News Alert – July 23, 2015
Individual/Consumer Markets

What to Expect for 2106 Open Enrollment Plans

"On Monday, the Texas Department of Insurance gave BlueCross and BlueShield of Texas (BCBSTX) the clearance to announce a change in retail product offerings for 2016. We wanted to share this information with you first.

The retail market has evolved significantly since the opening of the Health Insurance Marketplace in 2014. These changes require BCBSTX to make adjustments that will allow us to continue offering sustainable health insurance options.

There are some changes in the plans we intend to offer in 2016. Most significantly, we won’t be offering our Blue Choice PPO insurance plans for our under 65 block of business going forward.

We intend to offer other products, on and off the Marketplace. A new product has been filed that we believe will give you a flexible choice for your clients. We will be able to share information about that product if and when it is approved by the Centers for Medicare & Medicaid Services (CMS) closer to open enrollment.

We are committed to offering competitively priced individual insurance options in every county in the state, both on and off the Marketplace.

During the months leading up to the beginning of open enrollment, we will talk publicly about the plan transition, and make information available to members and key stakeholders. Below are some details you can use when reaching out to your PPO customers. We recommend that you start having these conversations soon since our proactive outreach could lead to media attention.

We stand ready to assist you and your clients through this transition.

Details for You

• Currently, we have about 367,000 individual Texas members who will have their PPO plan discontinued in 2016. This number fluctuates monthly.

• Around 148,000 Texas members are in grandfathered PPO plans that will not be discontinued. Our Blue Choice PPO network will continue to serve these members.

• This change does not affect our product offerings for our employer group customers or Medicare members.

• Our Blue Advantage® HMO network will remain. We are working to expand the numbers and reach of providers participating in that network.

• We only had the first full year of ACA claims data for analysis this year, for 2014 claims. In the individual market segment in 2014, BCBSTX paid out more than $400 million more in claims than it collected in premiums. Losses that high are unsustainable, and we have adjusted our offerings – as many insurers have – to be sustainable in the new market reality.

• Not all hospital systems or large physician networks will be participating in our network options for individual members. While this was true in previous years, the number of providers not in network due to the discontinuance may be greater in 2016. We have ensured that we have an adequate network to provide the physicians and hospitals needed to serve our retail members in each market, and we continue to have discussions with additional providers.

Talking Points for Discussing the Changes with Your Clients
Why is BCBSTX discontinuing the Blue Choice PPO?
For the past two years, BCBSTX has been the only health insurer offering an individual PPO plan in all Texas markets. BCBSTX found that the PPO is not sustainable at an affordable price due to anti-selection. BCBSTX will continue to offer other plan options in all 254 counties, on and off the Marketplace.

What will this mean for individual members who currently have the PPO plan?
BCBSTX will be transitioning affected individual members to another plan, so you will not experience a gap in coverage. You will also have the option of choosing a different plan during 2016 open enrollment.

Are there providers who were available under the PPO who will no longer be in network for BCBSTX members on any plan?
There are some providers who were in BCBSTX’s individual PPO plans networks who will no longer be an in-network option for individual members, except those in grandfathered plans. These providers declined to participate in the Blue Advantage network.

If you are seeing a provider who will no longer be available to you through the new plan’s network, BCBSTX will work with you to find a new provider. If you are currently undergoing a course of treatment, BCBSTX will work with you and your providers to minimize the impact to your care, just as if you changed plans for any other reason.

BCBSTX continually seeks opportunities to work with providers to offer the best solutions for our members.

Will there be a rate increase for HMO for 2016?
BCBSTX’s rate filings are currently under review by CMS, so that information won’t be available until rates are finalized and approved. BCBSTX pricing is designed to allow the insurer to offer sustainable products and services to its customers for years to come. A medical loss ratio (MLR) requirement is in place to protect consumers by requiring a high percentage of premiums to go to medical costs. If that requirement is not met, customers may be eligible for a premium rebate.

