WHAT'S NEW IN MEDICARE?

Medicare Advantage Plans

Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:

Medicare Health Maintenance Organization (HMOs)

Preferred Provider Organizations (PPO)

Private Fee-for-Service Plans

Medicare Special Needs Plans

When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.

If you join a Medicare Advantage Plan, your Medigap policy won’t work. This means it won’t pay any deductibles, copayments, or other cost-sharing under your Medicare Health Plan. Therefore, you may want to drop your Medigap policy if you join a Medicare Advantage Plan. However, you have a legal right to keep the Medigap policy.

Chronic Illness Plans

Chronic Illnesses include:

Asthma

Diabetes

Dementia

Hypertension

Arthritis

COPD (Chronic Obstructive Pulmonary Disease)

CVD (Cardio Vascular Disease)

CHF (Congestive Heart Failure)

Chronic Illness Plans offer members and their families continuity of care, which helps bring confidence and peace of mind to their health care needs. By maintaining an advanced technological system that tracks patients' medical history and recent conditions for the duration of their relationship – whether that is one year or 20 years – these plans help simplify the complex and fragmented health care system.

Records are frequently updated by Nurse Practitioners and Care Managers who visit patients regularly and provide updates for family members. This ongoing case management helps ensure members do not have to repeat or answer the same questions each time they need care.

Research shows that this approach to care improves access to medical and non-medical services, helps health outcomes, and lowers costs to the government. Teamwork among health professionals and continuity of care have been shown to reduce preventable emergency room visits by half and hospitalizations by 45%.

MSA Advantage Plans

Medicare began offering beneficiaries the option of consumer-driven health plans for the first time in 2007, a move likely to accelerate the push for cost and quality data on providers. The Centers for Medicare and Medicaid Services (CMS) announced that Medicare Advantage enrollees will have access to medical savings accounts and to more flexible, health savings account-like plans. Under the MSA option, Medicare will pay for a high-deductible insurance plan and put money into a tax-free MSA for participating beneficiaries. After the annual deductible, the insurance plan will pay for Medicare-covered services; amounts not used in the MSA will carry over year-to-year for use on future qualified medical expenses.

5 Ways to Lower Your Costs During the Prescription Drug Coverage Gap

Consider Switching to Generics, Over-The-Counter (OTC), or Other Lower-Cost Drugs

You may wish to talk to your doctor about the drugs you are currently taking to find out if there are generic, over-the-counter (OTC), or less-expensive brand-name drugs that would work just as well as the ones you're taking now.

Cost savings information through the use of mail-order pharmacies, generic or less-expensive brand-name drugs is also available in the Prescription Drug Plan Finder section of www.medicare.gov

Explore National and Community-Based Charitable Programs

National and community-based charitable programs (such as the National Patient Advocate Foundation or the National Organization for Rare Disorders) may have programs that can help with your drug costs. Information on programs in your area is available on the Benefits Checkup website.

Look into Pharmaceutical Assistance Programs

Many of the major drug manufacturers are offering assistance programs for people enrolled in Medicare Part D.
You can find out whether a Patient Assistance Program is offered by the manufacturers of the drugs you take by visiting our Pharmaceutical Assistance Program site.

Look at State Pharmaceutical Assistance Programs

There are also 21 states and one territory offering help with paying drug plan premiums and/or other drug costs.
You can find out if your State has a program by visiting our State Pharmaceutical Assistance Program site.

Apply for Extra Help

If you have Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. If you qualify, you could pay between $1-$5 for each drug. Contact Social Security by visiting www.socialsecurity.gov or by calling 1-800-772-1213. TTY users should call 1-800-325-0778

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