To better understand Medicare, especially Medicare Advantage, I queried Christopher Ciano, president of Medicare at Aetna®, a CVS Health® company. He is also a caregiver to his 93-year-old parents. Therefore, I thought it would be beneficial for readers to gain his perspective.
(Note: Open Enrollment is from October 15 through December 7.)
QUESTION: Please give us your vision of the future for Medicare programs. What would be the most significant changes you anticipate over the next decade overall?
COVID-19 has already impacted Medicare programs and will likely continue to have an impact for the foreseeable future.
Telehealth – A strong area of growth.
One of the areas where we’ve begun to see tremendous growth is in digital health, particularly telehealth. Medicare plans will continue to offer benefits that allow for care at home. The next few generations of seniors will likely have a higher level of comfort with technology than previous generations.
We already see this trend start to rise. According to the CVS Health Path to Better Health Study, 45% of respondents 65+ said they would be more likely to communicate with health care professionals if they could do so through digital messaging. Older adults opening up to new, digital means for communication is something I believe we’ll see much more of in years to come.
At Aetna, we’re taking steps to make sure our Medicare plans can help support members stay healthy in their homes during this time. Such is essential since older adults are among the most vulnerable to serious effects from COVID-19.
To ensure our members can safely receive the care they need, we extended waivers for Medicare Advantage member cost shares. Such allows for in-network primary care office visits and all telehealth visits for any reason through December 31, 2020.
Self-Care At Home Gains Popularity.
We also recently shipped Caring for You kits of over-the-counter items, such as thermometers, hand sanitizer, and face masks. Such helped support all Medicare Advantage members with simple self-care at home.
Also, all Aetna 2021 Medicare Advantage plans will offer virtual primary and urgent care visits to help members access to care, including after-hours or weekend care, sick visits, and prescription refills. Select plans will also cover virtual mental and behavioral health visits.
QUESTION: Medicare Advantage is a cost-effective program. However, we have great concerns over Part C, especially when it comes to innovative treatments for life-altering diseases. What improvements do you foresee down the road for Medicare Advantage?
In recent years, the Centers for Medicare & Medicaid Services (CMS) expanded the supplemental benefits Medicare Advantage plans can offer to members with chronic conditions. This increased flexibility allows MA plans to offer more innovative programs and benefits.
For example, in 2021, Aetna implements a Congestive Heart Failure (CHF) Remote Monitoring Program with six individual plans in Pennsylvania, Ohio, and Kentucky.
Eligible high-risk members with CHF who agree to participate in the program and follow the care management requirements will receive a 5G-enabled scale, blood pressure cuff, and electronic tablet to monitor their weight and blood pressure at home.
We’re also expanding the number of plans offering supplemental benefits for members with high cholesterol or high blood pressure to make it easier to access care. Aetna will provide a blood pressure monitor for our members with high blood pressure, which allows members to monitor their blood pressure from home at their convenience.
Individual members with high blood pressure and high cholesterol may also be eligible for transportation assistance to keep their appointments with health care providers.
Additional Benefits To Aetna’s Plans.
Other benefits we’re introducing with select plans in select locations include a Healthy Foods debit card, companionship benefit, a fall prevention benefit, and a program to lower insulin costs. These benefits are designed to bring care closer to home and make it more affordable for our members.
I foresee the continued expansion of benefits like these to help members with chronic conditions and more programs to address social determinants of health.
QUESTION: Please provide your thoughts for caregivers of elderly loved ones. How can they remain healthy and viable?
Speaking as a caregiver to my own 93-year-old parents, one of the most important, and often overlooked, is remembering to take time for yourself.
While caregiving is rewarding, it can also take a toll on your physical and emotional well-being. This is especially true during COVID-19, as we all continue to deal with additional stressors the pandemic has placed on our everyday lives. Ensure you’re taking care of yourself and finding time to relax, eat healthily, and exercise regularly.
Also, remember that you don’t have to do everything by yourself — ask for help. Aetna Medicare members and their caregivers have access to Resources for Living, which caregivers can use to connect with local support groups and other services that make their responsibilities feel more manageable.
Additionally, Aetna recently published a guide full of great information and resources for older adults and their caregivers called Putting the ‘Me” in Medicare, found at AetnaMedicare.com/eBook. The eBook offers tips and resources on eating healthy, staying active, using technology tools, and maintaining mental health during and after the pandemic.
QUESTION: What are your best ideas, pitfalls for the Medicare Open Enrollment season?
Choosing a Medicare plan and sifting through all the information Medicare beneficiaries receive can be overwhelming at this time of year.
Medicare Advantage Is All-inclusive.
It’s important to understand the various parts of Medicare and what each part covers. Original Medicare includes Part A (hospital insurance) and Part B (medical care), and consumers often elect to purchase a Part D plan for prescription drug coverage. On the other hand, Part C is a Medicare Advantage plan.
