36 The Courier sun • health • OCTOBER 1, 2015 for breaking news visit www.couriersun.com ▶health Medicare Advantage rates will be stable this year Individuals receiving health insurance coverage through Medicare Advantage should see stable rates this year, according to the Centers for Medicare and Medicaid Services (CMS). The CMS estimated that the average Medicare Advantage premium will decrease by 31 cents next year, from $32.91 on average in 2015 to $32.60 in 2016. The majority of Medicare Advantage enrollees (59 percent) will face no premium increase. “Seniors and people with disabilities continue to experience stable premiums in Medicare health and drug plans while benefiting from a transparent and competitive marketplace,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “Medicare Advantage and prescription drug plans remain affordable and provide high-quality care.” Access to the Medicare Advantage program is projected to remain strong, with 99 percent of beneficiaries having access to a plan. In addition, in 2016, more Medicare Advantage plans will offer supplemental benefits for enrollees, such as dental, vision and hearing benefits. Between 2010, when the Affordable Care Act was enacted, and 2016, premiums are expected to decrease by nearly 10 percent and enrollment is projected to increase by more than 50 percent to approximately 17.4 million enrollees, which represents about 32 percent of the Medicare population. At the same time, beneficiaries are receiving higher-quality care. About 65 percent of Medicare Advantage enrollees are currently enrolled in plans with four or more stars for 2016, a significant increase from an estimated 17 percent of enrollees in such plans in 2009. Premiums in the Medicare Prescription Drug Program (Part D) will also be stable next year, it was noted. The average basic Medicare prescription drug plan premium is expected to be $32.50 per month. People with Medicare are also seeing reduced costs through both savings on covered brand-name and generic drugs and access to certain preventive services at no cost sharing. Since the passage of the Affordable Care Act, which closes the prescription drug “donut hole” over time, more than 9.8 million people with Medicare have saved over $17.6 billion on prescription drugs through July 2015 as a result of the discounts in the donut hole and rebates in 2010, for an average of $1,796 per beneficiary. Close to 50 percent of Medicare Part D prescription drug plans have received four or more stars from user reviews, according to CMS. These plans serve about one-third of prescription drug plan enrollees, compared to 27 percent of enrollees in plans with four or more stars in 2009. The Annual Election Period for Medicare health and drug plans begins on Oct. 15 and ends on Dec. 7. Plan costs and covered benefits can change from year to year. Medicare beneficiaries should look at their coverage choices and decide what options best meet their needs. Beneficiaries who need assistance can visit www.medicare.gov, call 800-MEDICARE, or contact their State Health Insurance Assistance Program (SHIP). Beneficiaries who are satisfied with their current coverage do not need to do anything. For more info on the premiums and costs of 2016 Medicare Advantage and Part D plans, visit https://www. cms.gov/Medicare/Prescription-Drug- Coverage/PrescriptionDrugCovGenIn/ index.html. Selecting a Medicare Advantage Plan Americans over age 65 are increasingly choosing the Medicare Advantage option. If you’re interested in joining them, here are some tips on how. By Hany Abdelaal, DO, President of VNSNY CHOICE Health Plans Over the past decade, the number of older Americans enrolled in a Medicare Advantage plan at any given time has soared from 5 million to over 16 million. In fact, Medicare Advantage plans, which are administered by private health insurers rather than by the federal government, now account for about one-third of all Medicare recipients. It’s not surprising that these plans, also known as MA or Medicare Part C plans, are growing in popularity. MA plans are required by law to give the same benefits as standard Medicare, and most also include added benefits above what standard Medicare provides. Many people pay nothing for their MA plans beyond their usual Medicare B premium. Even the more expensive Medicare Advantage plans carry only a modest additional premium—often under $100 per month. Every MA plan also includes a maximum annual out-of-pocket cost of $6,700 per recipient, providing a certainty that ordinary Medicare can’t match. With plentiful plans to choose from—the average Medicare recipient has access to 18 different MA plans—and flexibility to switch to another Medicare offering if desired (any Medicare recipient can change plans during Medicare’s open enrollment period of October 15 through December 7), it’s easy to see why more and more people are choosing the MA option. Determining if Medicare Advantage Is Right for You If you’re interested in exploring the Medicare Advantage option, the first step is to determine your eligibility. Virtually everyone over age 65 who qualifies for coverage under Medicare Parts A and B is eligible for Medicare Advantage, unless they have end-stage renal disease (meaning they require regular dialysis treatments). The next step is to check whether you live in an area that has Medicare Advantage plans available. As noted above, most Americans live in areas where multiple MA plans are available. With our VNSNY CHOICE Medicare plans, for example, you can enroll if you are a Medicare-eligible New Yorker living in New York City, Long Island, Westchester County, or the four upstate New York counties of Albany, Rensselaer, Saratoga and Schenectady. A third essential thing to know is whether your primary care doctor participates in any Medicare Advantage plans. Most primary care physicians are part of one or more MA networks—but if your doctor isn’t, you might have to change primary care physicians if you want to join MA (which most people are understandably reluctant to do). Which MA Plan is Best for You? If your answer to all three questions above is “yes,” then the next step is to carefully review the benefits and cost of the available Medicare Advantage plans in your home area. I strongly advise that you reach out to the individual companies offering these various MA plans to learn all the details about their offerings. One question to ask is whether the plan requires a referral from your primary care physician before you can see a specialist. You should also look into the plan’s out-of-network benefits: While all Medicare Advantage plans typically have a network of providers whose services are fully covered by the plan, some also provide a certain amount of coverage for out-of-network providers as well. Before you contact a specific plan, be sure to have a good idea of your annual income, since this will determine what subsidies you might be eligible for. Many individual insurers offer a variety of Medicare Advantage plans, with costs and benefits that may vary somewhat. Most plans have representatives available by phone or online to walk you through their offerings. At VNSNY CHOICE, our Medicare benefit representatives can be reached at our toll-free number, 888-387-4167, from 8 a.m. to 8 p.m., seven days a week, to answer your questions and arrange an in-person consultation with a representative who is fully versed in our plans. There is also an option to chat online with expert consultants on our website, vnsnychoice.org. With a range of enhanced benefits, a cap on annual out-of-pocket costs, and the care coordination and health planning services of an experienced insurance provider, the appeal of Medicare Advantage is clear. If you’re a Medicare recipient, I recommend taking a few minutes to explore the MA plans in your area. This is one instance where there’s a healthy advantage in knowing exactly what all your Medicare options are.
SC10012015
To see the actual publication please follow the link above