7 Frequently Asked Questions During 2012 Medicare Annual Enrollment Period

 

MAYNARD, MA--(MONTH DAY, YEAR) – The 2012 Medicare Annual Enrollment period is underway, and PlanPrescriber (www.planprescriber.com), a wholly-owned subsidiary of eHealth, Inc. (NASDAQ: EHTH), has published a list of seven questions most Medicare beneficiaries and their caregivers are asking when they get on the phone with a licensed eHealthInsurance agent. eHealthInsurance maintains customer care centers staffed with licensed agents in Utah, Massachusetts and California.

 

Question 1: Are Medicare Advantage plans going away? Agents at eHealth’s customer care centers report that ongoing national debates on health care reform and government spending have some people concerned about the future of the Medicare program and– in particular – their specific Medicare Advantage plans. In some cases, when a plan does not renew or is changed, callers assume the changes are happening everywhere.

 

Answer: No, in fact there was very good news about the Medicare Advantage program this year. Overall, Medicare Advantage plan premiums are down 4% for 2012¹. Medicare Advantage plans offering prescription drug coverage and a cap on your out-of-pocket costs –benefits not provided by original Medicare – continue to be available for $0 per month throughout most of the country.

 

Question 2: Will my Medicare Part B premiums increase more than my Social Security cost of living adjustment? Many who collect Social Security are also on Medicare. Many are concerned that the Social Security cost-of-living-adjustment (COLA) would be effectively offset by increases in their monthly Medicare Part B premiums. Increases for both were made public in October, but many callers did not hear the news, or had heard rumors they wanted to confirm.

 

Answer: In October, the Social Security Administration announced that Social Security beneficiaries would get a 3.2% COLA adjustment². Shortly thereafter, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare Part B premiums would increase 3.6%, from $96.40 to $99.90³, for people who had been on the program since 2008. People new to Medicare Part B in the last two years who earn $85,000 or less per year will pay $115.40 in 2012. For that group, this is a $0.10 decrease from 2011.

 

Question 3: Is my doctor still accepting my Medicare Advantage plan? Is my hospital covered by this plan? According to agents, access to physicians is always a concern for people on Medicare. Many callers also ask about hospitals and hospital networks. Across the board, agents report that customers want to be very certain that they can continue to have access to their current doctor and their local hospital before they select a plan.

 

Answer: While finding a physician who accepts Medicare can be an issue, CMS continues to monitor the quality and access standards of Medicare Advantage plans. A good agent can help the customer review the physicians who are accepting their Medicare Advantage plan in their ZIP code.

Question 4: How does the Part D / Part C drug coverage work? Agents tell us that the callers who are on a larger number of prescription drugs tend to have a lot of questions about their drug coverage. In many cases, callers want to get a “refresher” on how the prescription drug “donut–hole” works. They also want to know if there’s a plan that helps them avoid the donut hole and if they can avoid changes in their medications when enrolling in a new plan.

 

Answer:  The answer varies depending on a person’s circumstances. A person’s actual drug plan costs will vary depending on the six following criteria, and possibly others as well: 1) what prescriptions they use; 2) whether their plan covers those drugs; 3) which plan they choose; 4) which pharmacy they use; 5) if the drugs they take are covered on their drug plan’s formulary (list of approved drugs); and 6) whether or not they get Extra Help paying your Part D costs. The PlanPrescriber.com Prescription Drug Plan comparison tool was built to help individuals more easily answer this question for themselves.

 

Question 5: How do Medicare Advantage HMOs work? In most parts of the country, Medicare Advantage HMO plans with $0 monthly premiums often available. But many people who enroll in Medicare have never been a part of an HMO before, so they have questions about HMOs and how they work.

 

Answer. HMO stands for Health Maintenance Organization. HMOs are managed care organizations that provide a form of health care coverage. HMOs coordinate a patient's health care according to the regulations of the patient's selected health plan. Health care providers are contracted with the HMO to provide care as outlined by CMS and the HMO's guidelines for each health care plan.

