Medicare Advantage health plan members can disenroll and return to Original Medicare from January 1 to February 14, 2011. This period is called the Medicare Advantage Disenrollment Period (MADP).

Regardless of whether your current Medicare Advantage plan included Part D drug coverage (PDP), you may disenroll during the MADP and will be eligible for a Special Enrollment Period (SEP) to enroll in Part D prescription drug plan. The effective date of a disenrollment request using MADP will be the first of the month following the date of the request. For example, a request made in January would be effective February 1.

Current Medicare Advantage-only (MA) plan members have three options:

1. Disenroll from the MA-only plan and return to Original Medicare
2. Disenroll from the MA-only plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-only plan

Current Medicare Advantage with Part D prescription drug (MA-PD) plan members have three options:

1. Disenroll from the MA-PD plan and return to Original Medicare
2. Disenroll from the MA-PD plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-PD plan

Current Medicare Advantage-only Private Fee-For-Service (PFFS) plan members (PFFS plans without Part D prescription drug coverage) have two options:

1. Disenroll from the PFFS plan and return to Original Medicare
2. Disenroll from the PFFS plan, return to Original Medicare AND use the SEP to enroll in a PDP plan

NOTE: PFFS members must first request disenrollment from the plan before requesting enrollment in a PDP.

If you have questions, call the Health Plan One Medicare expert at 1-800-328-7305.

The president will be using these to close your coverage gap.

1.)    The phrase “doughnut hole,” or “donut hole” if you prefer Dunkin Donuts to your average breakfast fare, refers to the coverage gap for seniors on Medicare prescription drug plans. After a prescription drug plan (PDP) pays a certain amount of cash for a beneficiary’s medication, the beneficiary is then responsible for paying out of pocket until they reach spending that requires catastrophic coverage, after which the plan will help cover prescriptions for the rest of the year.

2.)    AARP’s Doughnut Hole Calculator is a great tool that can help you avoid the doughnut hole. Type in the specifics about the drugs you need to generate a report for the year that will tell you if you are likely to hit the gap. If you are deemed likely to hit the gap, the calculator can show you alternatives that can reduce costs. It isn’t an instant cure-all, but knowing your needs can work wonders in closing your personal doughnut hole.

3.)    Some prescription drug plans cover generics within the gap, but often come with more expensive premiums. Remember, not all plans cover generics in the gap, so it’s crucial to understand what exactly your PDP or Medicare Advantage page covers.

4.)    In early June, the Department of Health and Human Sources sent out $250 doughnut hole rebates to seniors who fall into the coverage gap.  You’ll receive the checks automatically after you enter the doughnut hole, but keep record of prescription medication as backup just in case you don’t receive your rebate for some reason.

5.)    Scammers are preying beneficiaries who receive doughnut hole checks—which I like to think of as Munchkins. Remember, you don’t need to get your money through a third party, and you don’t have to tell anyone any personal information to receive a check. The Consumer Reports Money blog has a great overview of these scams. Help yourself or a loved one avoid fraud.

6.)    By 2020, the government hopes to close the doughnut hole completely. In 2011, the government will begin providing drug discounts to beneficiaries enrolled in Part D plans. Discounts will increase until 2020, when the doughnut hole will look more like a Boston cream doughnut than a regular ring doughnut.

While prescription drug plans can sometimes control costs, the wide expanse of the doughnut hole can really put a hurting on your wallet. Hopefully health care reforms will truly eliminate the coverage gap for seniors. Until then, the government will be taking baby steps to reduce drug costs for people with Medicare.

CIGNA will still accept clients enrolling during their individual election period (those aging in to Medicare or newly eligible to Medicare) and those with a Special Enrollment Period. Current clients who have CIGNA Medicare Access PFFS will not see a change in their 2010 benefits. They will continue to have coverage for the entire year. There will be no changes in benefits due to this decision.

Please note this does not effect plans such as CIGNA Medicare Rx, CIGNA Medicare Select Plus Rx, or any of CIGNA’s other medical or pharmacy plans.

Medicare is broken down into 4 parts: Medicare Part A, Medicare Part B, Medicare Part C or Medicare Advantage, and Medicare Part D.

Medicare Part A is the Original Medicare. You are automatically enrolled in the Original Medicare Plan which is managed by the federal government. Medicare Part A is the hospital insurance. It covers inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care. You don’t usually have to pay a premium for Part A because the individual paid Medicare taxes while working.

Medicare Part B is a medical insurance offered by the federal government to eligible beneficiaries. Medicare Part B covers physician services, non-physician services, diagnostic tests, lab services, and ambulance transportation. Preventative care is also covered by Part B. Most people have to pay a premium for Part B.

Medicare Part C, or Medicare Advantage is a combination of Part A and Part B. Medicare Advantage plans are private health plans provided by private insurance companies. Part C is an alternative to Original Medicare and offers extra benefits. Part C plans include Medicare Health Maintenance Organization (HMO), Medicare Preferred Provider Organization (PPO), Medicare Private Fee for Service (PFFS), and Medicare Medical Savings Account (MSA).

Medicare Part D is a prescription drug coverage that helps pay for outpatient prescriptions drugs. You can either add Part D to your Original Medicare Plan or join an HMO or PPO that includes Part D coverage.

Just like choosing health insurance, Medicare insurance should be tailored to your needs. You can choose a plan based on premiums and out of pocket costs, additional benefits, whether referrals are needed, and whether the doctor you currently have is in network or out of network. After you have researched and gathered all the information necessary to make an informed decision, it is then time to choose from a variety of plans that suit your needs.

• 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.

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 Power^SM, 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 11^th nationally in the 4^th 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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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.

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 31^st 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.

Anyone who is eligible for Medicare Part A and/or Medicare Part B is eligible to join the Aetna Medicare Rx- Costco Plus plan if the service is available in their state. The Aetna Medicare Rx- Costco Plus plan benefits include $0 deductible and $0 preferred generic prescription drug co-pay. The plan premiums range from $50 to $70 a month, depending on the region. It also provides coverage for all Medicare-approved Part D prescription drugs and coverage for preferred generic prescription drugs in the “coverage gap.” Save at Costco pharmacies on prescription drugs and get enhanced coverage for generic benzodiazepines and barbiturates, prescriptions that are not covered by Medicare Part D. Maximum co-pays for generic prescription drugs filled at Costco are $5, if nothing at all.

The difference between original Medicare plans and the Aetna Medicare Rx- Costco Plus plan is that most drugs are not covered under original Medicare. The Aetna Medicare Rx- Costco Plus plan uses a formulary which is a list of drugs covered by your plan to meet patient needs.

Information on the plans are available on the Costco website (www.costco.com) , in the Costco Connection member magazine, and in-warehouse displays and literature on the plans. These materials are available to help educate Costco members on the new product. To enroll in these plans, you can use the Aetna website, Costco website, or over the phone with Aetna and Costco sales representatives.

‘”Aetna is committed to finding cost-effective solutions through all of our Medicare plans,” said Frank McCauley, head of Aetna’s Consumer Business Segment. “Teaming up with Costco, which is known for providing great value to its customers, gives us a great opportunity to reach a significant number of Medicare beneficiaries with an innovative prescription drug plan.”