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Medicare Advantage Plan Highlights
A message from coach
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Dear retirees,
We’re all looking for ways to save money. That’s hard to do when health-care costs go up every year. Yet, you can’t do without health insurance. What you need is a good game plan to win this game.
Retirees have 5 plans from which to choose the best for you. Medicare Advantage plans offer you great coverage at a substantially lower rate then you pay for your Blue Cross HMO or PPO coverage. The city offers three MA plans: Aetna Private-Fee-For-Service, Texas HealthSpring, and TexanPlus, in addition to the HMO and PPO.
Since we introduced Medicare Advantage plans four years ago, 2,225 of your fellow retirees have joined the plans. This will save them $3.9 million collectively, and the city $7.9 million, this year.
What do the plans offer you? Here are just few highlights:
- Lower monthly premiums than the HMO
- Prescription-drug coverage designed to duplicate the city’s HMO/PPO plans, which far exceed Medicare Part D
- Familiar doctors and hospitals
- High satisfaction ratings
PPO members covered by Medicare -- pay special attention this year. As of Jan. 1, 2009, Kelsey-Seybold no longer accepts Medicare-covered PPO patients. See page 3 for more details. If you are a PPO member who uses Kelsey-Seybold, you will need to choose another physician or try one of our other options for your health care. Kelsey-Seybold doctors will continue to accept HMO Blue Texas HMO, Texas HealthSpring and TexanPlus members.
Think about what’s important to you in a health plan: monthly premiums, low copayments, choice of doctors and hospitals, generous prescription benefits – the MA plans we offer address each of these priorities. Now that’s a game-winning strategy.
Respectfully,
Mayor Bill White |
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Medicare Advantage plans - a good strategy for victory over rising health-care costs
Medicare offers you different ways to get your Medicare benefits when you reach age 65 or become covered under Medicare before age 65. One option, Original Medicare, is the traditional form that underlies your retiree health coverage from the city.
Another option is a Medicare Advantage plan, where Medicare contracts with private companies to provide the benefits. Medicare believes that contracting with quality health plans helps better manage retiree health benefits. So it pays MA plans to maintain closer contact with retirees – something Medicare cannot do for more than 50 million retirees in America.
If you are covered by Medicare, these MA plans are just a different way to have Medicare coverage at a cheaper premium. MA plans offer familiar benefits for lower costs than a traditional health plan.
City retirees and their eligible dependents can choose from five health-benefits plans, including the HMO Blue Texas HMO and PPO plans.
You have the choice of three MA plans
- Texas HealthSpring offers HMO-type benefits to Medicare-covered retirees, primarily in southeast and east Texas. The network includes Kelsey-Seybold, Sadler Clinic and Renaissance doctors from which to select a PCP.
- TexanPlus offers HMO–type benefits to Medicare-covered retirees in the southeast Texas and Dallas areas. The network includes Kelsey-Seybold and Heritage doctors from which to select a PCP.
- Aetna Private-Fee-for-Service offers copayment benefits for most services in all 50 states. Any doctor and hospital that accepts Medicare assignment can participate. You seek care from any doctor who agrees to Aetna’s terms of participation.
Here’s what this means to retirees:
- Your contribution for health coverage in an MA plan for one person will be only $10 to $61 per month. Compare that to the new $166 cost per month to enroll in the HMO and $507 in the PPO.
- Copayments are 25 - 70 percent lower for a visit to the PCP and specialist.
- Most other copayments are lower, as you can see from the chart.
- The plan design is familiar to you.
- You can get better than Medicare Part D drug benefits from these plans.
- There is no Medicare Part D premium.
- You can join an MA plan now, and your dependents can remain in the HMO or PPO.
- You can enroll in a city-sponsored MA plan on the first day of any month in 2009. If the MA plans do not meet your needs, you can re-enroll in the HMO or PPO within 90 days of your enrollment in the MA plan, or on January 1 or May 1, 2010.
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MA plan highlight reel
You can choose from three all-star MA plans that will all cost you less than $62 per month per member. TexanPlus and Texas HealthSpring offer benefits similar to those provided by HMO Blue Texas HMO. The Aetna PFFS plan provides benefits that require more thought on your part before making an appointment but will provide great savings – especially if you live outside of the service areas. Below is a summary of each plan, but be sure to see the comparison chart for more details.
Here’s more about your three choices:
Aetna Private-Fee-for-Service plan
- Aetna PFFS plan includes thousands of doctors but has no network or directory, so you will need to contact your doctor’s office and ask the questions in the box to the left to ensure your doctor will agree to participate in the plan. Below are the Aetna PFFS highlights:
- About 96 percent of doctors in the US can become part of the Aetna PFFS plan — they must accept Medicare assignment and agree to Aetna’s terms and conditions.
