We work closely with over 400,000 senior advocates to provide information about what Better Medicare Alliance is up to and how you can get involved. Make sure to check back here for regular updates on all things Medicare Advantage!

Have questions? Email us at community@bettermedicarealliance.org. We look forward to hearing from you!

What about Drug Prices in Medicare?

Prescription drug prices are a concern to almost everyone and that concern has captured the attention of policymakers. This is certainly true, many Medicare enrollees who have seen high out-of-pocket costs, particularly for specialty drugs.

The first step in tackling the question of how to keep drug costs down is to know how drug pricing works. Here’s a start:

Drug prices start with pharmaceutical companies. Pharmaceutical companies set prices for their products independently and can increase them at will. This often results in high out-of-pocket costs for consumers, as well as increased costs throughout the entire system.

Medicare Advantage-Part D (MAPD) plans and standalone Part D Prescription Drug Plans (PDPs)work to deliver value for seniors and for taxpayers by negotiating lower prices directly with pharmaceutical companies. They are able to do this by working with Pharmacy Benefits Managers (PBMs), such as CVS Caremark or Express Scripts, who are able to negotiate lower drug prices with pharmaceutical companies through the use of rebates.

Rebates are a vital tool used by health plans to lower drug premiums for their beneficiariess. Without the use of rebates, health plans would have no leverage to negotiate lower drug prices with pharmaceutical companies, resulting in increased premiums for health plan enrollees.Consumers are also able to change plans each year to better meet specific financial and health needs to help manage the prescription drug costs, should their medical or financial needs change over time.

The prescription drug supply chain needs comprehensive reform to protect seniors and those with disabilities on Medicare from high prices, abrupt increases, as well as rising drug costs in both routine medications and specialty prescription drugs. As beneficiaries, you can contact your representatives to motivate legislative change and you can share your stories to better build a case when we advocate for the stability of drug prices for our 400,000 advocates.

A Guide to Understanding Employer Group Waiver Plans (EGWPs)

Created in the Medicare Modernization Act of 2003, Employer Group Waiver Plans (EGWPs) are a type of health plan offered to you by a public or private employer. Also known as, employer retiree Medicare Advantage plans or “egg whip”, represents a successful public-private partnership that addresses the health care needs of 4.1 million retirees out of 20 million Medicare Advantage beneficiaries.

EGWPs coverage delivers high-quality, value-based care. Employers have turned to EGWPs to provide more affordable options than Medicare Supplement Insurance policies for beneficiaries. These types of Medicare Advantage (MA) plans are profitable for larger populations such as local and state governments, industries and unions.

Egg Whip plans like other MA plans cover all Medicare Part A and Part B benefits in addition to supplemental benefits, vision, dental, out-of-pocket cost protections, and innovations to enhance beneficiaries care. Employers provide uniform plan designs to administer coverage to their retirees.

MA plans share many similarities with EGWPs however some differences do apply. The two main differences include: retirees are enrolled as groups rather than individuals so employers have to be compliance with a bigger population. Secondly, Egg Whip plans must include a larger geographic area than MA individual plans. Therefore, EWGP requires providers nationwide and most plans are PPO (Provider Organizations) rather than HMO (Health Maintenance Organizations). Retiree coverage those include a range of benefits for beneficiaries such as risk adjustment, cost protection, benefit design, quality and value and beneficiaries right.

The biggest benefit of Employer retiree plans is that it’s a seamless coverage between what you had before and worked for you. Rather than enrolling into Medicare and the process of understanding the new options you get the same plan from when you were an employee and get Medicare supplements added on. As beneficiaries, we need your support. Medicare Advantage retiree plans are at risk and we want the administration to know the importance they have to employers and retirees. Moving forward, we encourage you to learn more about EGWPs and help us advocate for these types of plans.

Better Medicare Alliance wants employer plans to have greater access in rural areas, simpler enrollment process, more use for professional or group associations, and education on the benefit. Our goal is to maintain the stability of a public-private venture that has proven to be successful.

Medicare 101: Know the basics

As your source to learn everything on Medicare Advantage, Better Medicare Alliance wants to make sure beneficiaries know the facts. Medicare Academy week one is complete, and advocates got to learn about the basics from enrollment to types of MA plans. The most powerful tool an advocate can have to help BMA fight for affordable, high quality care is knowledge of the issues. Once you understand Medicare Advantage coverage, enrollment, benefits and limitations together we can build a stronger voice to advocate.  Consider this your cheat sheet to Medicare Advantage 101.

Key terms

Medicare Advantage: A Medicare coverage option that provides Part A and B benefits, as well as enhanced or supplemental benefits such as hearing, dental, vision, and wellness benefits.

Open enrollment: Annual time period when beneficiaries can join a Medicare Advantage plan, switch Medicare Advantage plans, or leave a Medicare Advantage plan and enroll in Traditional Fee-for-Service Medicare.

Enhanced benefits: Vision, hearing, dental, and wellness benefits that are offered by 97% of Medicare Advantage plans.

Dual eligible: A beneficiary who is eligible for both Medicare and Medicaid.

Extra Help: A program that helps beneficiaries with limited incomes and resources pay for Medicare prescription drug costs.

Open enrollment takes place from October 15 to December 7 each year. You can choose a Medicare Advantage plan during your initial enrollment period or each year during open enrollment. You could change Medicare plans each year depending on your economic and health needs but only during open enrollment period.

The total enrollment of Medicare Advantage beneficiaries exceeds 20 million. Individuals eligible for Medicare Advantage include people age 65 or older, people who are disable and people with pre-existing condition (except ESRD which has special rules under Medicare Advantage).

Medicare Advantage is another way to get Medicare coverage. When you choose Medicare Advantage your health coverage is provided through a Medicare Approved Organization rather than the federal government. Unlike Traditional Medicare, for which you pay a separate monthly premium for Part A (Hospital), Part B (Doctors, Outpatient), and Part D (Prescription Drugs), Medicare Advantage covers all Parts A, B, and if selected, Part D all in one monthly premium, often at a lower cost to you.

As an extra help, most Medicare Advantage plans also cover additional benefits, such as dental, hearing, vision and transportation at no additional cost. The biggest difference from traditional Medicare and Medicare Advantage is that Medicare Advantage has an annual out out-of-pocket spending limit.

Research has showed Medicare Advantage enrollees experience fewer hospitalizations than Traditional Fee-for-Service Medicare beneficiaries and often have access to chronic disease management. The type of Medicare Advantage plan you enroll in (i.e. PPO, HMO, SNP, PFFS) could impact the services or providers you receive.

 

Ready to test your knowledge on the basics of Medicare Advantage?

Click here to take the Medicare 101 Quiz Now!