Medicare Questions and Answers: PlanPrescriber Answers Five Common Questions from Caregivers of Medicare Beneficiaries

Maynard, MA – April 26, 2011 –Today PlanPrescriber (www.planprescriber.com), a wholly-owned subsidiary of eHealth, Inc. (NASDAQ: EHTH), published answers to five questions commonly asked by adult caregivers of Medicare beneficiaries. 

 

The questions are drawn from those posed by caregivers contacting the PlanPrescriber call center on behalf of Medicare beneficiaries.  Many caregivers work tirelessly to care for their loved ones (often their parents) and turn to PlanPrescriber.com when looking for someone to help them make sense of the Medicare coverage options available and the Medicare enrollment periods and disenrollment periods throughout the year. 

 

Caregivers want to better understand such things as how Medicare Advantage plans differ from MediGap (supplement) plans, why prices between one carrier and another can vary so much, and how to navigate the prescription drug coverage donut hole.

 

QUESTION: “How do the costs of my Medicare health plan options differ between Original Medicare, Original Medicare plus a Medicare Supplement plan or Medicare Advantage?”

 

ANSWER: The coverage that has the lowest monthly premium is typically Original Medicare followed by Medicare Advantage and then Medicare Supplement plans.

 

Once you’ve enrolled in Medicare Parts A & B you also have the option to enroll in a Medicare Advantage plan or a Medicare Supplement.

Some Medicare Advantage plans have no additional monthly premiums, but the majority do. Often times, Medicare Advantage plans include prescription drug coverage. People who choose not to enroll in Medicare Advantage have the option to buy additional coverage in the form of a Medicare Supplement (or ‘MediGap’) plan.

 

MediGap plans typically provide more benefits than Medicare Advantage plans, with fewer out-of-pocket costs (aside from the monthly premium). When you combine Original Medicare and a MediGap plan, you also need to enroll in a separate Medicare prescription drug plan (Medicare Part D) if you want prescription drug coverage.

QUESTION: “What’s the difference between the coverage provided by a Medicare Advantage plan and a MediGap plan?”

ANSWER: With a Medicare Advantage plan, the Federal government sends your Medicare part A & B premiums to a private insurance company who becomes the primary payer of your medical bills. When you have an illness or injury that requires medical care, the the private insurance company pays for the services instead of Medicare. Many Medicare Advantage plans do also include Medicare prescription drug coverage and doctor visits with a copayment or coinsurance.  Some have no monthly premium at all.

 

The standard benefits available through Original Medicare are also the required minimum benefits for Medicare Advantage. They include some out-of-pocket costs and deductibles for things like hospital stays, blood transfusions, durable medical equipment, time in a skilled nursing facility, medical care not deemed to be medically necessary, or routine dental care. Medicare Advantage plans cannot – by law - provide less coverage than original Medicare, but many plans provide additional benefits like dental and vision coverage, or extra office visits with lower co-pays.

 

Medicare Supplement or MediGap plans are typically more expensive than Medicare Advantage and they typically cover more medical services with smaller deductibles and smaller co-payments and/or coinsurance. If you enroll a loved one in a MediGap plan, you’ll also need to enroll them in a separate stand-alone Medicare Part D prescription drug plan if you want prescription drug coverage.

QUESTION: “I want to move my parent off of Medicare Advantage and into a MediGap plan. But, the price we were quoted online is lower than the price the insurance company is now telling us the coverage will cost. Why is that?”

ANSWER: One likely reason for the cost difference is that your parent was rated up – or charged more money – based on the results of Medical underwriting done to determine their eligibility for the MediGap plan.

 

The first six months after a person becomes eligible for Medicare (unless they have another form of credible coverage, like their spouse’s plan or an employer’s plan) is their Medicare Supplement open enrollment period. During that time, medical underwriting can’t be used to evaluate their application for a MediGap plan and they can’t be denied coverage or be charged a higher premium because of a pre-existing health problem.

 

But, after those six months are up, some insurers will review the application for MediGap and may either raise the premium or deny their application, based on the applicant’s health. Medicare Supplement plan costs typically increase each year due to factors like inflation, the pricing model of the plan, the plan type  (A, B, C, etc), and the state where the applicant lives. A licensed agent can help you understand what these differences are and how they might impact your loved ones.

QUESTION: “My parents take different drugs, but are on the same prescription drug plan. One of them pays much higher co-pays for their drugs than the other. Why is that?”

ANSWER: A common reason for this is that the parent with higher co-pays is taking a drug (or drugs) that’s not covered by their Medicare prescription drug plan.

Each year, most insurance companies have the option to change the formularies (the list of medications they cover) on their Medicare prescription drug plans. The percentage of covered drugs that are subject to prior authorization, which means you must get the insurer’s approval before the insurer will pay for the medication , increased from 12.4 percent in 2008 to 16.7 percent in 2011, according to an Avalere Heath Study¹. Medicare doesn’t dictate which drugs an insurer must cover on a plan. They only require each plan to cover two medications within each approved therapeutic class of drugs. 

 

If your parent’s plan doesn’t cover their drug, they will spend a lot more money out of their own pocket. It sounds incredibly hard, but it’s actually very easy to compare drug plans based on the medications your parent takes. A prescription drug plan comparison tool like the one we have at PlanPrescriber.com, makes the process very quick and easy to manage.

QUESTION: “Last year one of my parent’s fell into the donut hole. But, we got a $250 rebate check from the government to help us cover the costs. This year my other parent is getting ready to enroll jn Medicare. Will they also get a rebate, or is this the year that health reform closes the donut hole?”

ANSWER: The answer, unfortunately, is no in both cases.

 

Health care reform doesn’t completely reduce your out-of-pocket costs for prescription drugs that fall into the donut hole until the year 2020. And, the $250 donut hole rebate check was only for 2010.

 

For 2011, drug manufacturers provide a 50% discount on brand-name drugs and the government will provide a 7% discount on generic drugs for those who fall into the donut hole coverage gap. The 50% manufacturer discount on branded drugs is received by the consumer but 100% of the brand name drug price is counted toward the catastrophic coverage limit, which will help you get out of the donut hole faster. You will continue to pay any dispensing fee for the brand-name prescription. The dispensing fee isn’t discounted, as it’s added to the discounted amount of your prescription.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. For more information on Extra Help, you can contact PlanPrescriber.com at 800-404-6968 to be connected with a partner's licensed representative who can discuss Extra Help eligibility rules or contact Medicare directly at 1-800-MEDICARE (1800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or Your Medicaid Office (only required for pieces referencing Part D benefits or cost-sharing). In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.

 

The Centers for Medicare and Medicaid Services (CMS) has neither reviewed nor endorsed the information provided by PlanPrescriber.

 

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 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.

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.

¹ New Analysis Shows Wide Variation in Drugs Covered by Medicare Drug Plans in 2011: Avalere Health (http://www.avalerehealth.net/wm/show.php?c=&id=872)