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Changes for Medicare Advantage in 2023

January 13, 2023Medicare AdvantageBlog

Every year, Medicare Advantage plans change slightly. These changes can be confusing, which is why we’ll be explaining all the Medicare Advantage changes you’ll experience in 2023.  

First, what is Medicare Advantage?  

Medicare is federally-funded health insurance, designed to get you the care you need at a lower cost. Medicare Advantage gets you more coverage than Original Medicare—for example, your Medicare Advantage plan will often cover prescription drugs, while Original Medicare plans won’t. 

What do Medicare Advantage plans typically cover? 

Medicare Advantage usually covers all three Medicare Parts: 

• Medicare Part A: Covers hospitalizations. You usually won’t pay a premium for this, however, there’s a small chance you won’t qualify for premium-free Part A. If that’s the case, you can purchase premium-free Part A. 
• Medicare Part B: Covers medical insurance (non-emergency). Every Medicare Advantage enrollee pays a monthly premium for Part B.  
• Medicare Part D: Covers prescription drugs. Only some Medicare Advantage plans offer this coverage.  

Medicare Advantage changes in 2023 

Here are the changes to Medicare Advantage plans that you should be aware of: 

1. Cost 

In 2022, the average Medicare Advantage enrollee paid $19 per month. In 2023, the average monthly premium for Medicare Advantage enrollees is decreasing to $18 per month. This means you’ll be paying less for the same great coverage.  

The lower costs are a result of the Biden-Harris Administration and its efforts to make healthcare more affordable. “Thanks to President Biden’s Inflation Reduction Act, millions of Medicare enrollees will have lower prescription drug costs and improved benefits when they sign up this year,” said HHS Secretary Xavier Becerra. 

2. Maximum out-of-pocket limit (MOOP) 

In 2023, the Medicare Advantage maximum out-of-pocket limit (MOOP) will increase to $8,300, from $7,550 in 2022. This means that after you spend $8,300 on Medicare services, your plan will cover the rest of your covered care costs for the rest of the year. 

However, most Medicare Advantage plans have lower out-of-pocket limits than the established maximum. Ask your insurer what your out-of-pocket limit is.  

3. Expansion 

Depending on what state you live in, your access to Medicare Advantage plans are limited. This may have caused problems for you in the past, but in 2023, five major Medicare insurers are planning to expand into new states and counties. You’ll have new options from: 

• Aetna 
• Cigna 
• Elevance Health (which used to be known as Anthem Inc.) 
• Humana  
• UnitedHealthcare 

The expansion of Medicare Advantage insurers will help more people get great coverage.  

4. Drug coverage 

If your prescription drugs are covered, you’ll see a two important changes to your coverage in 2023: 

1. For certain types of insulin, you’ll pay no more than $35 per month.  
2. The Advisory Committee on Immunization Practices (ACIP) recommends certain vaccines, and all of these will be free. These include: COVID-19, HPV, measles, polio, smallpox, and more.  

With the changes to Medicare Advantage drug coverage, you can expect to save money.  

Quick summary 

Here’s a summary of all the 2023 Medicare Advantage changes:  

• The average monthly premium will be $18.  
• The maximum-out-of-pocket limit is increasing to $8,300. 
• Medicare Advantage plans will be offered in more states and counties. 
• Insulin costs will be capped. 
• Recommended vaccines will be free. 

Ōmcare engages with Medicare plans   

Ōmcare is actively engaging with Medicare Advantage plans to help bring technology into your home as part of the costs you already pay. Our goals are to increase healthcare access, improve health outcomes, and maximize care for what you already pay. 

Learn more about how we partner. 

by Ōmcare

What is Medigap, and does it cover prescriptions?

December 15, 2022Medicare AdvantageBlog

If you’re worried about affording your healthcare costs, you’re not alone. 37% of adults age 65 and older are concerned that they won’t be able to afford their healthcare expenses within the next year. As the cost of care rises, it’s wise to consider all the insurance options available to you — including Medigap. 

Today, we’ll help you understand what Medigap is, how it can help you manage healthcare costs, and whether or not it pays for prescription drugs. 

Understanding Medigap: What is it? 

Medigap is also known as a Medicare Supplement, because it can help you pay for healthcare expenses that aren’t covered by Original Medicare. Medicare writes that Medigap “helps fill ‘gaps’ in Original Medicare and is sold by private companies.” Some of these gaps include:  

• Copayments 
• Coinsurance  
• Deductibles 

To have these expenses covered, enroll in a Medigap policy on top of your Original Medicare policy. You can buy a policy from any insurance provider that’s licensed to sell in your state, but you and your spouse will need your own separate Medigap policies.  

