 24/7 access to Health Coaches, tools, and materials that empower

members to learn more about their health conditions and treatments and to stay healthy. “Take Care” offers support such as coordinate care for complicated conditions and coordinated care when transitioning from a hospital to home, and discounts on wellness products and services.

Health Net’s “Take Care” program also offers flu shot, customer appreciation and community events. Some of the events include Senior Wii Bowling events and the Health Net Cup. These events are offered at senior centers throughout Connecticut.

Health Net has a high retention rate with 96% of their Medicare members renewing their Health Net plans each year. 29 out of the 30 hospitals in Connecticut are in the Health Net network and they were ranked 11th nationally in the 4th annual America’s Best Health Plans rankings. Health Net has 6 Medicare plans ranging in premiums from $0 to

$179 to meet a variety of needs. Many of their plans offer low or no copayments for physician or specialist office visits, low or no copayments for preferred medications, and optional supplemental benefits.

Some of their plans, with built in prescription drug plans, are The Navy Plan, The Ruby Plan options 1, 2, and 3, and The Sage Plan. A Medicare Advantage plan without a prescription drug program is The Green Plan, and 2 stand-alone prescription drug plans with drug coverage but no medical coverage is The Orange Plan, options 1 and 2.

The Navy Plan is a Point of Service (POS) plan with a monthly premium of $179 and $0 deductible. Primary doctor co-pays are $20 and specialist co-pays are $35. The Navy plan allows the flexibility of using doctor outside of the provider network.

The Ruby Plan provides cost effective medical and prescription drug coverage in one plan and is more affordable than most Medicare Supplement plans. Option 1 has a low monthly premium of $109 with a primary doctor co-pay of $10, a specialist co-pay of $20, and a $0 deductible. The Ruby Plan option 2 has both a $0 monthly premium and deductible but with a primary doctor co-pay of $20 and specialist co-pay of $30. The Ruby Plan option 3 has a low monthly premium of $59 and a $0 deductible. The primary doctor co-pay is $15 and the specialist co-pay is $25.

The Sage Plan has a monthly premium of $119 with a $0 deductible. Primary doctor co-pays are $10 and specialist co-pays are $20. The Sage Plan is Health Net’s chronic condition Special Needs Plan that comes with $0 copayments for generic drugs.

The Green Plan, a Medicare Advantage plan with no prescription drug program, offers both a $0 monthly premium and deductible. Primary doctor co-pays are $15 and specialist co-pays are $25. This is a cost-conscious plan for those with prescription drug benefits through another plan or if you have chosen not to have drug coverage.

The Orange Plan option 1, a separate prescription drug plan with no medical coverage, has a monthly premium of $31.70 and a $295 drug deductible. Option 2, also a stand-alone prescription drug plan, has a $46.20 monthly premium and no deductible. The Orange Plan is Health Net’s Medicare Part D Prescription Drug Plan that features commonly prescribed generic and brand name drugs.

So why choose Health Net’s Medicare Advantage plans over its competitors plans? They are a faithful service to many Medicare beneficiaries throughout Connecticut, they reach out to their community by planning fun and interactive events, and they offer a variety of Medicare Advantage Plans to meet as many situations as possible.

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The Medicare Part D Open Enrollment Period is here

Thursday, December 18th, 2008

Beginning last Saturday, November 15th, the open enrollment period is here for eligible individuals of the 2009 Medicare Part D Prescription Drug Plan. The period extends through December 31st and coverage will start on January 1st, 2009. In this time period, individuals can join the Medicare Part D plan or current beneficiaries can switch from one plan to another or drop their plan altogether.

Medicare Part D Prescription Drug Coverage plan offers coverage for brand name and generic prescriptions drugs to anyone eligible for Medicare and is provided through private insurance plans. In order to be eligible for Medicare Part D, you must be entitled to Medicare benefits under Part A and/or enrolled in Part B. You must also be a resident in the prescription plan’s service area and not be enrolled in more than one Medicare Part D plan at a time. You usually pay a monthly premium and may pay a yearly deductible. Depending on the plan you select, you will also have co-pays or coinsurance for your prescriptions.

Since plans and premiums are changing, experts advise existing Medicare beneficiaries to review their current plans. Lists of covered drugs are changing and so are restrictions and costs so the plan you had for 2008 may not work for 2009. Also, new beneficiaries should look at a variety of plans to see what is best for them and their health needs. Make sure you talk to an expert and learn everything you need to know about the plan you have or are choosing because after Jan. 1, everyone is locked into their plan, with a few exceptions. The few exceptions include people who get low-income subsidies and people who have Medicare HMO or Medicare PPO private health plans.

The premiums of most plans are going up and prescription drugs that were covered last year may not be covered this upcoming year. The Centers for Medicare & Medicaid Services stated that initial deductibles for the standard benefit plan rose from $275 in 2008 to $295 in 2009. Also, beware of the donut hole. This term refers to a “coverage gap.” Within this gap, the beneficiary pays 100% of the cost of prescription drugs before catastrophic coverage kicks in. The initial coverage period covers up to $2,510 worth of prescription drugs. After the initial coverage period ends, the donut hole comes in. The donut hole lasts until you have spent $4,050 out of pocket on co-pays and drug costs. The catastrophic period is when the insurance company pays 95% of additional drug costs once you’re through the donut hole.

