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Aetna fitness reimbursement

Aetna has expanded their commitment to wellness by adding the Aetna fitness reimbursement benefit to some of their MAPD plans.  This benefit provides members of participating plans an allowance for activities or equipment for things such as; golf, pickleball, swimming, running, or even entrance fees for state and national parks.  Members can also use the benefit for fitness equipment such as athletic shoes, exercise mats, weights, wearable fitness trackers or any other equipment that helps them stay healthy.

Please note; this benefit does not cover expenses for fitness attire other than shoes.

Watch a quick video on Medicare advantage plans vs Medicare supplements

More about this benefit

Once the calendar year ends, you cannot roll over any portion of this benefit allowance.  This is a (DMR) direct member reimbursement, this means the member pays for the qualified item or activity up front and then submits the paid receipt to Aetna for reimbursement. Please make sure all fields are completed and receipts included before you send in the request to avoid delays in payment receipt.
If you are unsure if your plan offers this benefit,  either check the Evidence of Coverage for your specific plan or contact your broker to confirm this benefit as well as any other plan questions you have.

Learn the pros and cons of Advantage plans

Please note:  Members do not use the Fitness Reimbursement Form for reimbursement of benefits other than; fitness activity fees, or fitness supplies or wearable items.  Reimbursements  of any other expenses require a specific form for that purpose.

To determine if you should send in an item for reimbursement, make sure you can answer yes to the following 3 questions:

1.  Did you purchase this item or service this year to use this year?
2.  Is the item or service for your benefit/use only?
3. Do you have an itemized receipt for the items or services you are requesting the reimbursement for.  Please make sure the receipt includes the date of purchase, name of retailer, location of retailer and a description of the item as well as the amount paid.

How this benefit works

1.  The member pays up front for the qualified fitness-related services, activity fees or supplies from licensed provider or retail store.  They collect a detailed receipt that contains costs, date of purchase and payment method.
2. Plan member makes the request for reimbursement.  This can be done online at AetnaMedicare.com/Reimburse, once you are on the site, just follow the prompts and fill out the required form and upload a copy of your paid receipt.  If you do not want to fill it out online, you can either print out a copy from the website or request a form from the member services number on the back of your plan ID card. Please see below for more ways to submit your reimbursement.
3. Wait for your reimbursement to arrive.  Aetna will send members a check to reimburse them for qualified purchases.  Please allow up to 45 days to receive your payment.  Aetna must receive both the form and receipt within 365 days of the original purchase.  Allowance amounts do not roll over to the next calendar quarter or plan year.

To download a copy of the Fitness Reimbursement Form, click here

How to request the reimbursement

1. Members can go to AetnaMedicare.com/Reimburse or scan the QR code in this flyer.
2. You can either complete the form online or download, print and complete the reimbursement form and mail it to the claims address found on the back of your member ID card.  If you are requesting the reimbursement by mail, you should make a copy of your original documents; Aetna will not return them to you.

Please note:  any item you purchase from private, non-retail seller will not be accepted for reimbursement.  Plan members should always check their EOC for a full description of plan benefits, exclusions and limitations.

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 Aetna Medicare Elite Plan Connecticut

We are giving clients some information about the Aetna Medicare Elite Plan Connecticut.  The Aetna Medicare Elite plan is a Medicare Advantage Plan. This plan offers prescription drug benefits in Connecticut in both Fairfield and New Haven Counties for 2015.  This plan replaced the Aetna Medicare Value plan which was available throughout 2014.  Below is an outline of plan benefits along with links to benefits summaries. Read more

Aetna Health Insurance Quotes Online

This post will give clients a way to get Aetna Health Insurance Quotes Online.  Aetna has lowered their health insurance rates.  This gives them a substantial rate advantage over most other health carriers.   They offer a number of copay based plans that provide up front coverage for doctors visits with the need to pay a deductible first.   A quote engine has been provided through this blog that allows anyone to obtain a quote on their own. You may also apply for coverage through this same link if you choose.