Does Medigap cover prescription drugs? 

While Medigap helps you pay for some healthcare costs, it doesn’t help you pay for all of them. Most Medigap policies will not pay for any of your prescription drugs and medications.  

Medigap doesn’t cover prescription drugs. 

Since Medigap won’t help you pay for your medications, it is not the best option if you have a condition that requires you to take a lot of prescriptions. Likewise, if your prescriptions are really expensive, Medigap is not the best option for you. 

On the flip side, if you don’t have many monthly medications, or your medications aren’t too expensive, a Medigap policy may be perfect for you.  

Other options: Paying for for prescription drugs 

If you do need expensive prescription drugs on a regular basis, Medigap won’t help. But this isn’t a dead end—other insurance options can help you pay for your monthly medications.  

Here are some other insurance options to consider: 

• Coverage from a former employer or union. 
• Medicaid, which provides healthcare assistance to people with limited income and resources. Medicaid can help you pay for your medications, but it does depend on what state you live in. 
• Medicare Advantage, which covers more healthcare costs than Original Medicare. Some plans offer Part D coverage, which means it will pay for your prescription drugs.  

If you do decide to go with a Medicare Advantage policy, you can’t buy and won’t need Medigap. 

Quick Summary 

We’ve just covered a lot of confusing information. Here is a quick summary of it:  

• A Medigap policy can help you pay for healthcare expenses that Medicare doesn’t—including copayments, coinsurance, and deductibles.  
• A Medigap policy won’t help you pay for prescription drugs.  
• If you need pricey prescriptions on a regular basis, some Medicare Advantage will cover the costs for you. 

Ōmcare engages with Medicare plans  

Ōmcare is actively engaging with Medicare plans to help bring technology into your home as part of the costs you already pay. Our goals are to: 

• Increase healthcare access  
• Improve health outcomes  
• Reduce costs  

Learn more about how we partner.

by Ōmcare

4 top technological solutions to improve medication adherence for Medicare Advantage

November 14, 2022Medicare AdvantageBlog

55% of senior patients are noncompliant with their medication schedules, which is an issue for Medicare Advantage plans given 41% of the Star Rating depends on beneficiaries properly taking their medicine—especially medications for diabetes, cholesterol, and hypertension. 

Having a high Star Rating is key to earning more enrollees—90% of Medicare beneficiaries are enrolled in a plan with a 4.0 rating or above. Focus on improving medication adherence to positively impact your plan’s Star Rating.  

To improve medication adherence, we first have to understand why seniors aren’t taking their medicine properly. 

Understanding the reasons behind medication non-adherence

Some of the top reasons for medication non-adherence include:  

• Forgetfulness: This is the cause in 63% of cases.  
• Complex regimen: Having too many medications to manage. 
• Medication schedule is too confusing: 36% of U.S. adults struggle to understand medical terms. 
• Hassle of refilling prescriptions: In one study, 20% of patients didn’t renew their prescriptions on time, and another 10% put off refilling their prescriptions.  

What do all of these reasons for non-adherence have in common? They have solutions—especially cost-effective technology that takes the burden off healthcare teams. Here are the top technological solutions to help Medical Advantage plans improve medication adherence. 

Technology helps seniors take their medicine properly

1. Platform to virtually connect patients to providers 

Virtual appointments and messaging systems help patients easily refill their prescriptions. Using online communications, patients avoid an unnecessary trip into the doctor’s office—and this saves time for busy healthcare providers, too.  

If you’re worried that telehealth will cause a decline in quality care, don’t be. 82% of patients say that telehealth is just as effective as in-person care. After connecting online, patients can have medications delivered right to their doorstep.  

2. Automatic pill dispensers 

Another way to increase medication adherence among beneficiaries is by using an automatic pill dispenser. High-quality dispensers on the market automatically provide pre-slit packages of multi-dose medication at the right time.  

The dispenser helps patients that might otherwise forget to take their medication, plus it aids those with a complex regimen. With a dispenser, medication adherence is no longer dependent on whether the patient understands their schedule or not. Technology provides the medication they need, when they need it.   

3. Medication reminders

Beyond pill dispensers, some patients need more reminders to ensure they take their medicine. Automatic medication reminders often come in the form of text messages or emails, and they’re a very effective way to help forgetful seniors take their medicine on time. 

Medication reminders often go a step further with notifications to get refills and attend medical appointments. All of these reminders, used in combination, help seniors stay on track and adherent to their medication schedules.   