There are many people who can help seniors decide what to do when it comes to the Medicare part D Prescription Drug plan. For extra help and more information on Part D, you can visit the Medicare website (www.medicare.gov), call 1-800-MEDICARE, or call your local area agency. There is also a lot of information on the internet to help you in deciding on a plan.

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Have you enrolled in Medicare Part D yet?

Thursday, December 18th, 2008

The deadline for Medicare Part D enrollment is approaching fast so if you haven’t already, it’s time to review your current Medicare plan to make sure it still offers the same benefits and prescription drugs to meet your needs. Whether you want to change your current provider or you’re a new enrollee, you have until December 31 to enroll. Waiting until the last minute can cause you to face delays. This is a once a year opportunity that allows participants to choose among a variety of private insurance plans that can be custom tailored to their particular drug needs.

If you need help deciding what plan is best to fit your needs, there are many resources at your disposal to help during the open-enrollment period. In order to make an informed decision, you must know the basics first.

Medicare Advantage Prescription Drug Plans include Medicare Part A (hospital), Medicare Part B (doctor’s office visits), and Part D (prescription drug coverage). Medicare Part D plans only include prescription drug coverage and are usually purchased by people who already have Original Medicare (Part A and B).

Since the lists of covered drugs are changing as well as restrictions and costs, Medicare beneficiaries are being advised to review their current plans to make sure it will still benefit them in 2009. Because the enrollment period will soon come to a close, beneficiaries should review their plan and then begin viewing other plans and pricing. You should consider costs, doctors/providers, and travel when choosing a plan. Costs, such as premium, copayments, coinsurance, and deductible expenses, are changing. You also need to make sure that you’re able to visit the providers you want on your current plan and check to see if there will be additional costs if the provider is out of network or referrals are needed. You may also be travelling in the near future. Are you drugs covered if you travel to another state? You should make sure that your plan provides coverage in other states.

According to the Centers for Medicare and Medicaid (CMS), average monthly premiums for standard Part D coverage will be $28 in 2009, as opposed to the $25 in 2008.

What do you need to do when considering Medicare Part D plan?

1) Assess your needs. What prescription drugs are crucial to your life style?

2) Consult your doctor and pharmacist. Make sure they are still in your network under the plans you are considering.

3) Review all plans and prices to see which is best fit for you.

The Open Enrollment period for Medicare Part D ends on December 31st which gives you two more weeks to make some very important decisions. Plans begin on January 1, 2009 and late charges and penalties may apply if you wait too long.

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Have you enrolled in Medicare Part D yet?

Thursday, December 18th, 2008

The deadline for Medicare Part D enrollment is approaching fast so if you haven’t already, it’s time to review your current Medicare plan to make sure it still offers the same benefits and prescription drugs to meet your needs. Whether you want to change your current provider or you’re a new enrollee, you have until December 31 to enroll. Waiting until the last minute can cause you to face delays. This is a once a year opportunity that allows participants to choose among a variety of private insurance plans that can be custom tailored to their particular drug needs.

If you need help deciding what plan is best to fit your needs, there are many resources at your disposal to help during the open-enrollment period. In order to make an informed decision, you must know the basics first.

Medicare Advantage Prescription Drug Plans include Medicare Part A (hospital), Medicare Part B (doctor’s office visits), and Part D (prescription drug coverage). Medicare Part D plans only include prescription drug coverage and are usually purchased by people who already have Original Medicare (Part A and B).

Since the lists of covered drugs are changing as well as restrictions and costs, Medicare beneficiaries are being advised to review their current plans to make sure it will still benefit them in 2009. Because the enrollment period will soon come to a close, beneficiaries should review their plan and then begin viewing other plans and pricing. You should consider costs, doctors/providers, and travel when choosing a plan. Costs, such as premium, copayments, coinsurance, and deductible expenses, are changing. You also need to make sure that you’re able to visit the providers you want on your current plan and check to see if there will be additional costs if the provider is out of network or referrals are needed. You may also be travelling in the near future. Are you drugs covered if you travel to another state? You should make sure that your plan provides coverage in other states.

According to the Centers for Medicare and Medicaid (CMS), average monthly premiums for standard Part D coverage will be $28 in 2009, as opposed to the $25 in 2008.

What do you need to do when considering Medicare Part D plan?

1)Assess your needs. What prescription drugs are crucial to your life style?

2)Consult your doctor and pharmacist. Make sure they are still in your network under the plans you are considering.

3)Review all plans and prices to see which is best fit for you.

The Open Enrollment period for Medicare Part D ends on December 31st which gives you two more weeks to make some very important decisions. Plans begin on January 1, 2009 and late charges and penalties may apply if you wait too long.

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