What would have been the rate increase for PPO for 2016 if it was still available?
A plan’s success requires the right ratios of enrollees to providers, and of the amount of premiums paid in to amounts paid out for care provided. In the 2014 individual business, BCBSTX paid out millions more in claims than it collected in premiums. Losses that high are not sustainable. Like any business, BCBSTX must make necessary adjustments. There were no options that kept the PPO sustainable and still allowed for other plans to be offered across the state.

Why couldn’t you just continue offering the PPO and increase the rate for it?
Under ACA, individual business is rated using a single risk pool, meaning all individual plans had to be looked at together. This means BCBSTX couldn’t just look at the pricing of the PPO separately. If BCBSTX had kept both the PPO and HMO, it would have added dramatic costs for every member with an individual plan.

Is group subsidizing individual business?
The group line of business operates separately from the individual line of business. BCBSTX’s group rates are based on expected cost of doing business for 2016 for group business."

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TRICARE^® is the health care program that serves uniformed service members, retirees and their families worldwide.

Medicare is a federal health care program for U.S. citizens age 65 and older, under age 65 with certain disabilities and those who have end-stage renal disease.

You may be eligible for both TRICARE and Medicare. This article explains how the two can work together to help pay your health care costs.

Medicare Basics

Original Medicare consists of Medicare Part A and Medicare Part B.  Medicare Part A provides hospital coverage.  Medicare Part B provides coverage for doctor visits and outpatient care.

Medicare Part A is premium free for most people because they or their spouse paid Medicare taxes as an employee.  Part B charges a monthly premium.  Both parts charge additional costs such as deductibles, copays and coinsurance.  People who are getting social security or railroad retirement benefits when they become eligible for Medicare are enrolled in both Part A and Part B automatically, however, you may decide to refuse one or both.  Others must sign up.  You can sign up for Medicare at Medicare.gov or at your local Social Security Office.

Most people accept or sign up for Part A because there is no premium.  But some people choose to delay enrolling in Medicare Part B.  This may make sense when you have other coverage, such as employer or union coverage.  You can delay paying the Part B premium and use your other coverage for your medical care.  If you delay Part B, you can sign up when you leave or lose your employer or union coverage.  Pay attention to timing though because you may be charged a penalty if you miss your enrollment window.

TRICARE For Life

TRICARE For Life is Medicare wraparound coverage for TRICARE beneficiaries.  You are eligible for TRICARE For Life if you are entitled to Medicare Part A and have Medicare Part B, regardless of your age.  TRICARE For Life is available worldwide.  It offers secondary coverage after Medicare in the U.S. and U.S. Territories.  In other overseas locations, TRICARE For Life is the primary payer.

You must have both Medicare Part A and Medicare Part B to be eligible for TRICARE For Life.  Based on your specific situation and needs, you may have other TRICARE options when you are Medicare eligible that may not require you to have Part B.  For example, you may have coverage through a current employer that may allow you to delay signing up for Part B.  However, you may lose eligibility for any TRICARE benefits if you do not have Medicare Part B when it is required.  You can get more information about this in the TRICARE For Life Handbook.

TRICARE and Medicare Parts C and D

Medicare Part C is also called Medicare Advantage.  Medicare Advantage plans are offered by private insurance companies approved by Medicare. Each plan must provide all the benefits of Medicare Parts A and B. Many plans offer additional coverage as well, such as vision and dental care. You may choose to receive your benefits through a Medicare Advantage plan or through Original Medicare, which is administered by the federal government.

TRICARE For Life may work with either a Medicare Advantage plan or Original Medicare. It’s important to understand the coverage and costs of any Medicare Advantage plan you are considering. Plans are offered regionally, and coverage and costs vary.

Medicare Part D is prescription drug coverage.  Part D plans are also private plans offered by Medicare-approved insurance companies. The coverage is available in standalone Part D plans, or it may be included in a Medicare Advantage plan.

TRICARE For Life includes a prescription drug benefit, so you may not need a Part D plan.  If you have TRICARE For Life and decide you want to enroll in a Part D plan, you can do it at any time. The TRICARE drug benefit is considered “creditable coverage,” which means it is at least as good as a Part D plan. This allows you to sign up without paying the Part D premium penalty that may apply if you did not have creditable drug coverage.

