Medicare Advantage (MA) Plans

1. Medicare Advantage is a type of health insurance that provides coverage within Part C of Medicare in the United States Medicare Advantage plans pay for managed health care based on a monthly fee per enrollee ( capitation ), rather than on the basis of billing for each medical service provided ( fee-for-service, FFS ) for unmanaged healthcare services. The policies CMS finalized in April 2018 for Medicare health and drug plans for 2019 advance broader efforts to promote innovation that empowers Medicare Advantage and Part D sponsors with new tools to improve quality of care and provide additional plan choices for Medicare Advantage and Part D enrollees. Medicare Advantage health plans (such as HMOs and PPOs) are legally required to offer at least the same benefits as Original Medicare, but can include additional coverage as well, such as routine vision or dental benefits, health wellness programs, or prescription drugs. Keep in mind that the formulary may change at any time; the Medicare plan will notify you if needed. Some Medicare Advantage Plans also offer drug coverage; these plans are called Medicare Advantage Prescription Drug Plans (MAPD Plans). Get the same coverage as Original Medicare plus additional benefits in one convenient plan. There are plenty of good reasons to sign up for a Medicare Advantage plan for 2019, and starting next year, a new open enrollment period for Advantage will kick off on Jan. Explore our Plans and Premiums to learn more about coverage available in your area. You can find Medicare plan options based on location, insurance company, premium cost, and more. In addition, the percentage of MA-PD members in plans with 4 or more Stars has risen from 24% to 73% (Exhibit 2). MA program enrollment reached 18.5 million in 2017, compared with 9.7 million in 2008, 6 6.MedPAC. It wants to move into Medicare Advantage in 2020. Medicare Advantage health care plans provide comprehensive benefits, including coverage for medications and all medically necessary services. New York Medicare Advantage Plans include all the benefits of Parts A and B of Original Medicare plus benefits for Medicare-eligibles like extra vision, dental , and hearing coverage. Every year, Medicare evaluates plans based on a 5-star rating system. Our Medicare Advantage plans have a 50- year tradition of being highly rated by the Centers for Medicare & Medicaid Services (CMS) and for meeting the needs of our over 6.5 million Medicare members nationwide. Medicare open enrollment starts on October 15 and continues through December 7. Medicare Advantage represents private sector innovation, which CMS supports. Beginning in the late 1990s, Congress revised the payment formula to attract more plans throughout the country, particularly in rural and certain urban areas. Specific definitions of enrollment-weighted average and enrollment are provided below. The MSA plan deposits a certain amount of money into a medical savings account every year, which you can use to pay for qualifying medical expenses until you reach the plan's high deductible. No, Medicare Advantage plans are not offered to people with kidney failure also known as End Stage Renal Disease (ESRD). When people look at making a choice between enrolling in Medicare Advantage or the traditional program, they're going to see this as a tremendous opportunity,” she predicted. What are the costs associated with your coverage — Some Medicare Advantage plans may offer premiums as low as $0 However, keep in mind that even if your service area offers a plan with a $0 premium, you'll still be responsible for other costs, which may include deductibles, copayments, and coinsurance. So in 2009, the Medicare Payment Advisory Commission (MedPAC) reported that Medicare would spend 14 percent more on Medicare Advantage beneficiaries per person that year than they did per person for "like beneficiaries" under traditional Medicare, theoretically adding an additional 3% ($14 billion) to the cost of the

2. overall Medicare program compared to spending without Part C, 5 This lack of parity and disconnect with the original goal of Part C was primarily caused by so-called Private Fee for Service (PFFS) plans (designed primarily for the rural and urban poor), special needs plans (SNPs), and Employer Group plans (which primarily served retired union members ). A special situation relative to Puerto Rico contributed to the imbalance at that time. Medicare Advantage Plans are an alternative to traditional Medicare coverage and some include additional benefits. There are three types - Dual-Eligible SNPs target those with Medicare and Medicaid coverage; Chronic- Condition SNPs target those with certain chronic and disabling conditions; and Institutional SNPs target those who live in institutions, such as nursing homes. Retirees, survivors, and dependents enrolled in Medicare Parts A and B will need to call ERS toll-free at (877) 275- 4377 with their Medicare information (located on their Medicare cards) to start the enrollment process into HealthSelect Medicare Advantage. In a separate analysis, we found that MA plans have become more efficient than FFS coverage at providing Parts A and B benefits (Exhibit 7). Currently, the MA plans deliver Part A and B benefits at 90% of the costs of FFS coverage (or 92% if differences in risk coding are fully accounted for), compared with 102% in 2009. Some Medicare Advantage plans may have premiums as low as $0, but remember that you'll still need to keep paying your Medicare Part B premium, along with any copayments, coinsurance, or deductibles that your plan requires. Available through private insurance companies approved by Medicare, these plans offer another way to get your Medicare Part A and Part B benefits. While early December marked the end of open enrollment — when Medicare recipients can make changes related to their Advantage Plan (Part C) and prescription drug coverage (Part D) — two separate windows opened Jan. We hope that the Administration Medicare Advantage Plans 2019 will consider making the prior authorization and appeals process in Medicare Advantage more transparent and streamlined, as this is critical for patient access. Members of Congress from across the country from both parties are standing up for seniors in Medicare Advantage. For persons who receive Social Security benefits, will pay a lesser premium rate of $130 on average. After years of rate cuts imposed by the Affordable Care Act, Medicare Advantage rates are increasing again. An insurance company can also decide to charge a premium for Part C SNP enrollees who have both Medicare and Medicaid as well as those who don't have both. In response, the ACA of 2010 revised the methodology for paying plans by gradually reducing benchmarks. CMS requires that Medicaid pay for copayments and coinsurance for certain people enrolled in MSPs. If you have a specific doctor or hospital that you want to use, be sure to check that they're included in the network of the Medicare Advantage plan that you're interested in. The chart below shows how our plans compare to Original Medicare. To be eligible to enroll in a Medicare Advantage plan, you must be enrolled in Original Medicare, reside in the plan's service area, and (in most cases) not have end-stage renal disease (ESRD). You can enroll in a 2019 GlobalHealth Medicare Advantage Plan by clicking the link below. Humana recently acquired a stake in home health provider Kindred Healthcare and hospice operator Curo Health Services—two businesses that will help serve its senior population at a lower cost. Gavino said, for instance, there might be short-term medical plans available to tide you over, or if you are already covered through other insurance — i.e., employer-sponsored or through a health exchange — you might be able to retain coverage until then.

3. We excluded residents of long stay nursing homes, whom we identified using a validated algorithm ( 9 ), because these beneficiaries rarely enroll in Medicare Advantage plans other than special needs plans ( 10 ), and Medicare beneficiaries with end stage renal disease.