the marketing of medicare advantage and part d plans presented by david lipschutz and bonnie burns...

The Marketing of Medicare Advantage and Part D Plans

Presented by David Lipschutz and Bonnie BurnsWinter/Spring 2007

This California Medicare Coalition Regional Forum is supported by funding provided by the California HealthCare

Foundation, based in Oakland, CA

California Health Advocates (c) 2006 2

Our Focus

California Health Advocates is dedicated to Medicare beneficiary advocacy and education for Californians.

Policy – Public policy research and recommendations for improved rights and protections, partner with national Medicare organizations based in Washington D.C.

Training – Professionals and informal helpers, vibrant web resources, newsletter and regional forums

Advocacy – Bring the experience of Medicare beneficiaries to the public through media and educational campaigns with the legislative staff at federal and state levels.

www.cahealthadvocates.org


Outline

Overview of Medicare Plans

Overview of Medicare Enrollment Periods

Marketing Issues


Medicare And Its Parts

Part DNew Rx Benefit

Pays for hospital, skilled nursing, some home health

Medicare

Part AHospital Insurance Part B

Medical Insurance Part CMedicare Advantage

Pays for doctors, ambulance, lab, x-rays, home health, medical equipment and supplies

Authorization and contracting arrangements for MA plans.

Includes any type of organization that can contract with Medicare

Authorization and rules for the new Rx benefit, and much more

Medi-Cal(California’s Medicaid)


Types of Medicare Plans

Part D – stand alone prescription drug plans (PDPs)Offer prescription drug benefit only

Medicare Advantage (MA) plansOffer all services covered under

Medicare Parts A and BSome may offer Part D coverage

(called MA-PDs)


Medicare Advantage Plans

3 Types of MA plans:Coordinated Care Plans

• Health Maintenance Organizations (HMOs)

• Preferred Provider Organizations (PPOs)• Special Needs Plans (SNPs)

Private Fee-for-Service (PFFS) PlansMedicare Medical Savings Accounts

(MSAs)


Medicare Advantage and Other Part D Coverage Individuals enrolled in an MA coordinated

care plan (HMO, PPO, SNP) cannot also be enrolled in a PDP, even if MA plan does not provide Part D coverage

PFFS enrollees – if plan does not offer Part D coverage, can enroll in a PDP

MSAs cannot offer Part D coverage, so enrollees can also enroll in a PDP


Medicare Enrollment Periods

Several different periods during which Medicare beneficiaries can enroll in, switch, or get out of Medicare plansWhen first becoming eligible for

Medicare• Can enroll in Part D

When first have both Parts A and B• Can enroll in a Medicare Advantage plan


Enrollment Periods

Annually – Annual Enrollment Period (AEP)

• November 15th – December 31st • Effective following January 1st

When certain designated events occur • Special Enrollment Periods (SEPs)

Only Individuals who have both Medicare and Medi-Cal can switch plans every month


Medicare Advantage – Open Enrollment Period Open Enrollment Period (OEP)

2007 & beyond: January through March (three months)

Individuals have an opportunity to make one MA election

Cannot drop Part D coverage, or pick up Part D coverage during the OEP


MA-OEP

Options to change plans during an OEP:If MA-PD = MA-PD or Original

Medicare + PDP MA only = MA only or Original

Medicare only Original Medicare + PDP = MA-PD Original Medicare only = MA only

[* Cannot change from PDP to PDP]


New Enrollment Period: “Limited Open Enrollment Period (L-OEP)” Allows individuals in the original, fee-

for-service Medicare program one opportunity during the year to enroll in a Medicare Advantage-only plan (meaning an MA plan without Part D coverage)For 2007 and 2008 onlyFor use outside of other

enrollment periods (AEP, OEP)


L-OEP

Will primarily benefit PFFS plans Only kind of plan you can join during this

period and keep your PDP

Danger: people who enroll in MA plans without Part D coverage (MA-only HMOs and PPOs without Part D coverage) and have existing Part D coverage could lose those benefits for the rest of the year


Marketing of Medicare Plans

Number of factors converge to make informed decision making/choice more difficult for Medicare beneficiaries

Great increase in numbers and types of plans

being offered Many sponsors offering multiple products

(PDP, PFFS, Medigap, etc.) Many agents selling multiple products

Lock-in rules mean limited opportunities to change plans


Marketing …

Multiple plans/variations not always understood by agents and beneficiaries Some MA rules, benefit designs not

adequately explained (e.g. PFFS rules, PPO deductibles, etc.)

Plans can pay higher commissions to agents for MA enrollments vs. PDP enrollments Some plan sponsors actively seek to

convince current PDP enrollees to switch to same sponsor’s MA products


Marketing …

Beware: dual eligibles (people with both Medicare and Medi-Cal) being targeted for plans that may be inappropriate for them Agents aggressively selling PFFS plans Some using fraudulent tactics

Before enrolling in a PFFS plan, make sure your doctor(s) and other providers will take the plan


Marketing …

Agents/brokers can not: Do unsolicited door-to-door marketingSay they are from Medicare or HICAPOffer you money to join a planEnroll you in a plan without your

permissionMisrepresent the product you are

buying


Marketing …

Stop and think …. You don’t need to buy/enroll in a plan

on the spotIf you’re unsure, or need more

information, call HICAP


Contact Information

California Health Advocates

■ Websites: www.cahealthadvocates (Professionals) www.calmedicare.org (Consumers/General Public)

Health Insurance Counseling & Advocacy Program 1 (800) 434 - 0222

the marketing of medicare advantage and part d plans presented by david lipschutz and bonnie burns...

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