MEDICARE+CHOICE PLANS

In the fall of 2003 many Medicare+Choice plans (M+C) throughout the country, also known as Medicare managed care plans and HMOs, announced that they will be ending their Medicare plans, increasing beneficiary cost-sharing, and/or reducing benefits.  It is important that Medicare beneficiaries and those who represent them listen carefully to learn what benefits the M+C plans in their area will offer, what the costs will be, which health care providers will participate, and whether the plans will be accepting new enrollees.

While the number and coverage areas of M+C plans in Connecticut will not change from those in 2003, the costs to beneficiaries and the benefits will.  (An explanation of the Connecticut plans, changes, and coverage packages is included below.)  There will continue to be only two M+C plans in Connecticut: HealthNet and Oxford.  These plans will serve beneficiaries in just three of Connecticut's eight counties: Fairfield, Hartford, and New Haven counties.  Oxford is only in New Haven County, HealthNet is in Fairfield, Hartford, and New Haven counties.  (See chart below.)

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What Medicare Coverage Options Will Be Available for Beneficiaries Whose Medicare Managed Care Plans Will No Longer Operate in Their Regions?

The original Medicare program will continue to be available to all Medicare beneficiaries. Beneficiaries who return to original Medicare and wish to purchase a Medigap policy have specific rights.  Please click here to review the Center's Medigap information, where you can also learn about the ten standard Medigap plans and about the plans offered in Connecticut. 

Beneficiaries, including those with end stage renal disease (ESRD), may join another Medicare+Choice plan if other plans are offered in their region.

Individuals currently enrolled in a Medicare managed care plan can remain in those plans until December 31, 2003. Beneficiaries whose M+C plans are terminating need to make a decision by December 31, 2003.  Open enrollment for M+C plans is taking place in November and December in 2003, for coverage beginning January 1, 2004. Beneficiaries who find that their managed care plans are terminating should also investigate the feasibility of returning to the original Medicare program with a Medigap policy to supplement coverage as of January 1, 2004.

ADDITIONAL INFORMATION FOR CONNECTICUT

While the number and coverage areas of M+C plans in Connecticut will not change for 2004, the costs and benefits of those charges will differ from 2003.  The Original (traditional fee-for service) Medicare plan continues to be available to all Medicare eligible individuals. Beneficiaries who return to Original Medicare and wish to purchase a Medicare supplement (Medigap) policy have specific rights.  For more information regarding Medigap insurance click here.  

Medicare Managed Care Plans (HMOs) in Connecticut
By County Forecasted for January 1, 2004

w = Oxford has been granted a "capacity waiver." At this time (10/29/2003) Oxford has not reached its capacity for new enrollees. Therefore, enrollment is currently open. Only 89 spots are available now; when these are filled, enrollment will be closed. People who are enrolled in other individual or group Oxford plans may be able to enroll in Oxford’s Medicare plan, if space is available, when they become eligible for Medicare at age 65. Current members are not affected and may continue in the plan. 

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SUMMARY OF HEALTHNET PLAN

HealthNet has announced that the plan offered in Hartford County will have slightly different provisions than the plans offered in New Haven and Fairfield Counties.  Individuals considering enrolling in the HealthNet Medicare managed care plan for 2004 should take these changes into consideration and think carefully before deciding to join. 

Please note the following important information regarding the Medicare HealthNet plans for 2004:

• The coinsurance for certain outpatient tests such as x-rays, was 10% in 2003.  For the year 2004, the co-pay will be a flat fee of $20 for x-rays, $100 for CT Scans, $150 for MRA, MRI & PET scans, and $20 for radiation therapy.  
• Premiums for 2004 will remain at $99/month.
• Co-payments for an inpatient hospital stay in Hartford County will be $100 per day with a $1,000 annual out-of-pocket maximum.  In New Haven and Fairfield County, there will be a $500 co-pay per admission.  For inpatient mental health stays, the provisions are the same as inpatient hospital stays in each respective county.
• Co-payments for skilled nursing facility stays will not change in 2004 from the 2003 rates.  The rates are $0 for the first 1-20 days and $75 for days 21-100.
• The co-payment amount for primary care physicians routine physicals will decrease in 2004, from $20 to $15.  However, the co-payment for a specialist will increase, from $20 to $25.
  
  Individuals formerly enrolled in HealthNet will automatically be enrolled in HealthNet.  If, after reviewing the changes in HealthNet, an individual decides another choice is preferable for 2004, he or she must take action to disenroll.

Oxford has announced the following changes.  All benefits, premiums, copayments, and plan rules not listed here have not changed:

    Hospital Care

• The co-payment for each inpatient hospital stay per benefit period has increased from $810 to $840.

• The physician co-payment for each inpatient surgery has increased from $200 to $250.

• The physician co-payment for each outpatient ambulatory surgery has increased from $100 to $150.