CLICK HERE FOR AETNA HEALTH QUOTES

Note:  After you click the link, you are taken to the Crowe and Associates website.  Click on the “Aetna Health” link on the right hand side.  This link will take you directly to the Aetna quote engine.  Once you are on the Aetna quote engine, you enter any data that Aetna requires.  Afterwords, Aetna will give you a quote for the cost of each plan you choose.  When you have completed this step you can make an informed decision as to which plan is best for your needs.

If you prefer to use a paper application you may obtain it here:

CLICK HERE FOR AETNA HEALTH PAPER APPLICATION.    Once you have finished filling out your paper application, you can submit it to our office.  You can submit application to our office  either via fax at (203)567-6235 , email Edward@Croweandassociates.com or mail (Crowe and Associates, 304 Federal Road, Suite 107, Brookfield, CT 06804).

TIPS: Here is a list of the more popular Aetna plans:  CT Managed Care Open Access Value $3,000, CT Managed Care Open Access $5,000, CT Managed Care Open Access $2,500 as well as the CT Managed Care Open Access $1,500.  These plan values are subject to change annually.

If you have questions, please feel free to contact us.  You can reach us either by email at Edward@croweandassociates.com or by phone at  (203)796-5403.

If you currently have an individual health insurance plan for you and/or your family, you should be aware of which companies currently offer the best rates.  For the last few years, Golden Rule (United Healthone) had the best rates to offer in CT but that is not often the case any longer.

Aetna has moved their products into the best rate position in the last 5 months.   They now have a better price point than Golden Rule, Anthem BCBS , Connecticare and Cigna.   They have a number of products but the best price for the benefits seem to be in the Managed Care open Access plans (MC Open Access $1,500, $2,500 and $5,000) .  The Managed Care Open Access value plans also have great pricing.

The Open Access series of plans are PPO, copay plans.  They are not high deductible plans as they allow you to go to a primary Doctor or specialist for a copay.    While they are very competitive with their high Deductible plan prices, they do not have the same price dominance as they do with the Open Access plans.

Anyone that currently has an insurance plan would be wise to apply for the Aetna plans to see if they can get an approval with a lower premium.  Our website has links to the major companies that allows you to quote a plan and also apply from that same site.  This is not a lead generation site.  No one will call or email you if you quote and or apply on our  site.  CLICK HERE FOR QUOTES

It is most likely that Aetna will maintain this strong price point throughout 2013 in anticipation of the new Health reform plans that will be coming out.

Aetna Healthcare offers 3 Medicare Advantage plans in Connecticut. The plans are not available in every Connecticut county however as they only have the plan in Fairfield, New Haven, Litchfield, and Hartford county. Aetna also does not offer Medicare supplement plans in CT.

The most noteworthy Aetna Medicare Advantage plan in the $0 annual premium Aetna Basic plan. The plan is along the lines of its competitors such as United, Anthem and Connecticare. The plan also has a true national network which makes it stand out a bit from the others which do not. (United uses their Passport program but that has its problems)

The Most beneficial of all benefits on the Aetna plan is the part B copay of $50 for any part B drug. This is a huge benefit over all other MAPD plans in Ct as they are at a 20% cost share. A part B drug is a drug which is administered to the patient by the doctors or medical facility. To be a part B drug, the drug must also be provided by the facility or doctor. If the member picks up the drug at the Pharmacy, it will be a part D drug which is a different situation.

The other 2 Aetna offerings are nothing special. The premium HMO plan does not offer benefits that are strong enough to justify the premium and the PPO does not have adequate out of network benefits to be considered a strong out of network plan.

For a review of the Aetna 2013 benefits Aetna Medicare Plans 2013

Connecticut is a state which allows Medical underwriting on Health Insurance plans. As a result, you can apply for an individual health insurance plan in Connecticut with a number of companies. Current carriers offering individual health in Connecticut include…

Aetna
Anthem BlueCross Blue Shield
United Healthcare “Golden Rule”
Connecticare
Celtic Health
Assurant Health

The general public tends to believe that group insurance costs less than individual insurance but that is not true. Individual health insurance is actually much less expensive than group insurance. Individual insurance can cost 10% to 40% less than group insurance depending on age.

