Erickson Tribune

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UPDATED: Wednesday, November 07, 2007

Focus on Medicare

Posted on Monday, October 29, 2007
 

By Lisa Rademakers
THE ERICKSON TRIBUNE

“Medicare Advantage plans are the way of the future,” says Dorothy Schulz, manager of a Medicare Advantage health insurance plan offered only to residents in Erickson communities. Today there are more than 600 Medicare Advantage plans—more than double the number available in 2004.

“Beneficiaries have more choices for their health coverage than ever before,” says Michele Strollo, Dr.P.H., principal policy analyst at the Kaiser Family Foundation.

Also known as “Part C” of Medicare, Medicare Advantage plans provide Part A (hospital) and Part B (medical) coverage. A Medicare Advantage plan is formed when health insurance companies contract with Medicare to provide health benefits to Medicare beneficiaries, with the idea that private companies can better manage people’s care.

According to the government handbook, Medicare and You 2007, the premiums, co-pays, and deductibles can be lower for a Medicare Advantage plan than in Original Medicare (health coverage provided by the government for those 65-plus) or with a Medigap policy. Medicare Advantage plans usually offer extra benefits, and many include prescription drug coverage at a lower cost. “Not all, but most offer transportation too,” Schulz adds.

Reasons for the trend
In many ways, these plans provide advantages for beneficiaries— hence, the name Medicare Advantage. According to the BlueCross BlueShield Association, Medicare Advantage plans encourage prevention and care coordination services; reduce financial barriers to care; and foster quality of care and satisfaction among members.

Medicare Advantage plans place a strong emphasis on preventive health care services or services that aim to prevent illness, keep people healthy, and emphasize early detection of diseases. “They want you to stay healthy and independent, so they provide coverage for preventive services,” Schulz says.


Medicare Advantage plans

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Additionally, Medicare Advantage plans often provide care coordination or the organization of health care services between different providers. Care coordination can help manage your overall care, as well as save you money, states Medicare and You 2007.

Many Medicare Advantage plans designate a primary care provider to be responsible for your care coordination efforts. A single point of contact can help eliminate duplicate services—like tests and prescriptions.

Specifically, the BlueCross BlueShield Association reports that Medicare Advantage plans can better emphasize care coordination for those who can benefit from it most—people with chronic (ongoing) conditions like asthma or diabetes.

“Because of the tremendous importance of early intervention in treating chronic illnesses, Medicare Advantage plans’ focus on prevention and care coordination and management provides beneficiaries with additional tools to help them manage their health more effectively,” concluded the BlueCross BlueShield Association’s report.

Research results are in
The research on Medicare Advantage plans has shown promising results. The Kaiser Family Foundation found Medicare Advantage enrollees are generally in better health than beneficiaries in traditional Medicare. This suggests Medicare Advantage plans may be attracting healthier beneficiaries.

One of the national Medicare Advantage plans increased the number of preventive screening tests for colorectal cancer by over 9%. Another Medicare Advantage plan reduced inpatient admissions for heart failure patients and emergency room visits by about 20%.

While the health outcomes appear positive, so does member satisfaction. All of the respondents in a phone survey of members in Erickson’s Medicare Advantage plan said they were satisfied, very satisfied, or extremely satisfied with their plan. Another survey found what members value most are the low costs and free transportation.

Another survey of people with a Medicare Advantage plan found 75% of enrollees would recommend a Medicare Advantage plan to their friends or family members. A separate survey found 99% of members would recommend them to other people.

May not be for everyone
There is much to think about when considering a Medicare Advantage plan. As Strollo states, “Medicare Advantage  plans typically offer additional benefits to enrollees… However, plans may vary the cost-sharing requirements and could, for example, offer lower co-payments for physician services but higher fees for hospital or nursing home stays than traditional Medicare.”

The out-of-pocket costs with Medicare Advantage plans depend on many factors, including individual medical needs and the particular plan. So it’s important to understand the details of a plan before you join.

For some tips on comparing health insurance options, see the article, “What is a Medicare Advantage plan?” on www.EricksonTribune.com.

Only you or  someone you trust can ultimately decide if a Medicare Advantage plan is the best option for you. “If you can get the same benefits, and the same level of care for less money, why not?” Schulz asks. “Good insurance does not have to cost a lot of money.”

Editor’s note: Next month, the Tribune will discuss longterm care coverage.



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