- You do not need a primary care physician, but it is recommended you have one. No referrals are needed for specialists.
- Precertification for certain services is recommended but not required.
- Medicare Part B drugs are covered at 100 percent.
- Worldwide emergency care is available.
- One free routine hearing exam per year; $500 reimbursement on hearing aids every 36 months.
- One free routine eye exam per year. Discounts on frames and lenses.
- Membership discounts in GlobalFit Health Clubs.
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TexanPlus
TexanPlus is a great savings opportunity for retirees who live in Houston, southeast Texas and Tarrant, Dallas and Rockwall counties:
- TexanPlus includes established physician networks, including Kelsey-Seybold, Heritage, Memorial, Katy and CyFair doctors, in 15 Texas counties. See service areas.
- You must have a primary-care physician, and your PCP must refer you to network specialists.
- Medicare Part B drugs are covered with a 20 percent coinsurance, to $1,500. After you have paid $1,500, TexanPlus will pay for Part B drugs at 100 percent.
- Extra benefits include discounts on fitness memberships, hearing exams, dental services, eye exams and lenses.
- There is a one-time $500 reimbursement on a hearing aid.
Texas HealthSpring
Texas HealthSpring is a great savings opportunity for those who live in Houston, southeast and east Texas, and parts of the Valley:
- Texas HealthSpring includes established physician networks, including Kelsey-Seybold, Renaissance, Sadler, Memorial and independent doctors in 25 Texas counties. See service areas.
- You must have a primary -care physician, and your PCP must refer you to network specialists.
- Medicare Part B drugs are covered with a 15 percent coinsurance, to $1,000. After you have paid $1,000, Texas HealthSpring will pay for Part B drugs at 100 percent.
- Worldwide emergency care is available.
- Extra benefits include free health club membership for Silver Sneakers, discounts for hearing aids and dental services.
- Texas HealthSpring also provides up to 30 free rides (15 round trips) to the doctor, pharmacy or hospital per year.
What are your options during open enrollment?
- Enroll in an MA plan for yourself only.
- Enroll in an MA plan for yourself and your Medicare-covered dependents.
- Enroll in an MA plan for a Medicare-covered family member and leave another Medicare- or non-Medicare covered family member in the HMO or PPO plan.
- Return to the HMO or PPO within 90 days of MA-plan enrollment if you are not satisfied.
- After 90 days, your next opportunity to return to the HMO or PPO will be January 1 or May 1, 2010.
- Do nothing and remain in the plan you are in now. However, if you are a Medicare-covered PPO participant and you go to Kelsey-Seybold, you will either need to choose a new doctor or change plans.
Enrollment Options |
If you are currently enrolled in: |
You may enroll in one of these plans during this enrollment: |
Aetna
PFFS |
TexanPlus |
Texas
HealthSpring |
HMO |
PPO |
HMO |
yes |
yes* |
yes* |
- |
yes |
PPO |
yes |
yes* |
yes* |
yes* |
- |
Texas HealthSpring |
yes |
yes* |
- |
yes* |
yes |
TexanPlus |
yes |
- |
yes* |
yes* |
yes |
Aetna PFFS |
- |
yes* |
yes* |
yes* |
yes |
*If you live in the plan’s service area.
Savings? Show me the money!
Savings come from lower monthly contributions and lower time-of-service payments. Since May 1, 2005, more than 2,200 participating retirees and dependents have saved more than $8 million in contributions. That doesn’t count what they’ve saved in copayments. Here’s how the savings stack up:
- If you enroll in one of the MA plans, you could save 60 - 94 percent over what you would pay for HMO coverage and 89 – 98 percent over what you would pay for PPO coverage.
- You get lower out-of-pocket costs on many services:
- 25 - 70 percent on doctor visits
- $200 - $500 on hospital admissions
- $100 on emergency-room visits
- 5 - 10 percent on durable medical equipment, like wheelchairs and walkers
- 100 percent coverage for home health visits
- Free rides to the doctor if you enroll in Texas HealthSpring: up to 15 round trips to doctors, hospitals and pharmacies per year
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How can these benefits cost less than what I’ve been paying?
Medicare has delegated most of the responsibility for providing benefits for more than 50 million beneficiaries to managed-care companies, which can coordinate your care better than Medicare alone and can perform better analysis on prescription interaction. This means you can receive more personalized service and they can better manage the unique medical needs of the senior population.
The federal government is still responsible for making sure each Medicare beneficiary gets full Medicare benefits. With MA plans, employers can increase the benefit and provide benefits that are better than Medicare alone.
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