The key with individual insurance is passing medical underwriting in order to get the policy in the first place. Once the policy is obtained, it CAN NOT be canceled regardless of future health. The degree/amount of underwriting done depends on the company doing the underwriting.

There are a number of things to know when applying for an individual plan. For additional information, you may call Ed Crowe at 203-796-5403 (office), 860-992-4494 (Cell) or email Edward@Croweandassociates.com

One of the biggest points of confusion for seniors seems to be making a decision between a Medicare Advantage Plan and Medicare Supplement Plan. I receive phone calls on a daily basis from people either turning 65, moving from an employer plan to Medicare or just trying to decide what to do for the Medicare Annual Election period. Often they are confused and feel overwhelmed by the amount of information and plan choices available.

The reality is that it is actually very easy to learn enough to make an educated decision. This article is going to point out the basic differences between the plans and point out the strengths and weaknesses of each. With this info, anyone will be on their way to having enough information to make a confident decision on the best plan for them. (This Article is for people in Connecticut and NY- I will write one for other states in the next few days)

First, we need to break down the differences between the two types of plans and also dispel some myths about both.

Medicare supplement plans-

-They are secondary to your Medicare A and B (In other words, providers bill Medicare first and then your supplement covers some or all of the remaining costs depending on the plan you choose.

-They are for Medical only. You buy Rx coverage separately

-There is not a network. You can go to any doctor that accepts Medicare

-There are plans A-N available but only a few are popular. They Plan F, Plan N and High deductible F

-The plans are standardized in both Ct and NY. If a company offers a plan N, the benefits are identical regardless of the company offering it. Price is the only difference. Once companies plan N is not better than other companies. Just go by the price.

-There is no medical underwriting for them and in Connecticut and New York you can change them the first of any month at any time during the year.

Supplements are a good choice for people that do not want to have any network constraints. They also work well if you have doctors that do not take managed care plans (Medicare Advantage Plans) or if you travel to other states often.

Some clients like the fact that some of the supplements basically cover all of their costs for medical care. (Plan F and Plan C, Plan J for those whom still have it)

Finally, supplements work well for people that are very sick and receiving a high volume of care such as multiple injections at an outpatient facility or in the doctor’s office or people going to a number of physical therapy visits on a weekly basis. If you are on a plan F, you will not be billed for the services

I hear a tremendous amount of incorrect information being given out on a daily basis when it comes to Medicare Supplement plans. Here are some of the major areas where bad info tends to be most prevalent.

-” Such and such a company has the best Supplement plans”- In the world of supplements, there is no such thing as one companies supplement being better than the others. Supplements are mandated to have identical benefits. If United offers a plan F supplement, it has the EXACT same benefits as every other companies Plan F benefits. Supplement plans A-N are subsidized in Connecticut and New York. All plan benefits are the same. The only difference is the price that the company charges for them. If you have decided on a supplement and know which plan you want, take the company with the lowest cost for that supplement. (Example: You decide to take a plan N, Simply choose the lowest cost plan N being offered at the time.)

– “I can’t find all the companies offering supplements and the prices” – This is easy. Each state has a list of all companies in the state offering supplement plans and the prices of them. They can be found on the insurance websites of each respective state. Here is a link to Connecticut Supplement plans and prices for 2011

https://croweandassociates.com/images/stories/Medicare_Supplement_Rates_Connecticut_2011.pdf

“Supplements have underwriting outside of the guaranteed issue period”- There is no underwriting for supplements in Connecticut and NY. Both are guaranteed issue states even outside of the election periods.