Get Help

You can contact your local State Health Insurance Assistance Program (SHIP) for free health insurance counseling and assistance. Visit Medicare.gov to find contact information for the SHIP office in your state.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.  Contact Cruson Insurance Agency at 972-896-3851 for assistance.

Resources:

Medicare & You: Learn about Original Medicare coverage and costs.

TRICARE for Life Handbook: Get information about staying eligible, getting care and who to call for help.

TRICARE and Medicare Turning 65: Learn how Medicare may affect your TRICARE benefits.

by Colin Milner, CEO, International Council on Active Aging

Retirement communities are a living option welcomed by all kinds of people today. Outdated views can stop some men and women from seeing retirement communities as many of them really are today. But others choose these communities for the vibrant lifestyles they offer as well as the services and support. In fact, some people become more active after they move to a community because everything is there and easily accessed.

Here are four things to consider about making the move.

1. Why do you want to move?

There are lots of reasons to make the move. The word “community” attracts people who want to connect with others. Some people want the lifestyle. Others need ongoing assistance or care. The only reason that matters is your own personal reason.

2. Where do you want to live?

Do you want to stay close to family and friends or move to another part of the country? Do you want to live in the suburbs, city, or countryside? You’ll find everything from downtown loft apartments to countryside cottages available today. Also consider what kind of community will meet your needs, wants, expectations, and desires. Some options include active adult, independent living, assisted living, and long-term care communities. Continuing care retirement communities offer all these services on one campus.

3. What do you want out of the community?

People often feel reenergized when they move to a retirement community. To make the most of your opportunities, research the lifestyle options and services available. Ask how a community will support you if you want to connect with others, become fitter and healthier, train your brain, learn new things, or experience new adventures. Does the community have qualified staff to help you meet your goals—for example, fitness instructors, nutritionists, or life coaches? If you need ongoing assistance and care for yourself or a spouse, ask what services are available on campus. Examples include physical and occupational therapy, assisted living, nursing, and memory care services. No matter what drives a move - lifestyle or care support - it is best to plan for all life’s possibilities.

4. What is your bottom line?

Can you afford that house or apartment in a retirement community? That is another key question. The answer is not always simple. Why? It’s not just a matter of whether you can buy the place, but whether you can live in it based on your lifestyle and expenses. Ask each community to break down its fees, as well as any additional amenities they offer for an extra charge. Be sure you understand all the financial implications before buying. There is nothing worse than finding out you can’t afford to live in a home once you’ve bought it. Also, look at contracts in detail. These may vary based on services provided. Finally, remember to check a community’s finances to make sure the organization is stable.

As the saying goes, hope for the best and plan for the rest. Then make your move.

Would you like to speak to a Trusted Health Plan Advisor at no cost or obligation?  If so, please click here.  Thank you!

Resources:

Glossary of senior living terms: Learn about commonly used terms and the different senior housing and care choices available.

Medicare.gov: Visit the official U.S. government site for Medicare.

If you've got a chronic condition that requires a lot of medication, chances are you've got your prescription drug plan figured out.  If you're in tip-top shape and don't take a single pill, what's the point?  When it comes to prescription drug coverage and Medicare, if you don't sign up when you're first eligible, you could pay more down the road through penalties.

So you might be asking yourself "Why does the federal government require you to sign up and pay a premium for something you may not use right now?"  Susan Morisato, President of Insurance Solutions for UnitedHealthcare's Medicare and Retirement Services, says it's the same reason you have insurance on property.

"Once your house is on fire, you can't buy homeowners insurance," says Morisato.  "The whole concept of insurance is that it's a shared risk."

Prescription drug coverage is also known as Part D in Medicare.  The Washington Post reports there is a lot of confusion around the penalty for not signing up in time for Part D.  The confusion centers on people who have coverage from a current or former employer, union or other group plan.  The bottom line is if you have drug coverage that meets Medicare's minimum standards you won't pay a penalty for not signing up for Part D when you become eligible.

