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Anthem MediBlue Plus HMO

Anthem MediBlue Plus HMO is a Medicare Advantage plan with prescription drug coverage (MAPD). This plan is offered by Anthem Blue Cross Blue Shield in 4 counties in the state of Connecticut.  Clients can purchase in either Fairfield, Litchfield, New Haven as well as Windham counties.  Given the plan is an HMO plan, participants must use in network providers.  In fact, if you use out of network providers  anthem will not cover your claims. An exception to this would be when getting urgent or emergency care which allows of of network services.

The plan has a monthly premium of $37 a month. This would be in addition to the part B premium of $121.80.  This plan does not require a referral. Copays for a primary doctor are $15 and $40 for a specialist.  The plan has an annual out of pocket max of $6,700 per year. Annual max indicates the most the insured would need to pay in medical claims for  the year. It does not include prescription drug out of pocket costs. You can add dental coverage to this plan for an additional premium. They include Silver Sneakers  in the $37 monthly premium and they pay a local gym membership monthly fee for members. Diabetic supplies are covered at 100% when using approved diabetic supply vendors.

A Medicare Advantage plan should not be confused with a Medicare Supplement plan (also called Medigap).  MAPD plans offered medical and drug benefits combined with the insurance company as the primary insurance. With a Medicare Supplement, Original Medicare is primary.  The insurance company would be the secondary insurance. As a result, a Medicare Supplement plan does not have a network.  In fact, members may see any provider that participates with Original Medicare.  This is not the case with an Advantage plan.

 MediBlue Plus HMO Anthem summary of benefits

Anthem Mediblue Plus HMO application

Click here to request a personal Medicare review.

The high F Medicare supplement plan is not well understood by consumers and insurance brokers.  In the state of Connecticut this is a shame because if  people did understand it well, about 90% of those with a Medicare Supplement plan would have it.

The plan is priced tremendously well in CT at $35.00 a month.  With this price point, the math on the High F plan comes out better than the math on any other supplement including the AARP Plan F supplement priced at $214 a month.

Here is how High Deductible F works-(This is a very simplified version but you will get the point):   Medicare Part A covers hospital costs after a $1,200 deductible and Medicare Part B covers 80% of doctors and testing costs.  The anthem High F, will cover 100% of costs once a consumer spends $2,070. out of pocket in a year.  At $35 a month, the math can not be beat.  Try the math versus any other Medicare Supplement plan on the market and see how it comes out.    Keep in mind that only 1% of Medicare consumers with a high deductible F plan every actually hit their deductible.

There are very few situations when a person should have a Medicare supplement plan other than Anthem High F supplement in Connecticut.  Unfortunately,a lack of understanding from Medicare recipients and the low commission paid to brokers will limit the number of people that have this plan

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

The Anthem Blue Cross Blue Shield Supplements for 2012 are attached to the posting. The rates are competitive with most carriers but are slightly higher than the AARP lines of Supplements.
The Anthem High deductible F supplement is a very strong offering that should be considered by anyone with a Medicare Supplement in Connecticut. AARP does not currently offer a high deductible F in Connecticut. Look at other posts on our blog for additional information on the High Deductible F plan.

Anthem supplement 2012 summary of benefits
Anthem-Medicare-Supplement-Application-CT-2012

Applications may be faxed to 203-567-6235 or emailed to Edward@croweandassociates.com Please call 203-796-5403 with any questions

The  Anthem Mediblue Preferred PPO became available in CT on 1-1-12.  The plan offers advantages  over all competitors in CT. The key features of the new plan are $0 monthly premium, $0 copay for primary doctor and $0 copay for Generic Drugs. To further strengthen the offering the In network and Out of network Out of Pocket Max will be $3,400 combined. The hospital copay is $250 a day for a max of 6 days both in and out of network.

The plan offers many less high profile but non the less,  important benefits such as Major Radiology copay of $100, expanded Rx list including the Barbituates classed drugs, ect…..

The plan is not perfect as it does have a $60 Rx deductible for name brand drugs but the other benefits are so much better than the competing plans for 2012 that will not have much impact. The key will be to see if they are able to maintain these benefits for more than one year. It makes one wonder how they are going to be able to offer such a strong program compared to other large carriers in the market such as United Healthcare and Aetna.

Time will tell if they are trying to buy membership for one year just to make major benefit downgrades for 2013

Application and Summary of Benefits available below

Anthem PPO summary of benefits

Anthem Medicare PPO application

For additional information or questions call: 203-796-5403

Applications may be submitted to Edward Crowe for Processing:

Fax submissions:  203-567-6235

Email submissions: Edward@croweandassociates.com

Mail: Crowe & Associates, 155 Main Street, suite 205, Danbury, CT 06810

Getting a Medicare Supplement plan is difficult for someone on  under age 65 that is medicare eligible due disability.  Most of the supplement plans available are only offered to those on Medicare at age 65 and older.   Although the options are limited there are still some good choices.

If you are on Medicare A and B and under the age of 65 you can still obtain an Anthem Plan A supplement for about $190.00 a month.  The plan covers basic benefits and the 20% part B coinsurance.  It does not cover the hospital deductible however. Even without the Part A hospital deductible covered, this is a legitimate plan offering strong coverage.