“High Deductible F is not a good plan” – This could not be more off base. In Connecticut and Ny there are plans that have very low high deductible F plans. In fact, in Connecticut, Anthem BCBS offers a high deductible F plan for $39.00 a month. This math cannot be beat by any other supplement plan offered in CT. For more information on High Deductible F go to… https://croweandassociates.com/blog/?p=223 for NY

Although there are many good things about supplements, there is also a negative or two. First off is that they do not cover RX, you need to buy a separate drug plan if you want coverage. The going rate for Rx plans is about $32.00 a month. Secondly is the price of the supplements. The lowest cost plan F in CT is about $219.00 a month. When you add your Rx cost to that it brings you to about $250.00 a month for a plan. Keep in mind that you are going to be paying $3,000 in premium for the year no matter what. Even if you have a very healthy year you will have $3,000 less at the end of the year.

Medicare Advantage Plans
Medicare Advantage plans are managed care plans being offered by private insurance companies. They give you your A and B coverage, secondary coverage and Rx coverage all in one package. With a Medicare Advantage plan, your Medicare A and B is administered by the insurance company. As a result, when you go to the doctor you show them your Medicare advantage plan instead of your A and B card.

There are many positives and also negatives about an advantage plan. Here are the positives….

-They are included in your Medical and Rx in one package. You do not need to go and purchase a separate PDP plan.

-They are very inexpensive. All major carriers even offer $0 monthly premium* plans.

-They have out of pocket maximums.

-Preventative care is covered at no cost to the member.

*They can offer you a plan for $0 monthly premium because Medicare is paying the insurance company money to handle your enrollment and care for the year.

-Some carriers have national networks and plans with out of network coverage.

Some negatives about advantage plans…

-They have networks. If you take an HMO advantage plan (Which does not have out of network coverage) and you try to go to an out of network doctor, you will NOT be covered. Many people believe that Medicare will still cover them for the usual Medicare A and B amount if they go to an out of network doctor but it does not. You will need to pay the full cost.

-They have copays for services. You need to be aware of the copays on the plans you choose. Some plans cover certain services better than others. For example, one carrier may cover Major Radiology at 80% while the other covers it for an $80 copay.

-They have pre-certification requirements for some procedures. Your doctor is responsible for obtaining pre certs but they can hold things up at times.

Advantage plans tend to work very well for people in relatively good health that see a reasonable amount of doctors. You need to check to see that all your Docs and any hospitals you go to are in the network. There are now a number of plans with out of network coverage and national networks. This is good if you have a doc or two that is out of network.* The copays on most plans are reasonable and with $0 premium plans available, they can save the right person a lot of money for the year.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.

Often clients get upset when they go on an advantage plan and incur a large copay. (For example, a CAT scan which is a $150 copay on some advantage plans) They will say “If I was on a supplement, I would not have paid anything”. They tend to forget that the supplement is costing them money every month when the advantage plan is not.

The math on advantage plans actually makes sense for the majority of people but not everyone. Make sure you review the benefits and check networks prior to enrolling. Do the math and see how much you will save in monthly premium vs. how much exposure you have to copays. In the end, the advantage plan will likely win out but a little time needs to be devoted to make a comparison before you make a final decision.

*Make sure your out of network doctor will bill your insurance company for you and not make you submit yourself.

Choosing Medicare Supplement or Medicare Advantage

Choosing Medicare Supplement or Medicare Advantage plans can be both confusing and frustrating. Many seniors simply go with a company name they are familiar with (Most commonly AARP). A plan that a relative or friend suggested or they just stay in their current plan because that is what they have always had. The end result is usually a bad choice of plan for the given situation. The reality is that there is not one “best plan” for everyone. To choose the best plan for the situation, it is important to know all the options available.

Here is a quick overview of the options available to Connecticut residents and the strengths and weaknesses of each…..

Medicare Supplement Plans:

Medicare Supplement plans are secondary plans you can purchase from a private insurance company to help cover the gaps in Medicare part A and B.  In all states, the plans offer standard benefits.  Plans provide different levels of coverage.  This depends on which plan you choose. The plan benefits cannot change.  This means any company that offers a plan must offer the exact same benefits. For Example Plan N with Anthem BCBS is exactly the same as Plan N with AARP (United HealthCare). The only difference is the rate that the private company charges for them. Please keep in mind, the rate can vary greatly.  One company in CT charges $184.00 a month for plan J while another charges over $300.00 for the exact same plan.