Such plans bring together the benefits of cost, coverage, and convenience into a single plan and often include:
- Annual out-of-pocket maximum
- Prescription coverage
- Dental, vision, hearing, and fitness-related benefits
- Coverage through a private insurance company
- A network of doctors and hospitals
A common misconception about Original Medicare is that it pays for everything. Everyone who is enrolled in Original Medicare pays a premium for medical (or Part B) coverage.
Original Medicare Doesn’t Cover Everything.
Original Medicare also doesn’t cover prescription drugs or cap your annual out-of-pocket spending for medical care, which means that there’s no limit to the expenses you may have to pay each year for your medical services.
Second, check if the plan fits your budget. When it comes to plan pricing, no matter whether consumers select an Original Medicare or Medicare Advantage plan, many mistakenly only look at the monthly premium cost. While important, it is not the only price point to consider. Make sure you review all of the plan’s out-of-pocket costs, such as deductibles, copays, and co-insurance.
Prescription drugs are another important item to consider. Check if the plan’s formulary or drug list covers your prescriptions. Know what tier your prescription drugs are on and whether there are any coverage rules like step therapy or prior authorization. And don’t forget every year, plans can change which drugs are covered and at what tier and cost.
Also, check your plan’s network to see if your preferred doctors, hospitals, and pharmacies participate.
Finally, if extra benefits like routine vision, dental, hearing, and fitness are important to you, make sure the plan you choose covers them.
Visiting the Medicare.gov website and entering your zip code will allow you to see all of the various Medicare plans available in your area. You can also speak with a local trusted broker or community advisor. To learn more about Aetna’s 2021 Medicare plans, visit AetnaMedicare.com or see our latest announcement.
Important Points from RIA.
As a matter of disclosure, this post isn’t an endorsement of Aetna’s plans. However, it provides perspective from a senior professional in the trenches.
At RIA, we prefer Medigap solutions over Medicare Advantage plans. Many older Americans with strained cash flows find Medicare Advantage cost advantageous. Everybody’s situation is different; therefore, Medicare and healthcare planning are crucial.
HealthView Services is a company that provides healthcare projection analysis and tools to the financial services industry. The organization draws upon a database of 530 million medical cases, longevity, and government statistics to create their projections.
They estimate that the total lifetime healthcare costs (which include premiums for Medicare, supplemental insurance, prescription drug coverage) for a healthy 65-year-old couple retiring this year are projected to be $387,644 today’s dollars assuming the Mr. lives 22 years and Mrs. – 24.
Health-care inflation is averaging roughly 4.4% a year; we use a 4.5% inflation rate in our planning at RIA. Medigap or supplemental insurance coverage, which is offered by private insurance companies, has increased consistently by more than 6% a year, according to The Senior Citizens League.
Medicare Advantage vs. Medigap.
Medicare Advantage Plans are inclusive, which means they cover all services of Original Medicare, including prescription drugs. Most offer extra coverage like vision, hearing, dental, and/or wellness plans. Two-thirds of the plans offered are through closed-physician network HMOs.
Advantage Plans usually have lower premiums than Medigap (also known as Medicare Supplemental Insurance) and are offered without insurability evidence.
Per KFF.org: While average Medicare Advantage premiums paid by MA-PD enrollees have been relatively stable for the past several years ($36 per month in 2017), enrollees may be liable for more of Medicare’s costs, with average out-of-pocket limits increasing 21 percent and average Part D drug deductibles increasing more than 9-fold since 2011; however, there was little change in out-of-pocket limits and Part D drug deductibles from 2016 to 2017.
At RIA, we suggest older Americans select a Medigap policy over Medicare Advantage but our views may change in the future. Monthly premiums for Medigap policies will absolutely be higher. However, the Medigap insured can benefit from more choice among providers and ultimately lower total out-of-pocket costs.
Keep in mind, based on our study and Mr. Ciano’s expert commentary, if there’s room for great improvement and affordability, it would be within Medicare Advantage. Obviously, companies like Aetna are adept at changing with the tumultuous times!
Finally, Medicare-eligible individuals must be aware of Medigap enrollment periods; otherwise, they may not obtain coverage in the future.
Be mindful of Medigap’s open enrollment.
Medigap policies are available to eligible recipients during open enrollment periods regardless of pre-existing health conditions. Medicare Advantage plans are not subject to similar exclusions. Medigap’s supplemental coverage open enrollment is a six-month open enrollment period that starts the month you are 65 or older and enrolled in Part B.
Thank you, Mr. Ciano, for your insights from the C-Suite!
Richard Rosso, MS, CFP, CIMA is the Head of Financial Planning for RIA Advisors. He is also a contributing editor to the “Real Investment Advice” website and published author of “Random Thoughts Of A Money Muse.” Follow Richard on Twitter
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