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!

Want Better Retirement? Better Health Care? Learn How to Become a Senior Advocate

Are you concerned about prescription drug prices in Medicare? Perhaps you have a chronic condition and you are worried about how Medicare will cover your bills?

We are less than two months away from a midterm election and a new Congress. It is now more important than ever to make sure your voice is heard in Washington. Last year, Better Medicare Alliance (BMA) senior advocates sent 10,000 letters, made phone calls and signed petitions to successfully advocate Congress to ensure chronically ill Medicare beneficiaries have access to the high-quality care through passage of the CHRONIC Care Act.
Let’s build on that success! Better Medicare Alliance has created four voluntary senior advocate task forces. Our task forces are smaller groups of senior advocates that are passionate about certain issues that impact people enrolled in Medicare Advantage. When you sign up to join one of our tasks forces you will gain access to special resources on the part of Medicare Advantage you’re most passionate about.

Join one (or more) of the following task force:

Chronic Disease Task Force
Join our chronic disease task force to protect critical Medicare Advantage chronic disease care and work directly with Better Medicare Alliance to ensure seniors with chronic disease continue to receive high-quality, affordable health care through Medicare Advantage. Medicare Advantage has been at the forefront of developing and incentivizing ground-breaking ways to prevent, diagnose and treat chronic diseases such as diabetes, hypertension and heart disease.

Keep Our Prescription Drugs Affordable (KOPDA) Task Force
Prescription drug prices are on the rise affecting millions of seniors on Medicare Advantage, many of whom struggle to pay the out-of-pocket costs for their life-saving medications. Better Medicare Alliance understands the negative impact high drug prices have on beneficiaries and supports developing policies that make prescription drugs more affordable for everyone. Join our Keep Our Prescription Drugs Affordable Task Force to ensure seniors on Medicare Advantage have access to affordable and effective prescription medicines.

Medicare Advantage Retiree Plans Task Force
Join our Medicare Advantage Retiree Plans Task Force to protect Medicare Advantage plans provided to retirees by their former employers. Over four million retirees across the country are enrolled in a Medicare Advantage health plan sponsored by a former employer. These seniors depend on high-quality, affordable care, and continued funding for these plans.

Medicare My Way Task Force
Join our Medicare My Way Task Force to work directly with Better Medicare Alliance to advise the government on how to improve Medicare and advocate for what services you think your Medicare Advantage plans should cover, including supplemental benefits.

What happens next?

If you join our task forces, participation is free and completely volunteer-based – we just ask for 1-2 hours of your time each month. As an organization with over 115+ Allies we want to represent the voice of Medicare Advantage seniors around the nation.

The most important goal of our task force is education. Education is key for advocating for Medicare Advantage. We will provide you with legislative updates and talking points, so you can better advocate for each issue.

Some of the activities you will be asked to participate in when you join a task force include surveys, petitions, calls to other seniors, calls to offices of members of congress, and drafting letters and op-eds about positive experiences.

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 nearly 22 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!

 

Understanding Special Need Plans

Special Needs Plans (SNPs) were established by Congress through the Medicare Modernization Act of 2003. Since then, Congress has continued to reauthorize these specialized plans. The program has grown by over 60% and now represents 12.5% of Medicare Advantage. Special Needs Plans (SNPs) are a type of Medicare Advantage plan tailored to serve high-cost, high-need beneficiaries.

The primary three types of Special Needs Plans are (1) Dual-Eligible SNPs (D-SNPs), which serves beneficiaries eligible for coverage under both Medicare and Medicaid, known as dual-eligible beneficiaries. (2) The Chronic Condition SNPs (C-SNPs) which serves beneficiaries with a disabling chronic condition, such as End Stage Renal Disease (ESRD), severe diabetes, dementia, or cancer and (3) Institutional SNPs (I-SNPs) that serves institutionalized beneficiaries residing in a long-term care facility, such as a Skilled Nursing Facility, or living at home but requiring an institutional level of care.

Medicare Advantage Special Needs Plans include all Medicare Part A, Part B, and Part D benefits. Also, may include other services to beneficiaries depending on specific health status or quality of life. SNPs members usually have specialists tailored to focus on supporting their specific condition.

As of 2017, over 2.4 million beneficiaries are enrolled in nearly 600 SNPs nationwide.
Different types of SNPs may be available for different parts of the country. Every state or/and county decides what is available for their beneficiaries. Benefits and costs vary depending on area and insurance company. Some counties might offer a selection of Special Needs Plans through insurance companies if they have created that business opportunity. Parts of the country do not have access to these types of plans.

One of the biggest benefits of SNPs include ‘Model of Care’ (MOC) were the Centers for Medicare & Medicaid Services (CMS) requires approval by the National Committee for Quality Assurance (NCQA) for each Special Need Plan. MOC is a quality improvement tool that makes SNPs unique because they ensure the needs of each beneficiary enrolled are identified and addressed.

The main difference between a Medicare Advantage plan and a SNP are the tailored benefits and care delivery models that are provided to the specific populations SNPs serve. Better Medicare Alliance wants to ensure that beneficiaries understand and get more access to information on SNPs. As of this year, Congress has permanently authorized the special needs plan and we will continue to advocate for more access to beneficiaries around the country that can benefit from the enrollment in SNPs.

Learn more by watching the video below.