Supplement plans are best for a person who uses a high volume of health care services. Supplement plans tend to be costly but have very little out of pocket expense. If someone is consistently receiving a high volume of medical services, it may be wise to look at a supplement.  It may also be wise to use a supplement as some doctors that will not accept Medicare Advantage plans. In such a case, a Medicare supplement plan will provide coverage when an Advantage plan will not.

If you are in the market for a supplement plan it goes without saying that AARP should be considered.

They currently have the best rates available.  If you are considering plan F, you should purchase plan J instead. Plan J cost less, has all the benefits of F and some additional benefits as well.

The drawback to a supplement in the monthly premium cost compared to the premiums of Medicare Advantage plans. Also, supplements do not come with Rx coverage which must be purchased separately if it is needed.  If you are not a high volume user of medical services, it is warranted to look at the available Medicare Advantage plans.

One last thing to mention with supplements is that some people are simply more comfortable with them.  For some seniors the most important thing is to be able to see any doctor and not worry about copays or anything associated with managed care.  The person who feels this way may be willing to pay the extra monthly premium for this luxury.

Medicare Advantage Plans:

Medicare Advantage Plans are a low cost way to for seniors to obtain health care coverage. Advantage plans provide benefits equivalent to Medicare Part A and B with most plans providing additional benefits beyond what is covered by A and B. The plans can come with or without Rx coverage build into the plan design. Medicare advantage plan administer your benefits instead of Medicare Part A and Part B which makes the plan primary. Premiums range from $0 monthly premium to $179.00 month premium depending on the plan selected.

Medicare Advantage Plans do have some drawbacks compared to supplements such as the fact that you need to stay in network in most cases (There are PPO plans with out of network benefits)  There are also copays associates with services.  The higher premium plans have very low or no copays for many services but the lower premium plans ($0 premium) tend to have more out of pocket costs on things such as hospitalization)

Here is a breakdown of the plans available in Connecticut for 2009….

AARP Medicare Complete:

Positives– $0 monthly copay, Rx coverage build in with Medical, very low copays to primary doctors and specialists and out of network coverage.
Negatives– The network can have a lack of physicians in network in certain parts of the state, New Milford and some other key hospitals are not participating and the hospital copay is stiff at $225 a day for a total of 17 days.

Aetna Golden Medicare:

Positives-The Golden Medicare plans offer a national network which is nice for people who travel out of the Connecticut area. The Physician and hospital network is now one of the largest in Connecticut.  The $59 plan is the lowest cost plan on the market that still covers Inpatient hospitalization at 100%. There are a number of different plans to choose from including PPO options that provide out of network coverage, the $0 premium plan offers strong benefits compared to the rest of the $0 premium plans in the market.
Negatives-Some drugs fall into the 4th tier when they are only 2nd tier with other plans.

HealthNet:

Positives- Strong provider network, many high dollar drugs are on the 2nd tier.
Negatives-At current premium levels, the benefits are not competitive with other carriers in the Connecticut market. The Navy plan has weak benefits ($150 copay for 5 days inpatient hospital) for the high premium charged ($179.00)

Evercare (Secure Horizons/United Health):

Positives-$0 premium plans with low physician copays and Rx coverage, Chronic conditions plans coverage more conditions than any other in the state, only Dual Eligible Plan (Medicare and Medicaid) offered in CT market.
Negatives- High out of pocket costs for inpatient hospitalization, weak network can be difficult to deal with from an administrative standpoint, weak out of network benefits compared to AARP Medicare Complete

Be cautious of anyone who is only able to sell one or two of the companies listed above.  If they only offer a few plans, they may not know everything available that could best fit your needs.  Find someone who has the ability to work with all plans available in Connecticut in order to see all of the choices.  Although there are a number of plans available, each person has their own needs.

Image by Jose R. Cabello from Pixabay