Creditable Coverage

What are those minimum standards for prescription coverage?  Coverage needs to be "creditable."  This means that the coverage is expected to pay on average as much as the standard Medicare prescription drug coverage, or more.  If you have drug coverage through a group plan, that plan is required to tell you if your coverage is considered "creditable," or not.  Medicare requires your plan to send you this information at least once a year.  It may come in a standalone notice or in a letter or newsletter.  Keep this information; you might need to provide it when you sign up for a Medicare drug plan later.

Calculating the Penalty

If you don't have "creditable" prescription drug coverage, you may pay more to get a Part D plan down the road.  Time runs out 63 days after you don't have "creditable" prescription drug coverage.  After that you may have to pay a penalty.

The way the penalty is calculated is based on a few factors.  The formula includes the base premium, amount of time you are late and a fixed percentage -- one percent per month of late enrollment.  You can see the math in this Medicare.gov example:

The cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

This is important because your healthcare needs may change as you age and your doctor may prescribe different or additional medications.  Morisato recommends using the Open Enrollment Period from October 15th to December 7th each year to reevaluate your plan and make changes as your needs change.  People who qualify for Extra Help, a Social Security program for people with limited resources and income, will not be penalized.

Signing up for Part D

You can avoid penalties by ensuring you have prescription drug coverage.  There are two ways to get a Medicare Part D plan.  Both are through private insurance carriers.

1.  You can enroll in a Medicare Advantage plan (Part C) that combines Parts A and B along with a Part D prescription drug plan.
   
2.  You can get a standalone Part D plan to add prescription coverage to Original Medicare Parts A and B.
   

Want a quick review?  Watch this video to understand how Part D works and your options.  https://www.youtube.com/watch?t=32&v=8cfAbG9EFH4

For more information please contact Cruson Insurance Agency at (972) 896-3851, Monday - Friday 9 AM to 9 PM or Saturday 9 AM to 6 PM.  You can also contact Medicare 24 hours a day, 7 days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

As the days get shorter and the nights get cooler, you can already see the leaves starting to change. Like the changing leaves, the fall also brings your chance to make changes to your Medicare coverage. That’s because October 15 – December 7 is Medicare Open Enrollment. It’s your chance to review your health care coverage and see if you need to make any changes for next year. Or, you may decide you’re happy with the plan you have now. If that’s the case, and the plan is still being offered next year, you don’t need to do anything.

Over the next few weeks, look around – you’ll find a wealth of information about your Medicare benefits, especially in these everyday places:

1. In the mail

Look through your mail carefully — you may get important notices from your current plan, Medicare, or Social Security about changes to your coverage or any Extra Help you may get paying for prescription drugs.

Also, look for your Medicare & You handbook. It contains information about all of the Medicare plans in your area. If you decided to “go paperless,” you’ll get an email pointing you to Medicare.gov where you can get all the same information.

You’ll also start to see brochures from companies that offer Medicare health and drug plans. Just remember, be smart about protecting your personal information and your identity — plans aren’t allowed to call or come to your home without an invitation from you.

2. On your computer

Comparing your plan choices is important. Our Medicare Plan Finder is ready with all of the 2015 health and drug plan cost information to make it as easy as possible. Enter the drugs you take to find out how you can lower your costs and review the plan’s ratings to compare plan quality. If you find a plan that meets your needs, you’ll be able to join the plan right online starting October 15.

3. In your community

Take a moment as you enjoy these crisp mornings to review the Medicare information that’s out there. You may find a local event — somewhere right around the corner with counselors to help you, like your State Health Insurance Assistance Program. Don’t miss the chance to get personalized help if you need it!  Be sure and check out the Calendar of Events for Cruson Insurance Agency by following this link:  https://frisco.bubblelife.com/community/cruson_insurance_agency

We are here to assist you with all of your Medicare health care options so please feel free to contact us soon!  Cruson Insurance Agency ~ info@crusoninsurance.com (972) 896-3851.  Thank you!