4. Adherence tracking

To make sure your efforts are successful, we recommend an adherence tracking technology. This is a great alternative to relying on self reports—which can often be highly inaccurate. Dispensing data and video observation enable reporting when a patient misses a dose.   

That way, providers are directly notified when a patient is being non-adherent to their medication schedule, giving them the chance to respond quickly. 

Finding the right medication adherence technology

Medication adherence is very important to improve a plan’s Star Rating. We highly recommend looking for technology that includes:  

• A communication channel between healthcare professionals and families  
• Pill dispenser 
• Medication reminders 
• Medication adherence tracking 

The Ōmcare Home Health Hub® has all of these features to help Medicare Advantage plans increase medication adherence among senior patients. Reach out to Ōmcare today to learn more!  

by Ōmcare

Medicare Advantage vs. Original Medicare: What's the difference?

October 31, 2022Medicare AdvantageBlog

Making decisions that impact your physical and financial well-being can be confusing. Should you pick Medicare Advantage, or Original Medicare? What’s the difference? Here’s a comparison of your two options. 

What is Medicare?

To dive into the differences between Medicare plans, we have to understand Medicare as a whole: it is federally-funded healthcare insurance. Medicare plans are much more cost-effective compared to private insurance plans.   

Most people who sign up for Medicare are 65 or older, but it also assists younger people with certain disabilities and anyone with End-Stage Renal Disease. No matter why you qualify for Medicare, you have the choice between Medicare Advantage and Original Medicare. 

Medicare Advantage vs. Original Medicare

Coverage

When we say coverage, we mean “What will the Medicare plan pay for?” 

Prescription Drugs 

Medicare Advantage often covers prescription drugs. However, only certain plans cover medications—if you need prescription drugs covered, make sure to pick a plan with Part D coverage. Each plan will cover different drugs. 

With Original Medicare, you’ll either have to purchase separate coverage for drugs or pay for them out-of-pocket.  

Medicare Advantage offers extra coverage 

Medicare Advantage covers more medical services—like dental care, vision, and hearing—that Original Medicare doesn’t. Both Advantage and Original usually cover medically necessary services or supplies. 

Medicare Advantage requires approval  

With Medicare Advantage, you often need approval of services or supplies before the plan covers it. In contrast, with Original Medicare, you usually don’t have to get any sort of approval ahead of time.  

Costs

When considering coverage, cost is a very important part of the equation. First, we need to understand a few insurance terms: 

• Premium: The amount you’ll pay for your health insurance per month. 
• Deductible: A specified amount of money that you agree to pay before your insurance pays. 
• Coinsurance: The amount you pay for covered health care after you meet your deductible. 

AARP writes, “The federal government sets the premiums, deductibles, and coinsurance amounts for Part A (hospitalizations) and Part B (physician and outpatient services).”  

Original Medicare  

Most people qualify for premium-free Part A—meaning your hospitalizations are covered with no monthly fee. As for Part B, you pay a premium for that. 

As for out-of-pocket costs, you usually pay 20% of the Medicare-approved amount after your deductible. Before you meet your deductible, you cover all the costs yourself. There’s no cap on out-of-pocket costs.  

Many people who enroll in Original Medicare enroll in Medigap policy too, which helps cover the costs of:  

• Copayments 
• Coinsurance 
• Deductibles 

Aside from Medigap, you can pay for these costs using coverage from a former employer or union, or Medicaid. 

Medicare Advantage 

Similarly to Original Medicare, most people qualify for premium-free Part A. As for Part B, you pay a monthly premium. Plus, it’s possible you’ll have to pay a separate premium to the plan. Premium costs vary greatly depending on what plan you pick.  

Out-of-pocket costs also vary by plan, but there is a yearly limit on out-of-pocket costs for Part A and B. Once you reach your plan’s limit, you won’t have to pay anymore for the rest of the year.  

As for Medigap, you can’t buy it and you don’t need it when with a Medicare Advantage plan.

Breakdown of costs 

At the end of the day, costs depend on your individual plan. Many seniors do feel more comfortable with a Medicare Advantage plan, because there’s a yearly limit on costs, plus more coverage in general. 

After costs, there’s still one more factor to consider. 

Freedom of choice: Doctors and hospitals

The last question to ask yourself is, “Can I choose my doctor and provider?” 

Original Medicare offers more freedom. You can go to any doctor or hospital that takes Medicare, and you usually won’t need a referral to see a specialist. 

Medicare Advantage has more limitations. Typically, you can only use doctors who are in the plan’s network and service area. If you want to see a specialist, you often will need a referral.  

