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FOR BREAKING NEWS VISIT www.couriersun.com NOVEMBER 6, 2014 • HEALTH • The Courier sun 3 Medicare Advantage Plans Offer Options That Original Medicare Doesn’t By Alexander Clague, Humana Northeast President for Senior Products One of the best things about health care in the U.S. is the availability of multiple options when seeking the coverage and quality care we need. The challenge many of us face is sifting through those options to determine which one best meets our own individual health needs. This is particularly true for people who are studying different Medicare plans and trying to determine which one provides the best balance of cost, access and care. Medicare’s Annual Election Period (AEP) starts on October 15, and for those who have Medicare (or are caring for someone who does), now is the time to explore what’s available this year. Millions of Americans who want more than Original Medicare offers select a Medicare Advantage plan. Both cover essentials like check-ups, hospitalizations and emergency care. Medicare Advantage plans are worth a close look because of the more comprehensive array of options they offer to help people maintain and improve their health. Many Medicare Advantage plans, for instance, include coverage for prescription drugs. (However, for those who do go with Original Medicare, another option is to purchase a Medicare Supplement Plan – also called a Medigap plan – and/or a stand-alone Medicare prescription drug plan to help cover costs that Original Medicare doesn’t cover.) What is making Medicare Advantage increasingly popular for people with Medicare? With these plans, you get all the benefits of Original Medicare … and more. For instance, some Medicare Advantage plans offer: • Choice of a primary care physician in the plan network; • Affordable monthly plan premium; • Prescription drug coverage equal to or better than the standard requirement for a Medicare Part D plan; • Affordable copayments for doctor visits and annual routine physicals; • Emergency coverage anywhere in the world; • Coverage for most annual screenings at no charge; and • Extra benefits on some plans such as dental, vision, a nurse-advice line, and health and wellness programs – a gym membership, for instance. About 15 million Americans have Medicare Advantage plans and customer satisfaction is high. A 2013 survey by North Star Opinion found that among Medicare Advantage beneficiaries, 90 percent or more: • Are satisfied with their plans; • Satisfied with the quality of care provided by physicians in the plan’s network; and • Satisfied with the benefits received in their Medicare Advantage plan In addition, Medicare Advantage is evolving with the health care system by adopting what’s known as Accountable Care. Under this model, all the stakeholders in a person’s health – the doctor, the pharmacy, the insurer, the caregiver (in some cases), and the patient him- or herself – team up to help ensure that the patient is receiving effective care. The goal is that more appointments are made and kept, regimens followed and that everyone is working together. In the Accountable Care model, which is in wide and growing use among Medicare Advantage plans, your doctor’s pay is often tied to how his or her treatment positively impacts your health. In the model still employed throughout Original Medicare (a system also known as Fee-For-Service), that isn’t the case. There, health care providers’ compensation rests on the volume of patients and procedures, not on the outcomes. Extensive health care research indicates this method doesn’t offer patients optimal care. Which approach sounds better to you? The truth is that with Medicare Advantage, you’re partnering with a private insurer whose resources are there to help you. A study published in the journal Health Affairs in 2013 found that patients with Medicare Advantage plans did better than those with Original Medicare in terms of obtaining breast cancer screenings, diabetes care, and cholesterol testing and control. Another study published in the American Journal of Managed Care in 2012 found that people who had Medicare Advantage plans had hospital readmission rates up to 20 percent lower those who had Original Medicare. At Humana, for example, we provide our members with guidance and support through programs like Humana At Home care coordination. We also offer useful information, like the Humana SmartSummary, which serves as the health equivalent of a bank statement. SmartSummary details the member’s medical and prescription drug activity to help people keep track of the steps they’re taking and the costs they’re incurring to protect their health. If you or someone you care for has Original Medicare today, you can enroll in a Medicare Advantage plan during the upcoming Annual Election Period. Make no mistake – this is an important decision that’s worth studying. You might want to review your records to see how much you’ve spent on health care during the past year. (Be sure to include hospital expenses, pharmacy costs and doctor bills.) Determine if the past year is typical and try to give your best estimate for the year ahead. The Medicare website – medicare.gov – allows you to find and compare Medicare health and prescription drug plans in your area. Of course, cost is an issue, but so is access and convenience, particularly for anyone with chronic health conditions. Remember that whatever plan you choose will, in most cases, be yours for all of 2015. So I encourage you to do your research and choose carefully. Find a company you can trust to be a reliable health partner. The Medicare AEP runs from October 15 through December 7. For additional information, please visit Humana-Medicare.com. ADVERTORIAL


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