SOURCE: eHealthInsurance

September 20, 2010 08:00 ET

Increased Medicare Payments to "Frontier States" PlanPrescriber Identifies Tips for "Frontier State" Medicare Beneficiaries

MAYNARD, MA--(Marketwire - September 20, 2010) - Medicare patients in the "frontier states" are likely to see an increase in the list of providers accepting Medicare. The wage index for hospitals and physicians in "frontier states" will be brought up to the national average of 1.0 beginning in fiscal year 2011, as a result of the Affordable Care Act of 2010. Today, PlanPrescriber (http://www.planprescriber.com), a wholly-owned subsidiary of eHealth, Inc. (NASDAQ: EHTH) identified tips to help Medicare patients in the "frontier states" identify coverage opportunities.

The Frontier States include Montana, North Dakota, South Dakota, Utah and Wyoming where at least 50% of their counties have a population density of less than six persons per square mile(1).

As hospitals and physicians in the frontier states begin to benefit from Medicare payment increases of approximately $2 billion over the next ten years, patient costs are expected to decrease as hospitals are no longer faced with compensating for lost revenues due to lower Medicare reimbursement rates.

Medicare patients are expected to benefit from a wider selection of hospitals and physicians from which to choose. In recent years, some physicians and hospitals in the U.S. have stopped accepting new Medicare patients due to what they have deemed as inadequate reimbursement from Medicare. The increased Medicare payments for "frontier states" may result in these hospitals and doctors accepting more Medicare patients. 

Tips for "Frontier State" Medicare Beneficiaries

1. Check your network of providers: Some patients may have been attending their second or third choice hospitals or medical offices because their first choices were not accepting new Medicare patients. Now is the time for "frontier state" Medicare beneficiaries to reevaluate their options.

  • If you have a specific hospital or physician in mind, call their office and find out if they will be accepting new Medicare patients in 2011.
  • If you have Original Medicare Parts A and B, you can go to www.Medicare.gov for an updated list of providers that accept Medicare.
  • If you are on a Medicare Advantage or Medicare Supplement insurance plan, call your insurance provider and ask if they will be covering any new physicians or hospitals as a result of the "frontier state" provision.

2. Start shopping: With new options becoming available in 2011, be sure you're still on the most cost effective Medicare Advantage or Medicare Supplement plan. Premiums and deductibles can change from year to year, and plans with lower cost options could be available. Comparing your Medicare options every year could help you identify new plans, as well as changes in coverage and costs in existing plans. But be aware that Medicare Supplement plan costs can be affected by the types of pricing models they deploy. Plans that use an "issue-age" pricing model determine the plan's premium based on your age when you first enroll in the company's plan. The monthly premium may increase due to inflation and other factors, but -- as long as you stay in that plan -- they won't increase because you age. But, if you leave an "issue-age" plan, you won't be able to return to that plan and get the same price. A person who enrolls at age 75 will pay higher premiums than a person who enrolls at age 65.

PlanPrescriber.com customers can save an average of $925 per year, the first time they enroll in a Medicare Part D prescription drug plan, and an average of $586 per year when they switch from a Medicare Part D prescription drug plan(2).

PlanPrescriber's Medicare Plan Savings Finder offers an easy solution to compare Medicare Advantage, Medicare Supplement, and Medicare Prescription Drug plans online or by phone. The Medicare Plan Savings Finder offers the following features to make your plan comparison as seamless as possible:

  • Up-to-date plan information
  • Plan filtration by zip code
  • Ability to sort plans by premium or lowest estimated annual costs based on specific medications entered
  • Simple side-by-side comparison of coverage for up to three plans at once

3. Do a personal health assessment: Ask yourself a few simple questions to assess what type of coverage is right for your healthcare needs. It's possible that you may need more robust coverage or that you may be paying too much for your healthcare. 

  • Review your records and receipts, and ask yourself: How much did I spend on my healthcare needs in 2009 and 2010?
  • Figure out how much you can afford to pay in premiums, deductibles, and copayments.
  • Make a list of your current prescriptions and how much you spend each year on these medications.
  • Assess your current state of health, and ask yourself whether your current Medicare plan includes all of the coverage that you need.

Once you have the answers to these questions, you can go to PlanPrescriber.com to do an online comparison of the coverage offered under Medicare Advantage, Medicare Supplement, and Part D Prescription Drug plans. On the results page, you will be able to check details on healthcare coverage, whether your prescription drugs are covered, as well as details on premiums, deductibles, and co-pays.

(1) http://www.nytimes.com/2009/12/21/health/policy/21healthcare.html?_r=2&emc=tnt&tntemail0=y
(1) http://www.kaiserhealthnews.org/Daily-Reports/2009/December/21/Policy-Issues.aspx
(1) http://www.ama-assn.org/ama/pub/health-system-reform/hsr-impacts-practice.shtml
(2) Based on 337,000 www.planprescriber.com website visits, between January 1, 2010 and March 31, 2010, in which an end-user provided the requested data (e.g. zip code, current prescription medications, insurance (if any), etc.). End-users were categorized as "new enrollees" or "switching plans" based on the information they provided on the website. End-users were assumed to be qualified for Medicare Part C and D. Based on that information, savings were calculated by subtracting the estimated current cost an end-user was paying for prescription medication and insurance (if any) from the plan that presented the most amount of savings to the end-user and offered through planprescriber.com. Actual savings may vary depending on prescription medications, geographic location, actual plan selected and other factors. The type of benefits and coverage may vary between plans; the average savings examines only plans presented by PlanPrescriber that offer only prescription drug coverage. Plans presented may not include the same benefits or coverage as an existing plan. 

About PlanPrescriber.com
PlanPrescriber (www.planprescriber.com), a wholly-owned subsidiary of eHealth, Inc., is the leading provider of unbiased comparison tools and educational materials for Medicare Advantage, Medicare Part D Prescription Drug Plans, and Medicare Supplement insurance products. Seniors can take advantage of PlanPrescriber's free online advisor tools by logging on to www.planprescriber.com, or by navigating to the Medicare sections of national pharmacy chain web sites, including Wal-Mart, Rite Aid, Kroger and others. PlanPrescriber helps Medicare recipients find a Medicare plan that covers their specific medical and prescription drug needs at the lowest possible out-of-pocket cost.

About eHealth
eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation's leading online source of health insurance for individuals, families and small businesses. Through the company's website, www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of health plans underwritten by more than 180 of the nation's leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through its eCommerce On-Demand solution (www.eHealth.com/eOD), eHealth is also a leading provider of on-demand e-commerce software. eHealth's eOD platform provides a suite of hosted solutions that enable health plan providers and resellers to market and distribute products online. eHealth, Inc. also provides powerful online and pharmacy-based tools to help seniors navigate Medicare health insurance options and choose the right plan through its wholly-owned subsidiary, PlanPrescriber.com (http://www.planprescriber.com).

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