United/AARP will offer plans to those under age 65 as well but only down to age 50. For those on Medicare age 50 to age 64, AARP will offer plan A, B and C.   Plan A has the exact same benefits as the Anthem plan A discussed above.  Plan B covers the same thing as plan A supplement but also will cover the Hospital Part A deductible.  Plan C covers Basic benefits, 20% coinsurance, Part A and B deductibles and skilled nursing facility.  With the extra coverage comes additional cost as plan C with AARP costs over $230.00 a month

For an Anthem BCBS Plan A supplement summary of benefits click here

For an Anthem BCBS Plan A supplement Application, click here

For an AARP Plan A-C application click here

For an AARP plan A-C summary of benefits click here

Applications may be printed out and sent into Anthem or United HealthCare directly or they may be sent to Crowe & Associates for processing. Crowe & Associates will review applications to ensure they are complete prior to submission to United HealthCare. Applications can be sent to Crowe & Associates by the following methods

Fax- (203)-567-6235

Email- Edward@CroweandAssociates.com

Mail- Crowe & Associates, 155 Main Street, Suite 205 Danbury, CT 06810

Additonal questions may be emailed to Edward Crowe at Edward@CroweandAssociates.com or by phone at (203)-796-5403

People choose medicare supplement plans for a variety of reasons.  Some people choose them based on the name of the company offering them, advice from family or neighbors, and advertising on TV. Others may go with advice from a local senior center or simply go with a Plan F because it offers the most coverage.  Whatever the reasons may be, they are usually not enrolling in the most financially sound option.

High Deductible plan F should be the choice for any  person over the age of 65 taking a Medicare Supplement Plan. ( I say over 65 because it is not usually available to those on Medicare under the age of 65) High deductible F is not as easy to understand as the more popular options such as Plan F,C,D or even plan N.  However, if people did take the time to understand the plan, they would see that it is by far the best option from a mathematical standpoint.

Plan F High Deductible works in the following manner:  It will cover the Medicare co insurance and cost share once a person spends $2,000 in any given year.  In general, this means that when a person goes to the doctor, Medicare will pay 80% of allowable charges and the patient will pay the 20% left over.  It works the same way with other services such as testing and physical therapy.  If they go to the hospital, they will pay the hospital deductible and then Medicare will pick up the rest.  If these expenses add up to $2,000 in any given year, the high deductible F plan will pick up the remaining charges just like a normal Plan F does from the start.

The reason that high F makes so much sense is the math.  In Connecticut, high F costs $33.06  a month.  The lowest cost standard Plan F is $214.50 a month.  Plan F covers all medical costs (Medicare allowable) so there is no out of pocket expense, but the premium totals up to $2,574.00 a year.  Even if someone uses little or no services for the year, they will still pay this amount.   High F has a total cost of  $396.72  annual premium ($33.06 x 12 months) and a max out of pocket of $2,000 for a total of $2,396.70.  The worst case scenario leaves the person with High F saving $177.00 for the year.

The reality is that few people experience the worst case scenario.  Very few will actually hit the $2,000 deductible for the year. Some estimates show that only 5% of people accumulate over $2,000 of utilization.  There are a number of sources that estimate how much the average senior actually accrues in part A and B coinsurance and deductibles for the year but the average seems to show it is about $900 a year. Given this estimate, the average senior would save about $1,277.00 a year on plan F high deductible.   If they have a very healthy year, they will save even more.  If they have a catastrophically bad year, they will only save $177 but there is no risk involved.  At the end of the day, they will save money period.

Due to a general lack of understanding, High F will never be as popular as plan F but it should be the overwhelming choice for anyone in a supplement.  The math behind it is undeniable.

Anthem Medicare Supplement Summary of Benefits

Anthem Medicare Supplement Application CT 2012 

Applications may be printed out and sent into United HealthCare directly or they may be sent to Crowe & Associates for processing. Crowe & Associates will review applications to ensure they are complete prior to submission to United HealthCare. Applications can be sent to Crowe & Associates by the following methods

Fax- (203)-567-6235

Email- Edward@CroweandAssociates.com

Mail- Crowe & Associates, 155 Main Street, Suite 205 Danbury, CT 06810

Additonal questions may be emailed to Edward Crowe at Edward@CroweandAssociates.com or by phone at (203)-796-5403

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.

Medicare Supplement Plan N was approved for enrollment on June 1, 2010. The plan is offered at a competative price point by Anthem BCBS and United Healthcare “AARP Branded”. They both offer plan N for around $150 a month depending on availability of discounts.

Plan N is a departure from other supplements in that is allows the physician to bill up to a max of $20 per visit. It also has a $50 emergency room copay and does not cover the part B deductible (disappointing) of $155 a year. Many seniors have been willing to give the plan a try in order to save $50 a month in premium. This has been especially true of those in plan F supplements. Plan J enrollees need to be careful as plan J is a closed plan an they will not be able to go back to it in the event they try plan N and decide they do not like it.

The most suprissing part plan N has been the low number of providers that actually bill any type of excess on the plan. Providers are allowed to bill up to $20 dollars but seem not to do so often. (That has been our limited experience so far anyway)

People switching from their current plan to Plan N do not need to pay the $155 part B deductible as it has already been met for the year. They will however be subject to the Part B deductible in 2011.