Quick Summary

We’ve thrown a lot of information at you, so here is a quick summary of it all: 

• Coverage: Medicare Advantage offers more coverage. 
• Cost: Original Medicare may be less expensive if you have minimal healthcare needs, but Medicare Advantage offers a yearly cap on out-of-pocket expenses. 
• Choice: Original Medicare offers more freedom of choice in doctors and hospitals. 

Ōmcare engages with Medicare plans 

Ōmcare partners with organizations that are seeking to:  

• Increase access 
• Improve health outcomes 
• Reduce costs 

Ōmcare is actively engaging with Medicare plans—both traditional and Advantage—to help bring technology into the home as part of the costs you already pay. Learn more about how we partner.  

by Ōmcare

Choosing a Medicare Advantage Plan: What you need to know

October 14, 2022Medicare AdvantageBlog

If you’re a senior looking for affordable healthcare, you’ve probably heard of (and may already be using) Medicare. It’s federally-funded health insurance, designed to get you the care you need at a lower cost. 

When you sign up for Medicare, you have two options: Original Medicare or Medicare Advantage. We’re focusing on Medicare Advantage because it has extra benefits that Original Medicare doesn’t—including coverage for vision, hearing, dental services, and prescription drug coverage.  

What does Medicare Advantage cover?

Medicare Advantage usually covers all three Medicare Parts: 

• Medicare Part A: Covering hospitalizations. You usually won’t pay a premium for this, however, it’s possible you won’t qualify for premium-free Part A. If so, you can buy it. 
• Medicare Part B: Covers medical insurance (non-emergency). Every Medicare Advantage enrollee pays a monthly premium for Part B. 
• Medicare Part D: Covers prescription drug coverage. You pay for Part D coverage, and you’ll have extra out-of-pocket costs throughout the year. Only some Medicare Advantage plans offer this coverage. 

We’ve covered the basics of Medicare Advantage, but you have more choices to make when it comes to choosing a plan. It can get confusing, which is why we’ll walk you through what to consider before making your decision.  

What to consider when choosing coverage

Here are five factors to consider when choosing a Medicare Advantage plan: 

Five factors to consider

• Costs: How much are the premiums, deductibles, out-of-pocket costs, and yearly caps? 
• Coverage: How well does the plan cover your needs?  
• Prescription drugs: Medicare Part D covers prescription drugs, but plans vary with costs of certain medications and which ones are covered.  
• Doctor and hospital choice: You’ll only be able to visit doctors and hospitals that are within the plan’s network.  
• Quality of care: Each Medicare Advantage Plan receives a star rating, so you can see how high its quality of care is before you enroll. Compare your options based on this factor using  an online tool. 

 While you’re considering these factors, we highly recommend documenting your needs. This will help you remember what you need while you’re picking a plan. 

Types of Medicare Advantage Plans

There are different types of plans. Here are the most common types of Medicare Advantage Plans: 

Health Maintenance Organization (HMO)

An HMO generally limits coverage to care from doctors, hospitals, and providers who are within their network. HMOs typically have lower monthly premiums, but more limitations when it comes to which doctors they cover. With an HMO, prescription costs aren’t usually covered. 

Preferred Provider Organization (PPO)

Similarly to an HMO, PPO plans have a network of doctors and healthcare providers that are cheaper to use. You can use other providers, but they’re more expensive. You’ll have more flexibility than your typical HMO plan, and unlike HMOs, prescription drugs are usually covered.  

Private Fee-for-Service (PFFS)

Some PFFS plans work with any provider, while others have a network of specific doctors. Often, you can go outside of that network for a higher cost. This plan determines how much it will pay, versus how much you must pay when you get care. Prescription drugs aren’t always covered under an PFFS. 

Special Needs Plans (SNPs)

According to Medicare, “SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.” The chronic or disabling conditions these plans tailor to include: diabetes, HIV/AIDS, and dementia.   

Care will typically be provided by specialists that cover your condition. 

Joining a Medicare Advantage Plan

Once you decide what plan is best for you, all that’s left to do is enroll. You can enroll when you turn 65 or during open enrollment (every year from October 15 – December 7). You’ll also be able to switch plans one time from January 1 – March 31 each year. 

When you’re ready to sign up, Medicare has created a resource to help you through the process.  

Ōmcare engages with Medicare plans

Ōmcare’s goals are to help increase access to senior patients while reducing costs. Yet at the same time, we seek to improve health outcomes. We actively engage with Medicare plans to help bring cost-effective healthcare technology into your home as part of the price you already pay.  

Learn more about how we partner.  

by Ōmcare