The Marketing of Medicare Advantage and Part D Plans Presented by David Lipschutz and Bonnie Burns Winter/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) 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.

California Health Advocates (c) Outline Overview of Medicare Plans Overview of Medicare Enrollment Periods Marketing Issues

California Health Advocates (c) Medicare And Its Parts Part D New Rx Benefit Pays for hospital, skilled nursing, some home health Medicare Part A Hospital Insurance Part B Medical Insurance Part C Medicare 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)

California Health Advocates (c) Types of Medicare Plans Part D – stand alone prescription drug plans (PDPs) Offer prescription drug benefit only Medicare Advantage (MA) plans Offer all services covered under Medicare Parts A and B Some may offer Part D coverage (called MA-PDs)

California Health Advocates (c) 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) Plans Medicare Medical Savings Accounts (MSAs)

California Health Advocates (c) 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

California Health Advocates (c) Medicare Enrollment Periods Several different periods during which Medicare beneficiaries can enroll in, switch, or get out of Medicare plans When 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

California Health Advocates (c) Enrollment Periods Annually – Annual Enrollment Period (AEP) November 15 th – December 31 st 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

California Health Advocates (c) 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

California Health Advocates (c) 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]

California Health Advocates (c) 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 only For use outside of other enrollment periods (AEP, OEP)

California Health Advocates (c) 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

California Health Advocates (c) 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

California Health Advocates (c) 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

California Health Advocates (c) 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

California Health Advocates (c) Marketing … Agents/brokers can not: Do unsolicited door-to-door marketing Say they are from Medicare or HICAP Offer you money to join a plan Enroll you in a plan without your permission Misrepresent the product you are buying

California Health Advocates (c) Marketing … Stop and think …. You don’t need to buy/enroll in a plan on the spot If you’re unsure, or need more information, call HICAP

California Health Advocates (c) Contact Information California Health Advocates ■ Websites: (Professionals) (Consumers/General Public) Health Insurance Counseling & Advocacy Program 1 (800)