What is Medicare Advantage

1. What is Medicare Advantage? Kelly R. Brantley Health Assistance Partnership

2. Background of MA New program with significant changes to replace Medicare + Choice program Regional plans Expansion of plan options Increased range of benefit choices Limited enrollment period

3. Managed Care Concepts Medicare Advantage is managed care Medicare = Medicare No health status limits Enrollment periods All Medicare services covered Extra benefits possible Network of providers Rules for certain services Appeals process

4. MA Costs in 2007 Part A and B Premium: $93.50 (and up, depending on income) MA Premium: Varies from $0 and up (covers extra non-A and/or non-B benefits) Part D Premium: Varies from $0 and up Part D Deductible: Varies from $0 to $250 Copayments for each health care service received (not coinsurance, like FFS Medicare)

5. Types of MA Plans Five types of MA plans: Local Coordinated Care Plans (HMOs and PPOs) Regional Preferred Provider Organizations Private Fee-for-Service Plans Medical Savings Accounts Special Needs Plans

6. Local Coordinated Care Plans Most common type of MA plan Two varieties HMOs (Health maintenance organizations) All services must be in the network Some prior authorization requirements No coverage for out-of-network care (except emergencies) Some offer POS for out-of-network (at higher cost) PPOs (Preferred provider organizations) Lower costs for services in the network Higher costs for out-of-network care

7. Regional Preferred Provider Organizations New in 2006 Offers network coverage throughout the region Combined A and B deductible Limit on out-of-pocket costs for covered services

8. Private Fee-for-Service Plan (not Medicare) decides reimbursement rate for physicians Enrollees may have higher out-of-pocket costs No network of providers� providers must agree to plan�s terms for each patient and for each visit

9. Medical Savings Accounts Special savings account for Medicare to deposit set amount of money for covered services Partners with a high-deductible MA plan Deposit may not cover the plan�s deductible New to the market in 2007

10. Special Needs Plans Generally Coordinated Care Plans Limit enrollment to certain subsets of Medicare beneficiaries: Institutionalized beneficiaries Full dual Medicare beneficiaries Beneficiaries diagnosed with certain chronic and/or disabling conditions *

11. MA Enrollment Annual Election Period (11/15 to 12/31) Initial Coverage Election Period [A & B] (7 months around date of eligibility) Initial Enrollment Period [D] (7 months around date of eligibility) Open Enrollment Period (01/01 to 03/31) OEP for Institutionalized Individuals (continuous) Special Election Periods (similar to PDP SEPs)