    Skilled Nursing Facility

• Skilled nursing facility services will now require a co-payment.
          Day 0-10            No charge
          Days 11-100       $75 per day

• Coverage is limited to 100 days per benefit period.

   Diagnostic Tests and Services

• Clinical diagnostic, laboratory, radiology and therapeutic services will now require a 20% coinsurance.  Oxford will pay 80% of the cost and the beneficiary will be responsible for 20% of the cost.

    Ambulance Services

• Ambulance services will now require a 20% coinsurance.  Oxford will pay 80% of the cost and the beneficiary will be responsible for 20% of the cost.

   Preventive Care Services

• A colorectal screening exam will now require a primary care physician co-payment of $25 or a specialist co-payment of $35, depending on who performs the services.

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Members may remain in their Medicare HMO until December 31, 2003. They are strongly encouraged not to make any plan changes until they review all the particulars about other Medicare HMO alternatives, including premiums and benefits for the year 2004. See the information listed above regarding HealthNet and Oxford. Members should also investigate the feasibility of returning to original Medicare with additional supplemental coverage to become effective at plan termination on January 1, 2003.

Managed care plans must give notice of non-renewals by October 2^nd to be effective January 1^st of the following year. Once this notice is received, the members have a special enrollment period during the months of October, November, and December. Beneficiaries may choose an effective date for enrollment in another managed care plan as of 11/1, 12/1 or 1/1. Beneficiaries may also disenroll and return to the traditional Medicare during this time. The effective date on which traditional Medicare resumes is the first day of the next month. (Example: disenroll on November 29^th for a traditional Medicare effective date of December 1^st.) If an individual plans to disenroll from an HMO and return to traditional Medicare, it is very important to assure coordination of the effective date of a Medigap policy or QMB benefits. See number 3, below, regarding QMB). For Medigap rights, see the attached handout "Medigap Insurance; A Summary of Rights" For more information on the managed care plans, please contact:

Yes.  Medicare beneficiaries of modest means who are having trouble paying Medicare premiums, deductibles and co-payments may qualify for help from the state to pay for these costs under the QMB, SLMB, or QI programs. To qualify for QMB or SLMB individuals must be eligible for Medicare and have limited assets must not exceed. The QI program does not have an asset limitation. The programs also have income limits which are adjusted in April each year. Details on income limits can be found HERE.  For more information, contact CHOICES at 1-800-994-9422.

Yes.  The ConnPACE program helps eligible seniors 65 years or older or disabled over age 18 to pay for certain prescription drugs, insulin, insulin syringes, and needles. You must have been living in Connecticut for at least 183 days with an annual income, for 2009, not exceeding $25,100 for a single applicant or $33,800 if married.

You may not have another insurance plan that pays for all or a portion of each prescription on a continuous basis, including Medicaid (Title XIX) or another deductible insurance plan that includes prescriptions. You may have an insurance plan with a maximum benefit, such as a Medicare managed care plan. Eligibility will be granted when you have exhausted these other benefits. Enrollment is $30 per year. Participants pay $16.25 toward the cost of approved drugs each time a prescription is filled.

There is no asset test for ConnPACE eligibility.  There is an asset question on the application for the purpose of checking the applicants eligibility fo rthe Low Income Subsidy.

For more information, contact ConnPACE at (800) 423-5026 or (860) 832-9265.

The Centers for Medicare and Medicaid Services has designated the Connecticut Department of Social Services’ CHOICES Health Insurance Assistance Program, operating through each regional Area Agency on Aging, as the State Health Insurance Program (SHIP) for Connecticut. For free, up-to-date information and assistance about Medicare choices and other related state and federal programs in Connecticut, call the CHOICES toll-free number at 1-800-994-9422 for your regional Area Agency on Aging. Staff and volunteer counselors have received extensive training in health insurance issues for Medicare beneficiaries and are available, if necessary, to meet with Medicare beneficiaries at sites throughout the state. Counselors do not sell or market insurance.

The Original (traditional fee-for service) Medicare plan continues to be available to all Medicare eligible individuals. Beneficiaries who return to Original Medicare and wish to purchase a Medicare supplement (Medigap) policy have specific rights. 

Beneficiaries, except those with end stage renal disease (ERSD), may join another Medicare managed care plan (HMO) if other plans are offered in their region. Beneficiaries with end stage renal disease (ERSD) are precluded by law from enrolling in a Medicare managed care plan.

Information and assistance is available for residents of Connecticut from the CHOICES/HICAP program at (800) 994-9422, and from the Center for Medicare Advocacy at (860) 456-7790 or click here to contact the Center.

Connecticut Area Agencies on Aging

Eastern CT Agency on Aging (Senior Resources)
  4 Broadway, 3rd Floor
Norwich, CT 06360
(860) 887-3561
www.seniorresources.org

Agency on Aging of South Central CT
One Long Wharf Drive, Suite 1L
New Haven, CT 06511
(203) 785-8533
www.agencyonaging-scc.org