When it comes to Medicare, HMOs can be a terrific option. Because the plans coordinate care, they often do an excellent job of managing chronic illnesses and providing a cohesive care delivery system. The plans are also regulated by CMS.

Question 6 (From Caregivers): How do I avoid unexpected bills? An increasing number of people in their 30’s, 40’s and 50’s are caring for older parent’s who are on Medicare. These people are often referred to as “caregivers” in Medicare parlance. Agents report that caregivers are typically concerned about unexpected bills from hospitals or insurance companies, and they want to know how to avoid surprise medical bills.

 

Answer: This aversion to unexpected costs often leads caregivers to enroll their loved-ones in a Medicare Supplement plan instead of a Medicare Advantage plan. Both types of coverage have their benefits. One benefit of a Medicare Supplement plan is that they typically cover most out-of-pocket costs. But, the monthly premiums can cost in excess of $200 per month ($2,400 each year). And, the Supplement plans do not include the cost of their loved-one’s Medicare Part B premium, or the separate monthly premium for prescription drug coverage. By comparison, Medicare Advantage plans are available at no additional cost each month beyond the Part B premium, in some areas. And, many of these plans include prescription drug coverage. Medicare Advantage plans do typically have deductibles, co-insurance and copayments. But those costs for Medicare Part A and Part B services are capped at $6,700 per year as required by CMS regulations.

 

Question 7: When will I be able to get generic alternatives to my current drugs? Many want an agent to tell them when certain drugs will go generic, and be available on their existing Medicare Part D or Medicare Advantage plan.

 

Answer: Unfortunately, there is no easy way to tell if a drug plan will cover the generic form of a branded drug until the generic alternative is actually available on the market. Agents will often know the date that patents for certain drugs are supposed to expire, and they can share those dates with a customer. But those dates can change for a number of reasons. One example is when a drug manufacturer files for an extension of their patent. Until a drug is actually available in generic form, and that generic is on the market, it will not be added to a plan’s formulary.

 

¹ September 15, 2011: U.S. Department of Health and Human Services; 2012 Medicare Advantage premiums fall and projected enrollment rises: http://www.hhs.gov/news/press/2011pres/09/20110915a.html

² October 27, 2011:  Medicare Part B premiums for 2012 lower than projected: (http://www.hhs.gov/news/press/2011pres/10/20111027a.html)

³ Social Security: Cost-of-Living Adjustment (COLA) Information for 2012: (http://www.ssa.gov/cola/)

 

About PlanPrescriber.com
PlanPrescriber (www.planprescriber.com), a wholly-owned subsidiary of eHealth, Inc., is a leading provider of comparison tools and educational materials for Medicare Advantage, Medicare Part D Prescription Drug Plans, and Medicare Supplement insurance products. Medicare beneficiaries can take advantage of PlanPrescriber's no cost, no obligation online advisor tools by logging on to www.PlanPrescriber.com. PlanPrescriber is a tool designed to help Medicare recipients find a Medicare plan that covers their specific medical and prescription drug needs at the lowest possible out-of-pocket cost.

About eHealth 
eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation's leading online source of health insurance for individuals, families and small businesses. Through the company's website,www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation's leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through eHealth's technology solutions (www.eHealthTechnology.com), is also a leading provider of health insurance exchange technology. eHealth provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides online tools to help seniors navigate Medicare health insurance options through PlanPrescriber.com (www.planprescriber.com) and eHealthMedicare (www.eHealthMedicare.com).

For more news and information about health insurance, health reform and Medicare, visit eHealth's consumer blog: Get Smart - Get Covered.

 

Medicare has neither reviewed nor endorsed this information.

 

 

Sande Drew
eHealth, Inc.
(916) 207-7674
sande.drew@ehealth.com

 

Erin Bocherer

Cogenta Communications

(678) 294-2258