Medicare beneficiaries in Cook County now have access to almost twice as many hospitals and physicians compared with last year through two types of Aetna Medicare Advantage plan options – the Aetna Golden Medicare Plan® (HMO) and the Aetna Golden ChoiceSM Plan (PPO). “Aetna is extremely pleased to have added 18 hospitals and more than 1,200 physicians to the Aetna network, and more specifically, our HMO and PPO offerings for Medicare,” said Nitin Bhargava, North Central Region head of sales for Aetna’s Consumer Segment. “Some notable additions to our network include the University of Illinois at Chicago Health System, Resurrection Health System, Little Company of Mary Hospital and Healthcare Centers, and St. James Hospital and Health Center, among others.”

In addition, Aetna is offering two HMO plans with a zero-premium option in 2009 that are available to all Medicare beneficiaries in Cook County.

Plan Features

Aetna’s Individual Medicare Advantage plan options in Cook County that also include Part D prescription drug coverage feature a wide range of benefits, including:

• Coverage for doctors visits, hospitalization and prescription medications through one plan with the convenience of a single ID card.
• Coverage for all Medicare Part D prescription drugs, including those for common conditions such as high blood pressure, diabetes, allergies, high cholesterol and arthritis.
• Discounts on vision and hearing aid products and services, and special rates on alternative health care services.

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Tags: Aetna Medicare, Aetna Medicare Advantage Plans, Medicare Cook County

Effective January 1, 2009, Prime Therapeutics will become the Medicare Prescription Drug Plan (PDP) pharmacy mail-order vendor for Blue Cross Blue Shield of Illinois plans, replacing Walgreens. Existing members who use the mail order program are being notified via letter of the change and efforts are underway to make the transition as seamless as possible.

Current clients of Illinois Health Agents can contact our office for personal assistance with the new mail order forms by phone at (630) 930-9364 or by email at info@ilhealthagents.com.

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Arthur Laupus joined AARP because he thought the nonprofit senior-citizen-advocacy group would make his retirement years easier.

He signed up for an auto insurance policy endorsed by AARP, believing the advertising that said he would save money.

He didn’t. When Laupus, 71, compared his car insurance rate with a dozen other companies, he found he was paying twice the average.

Why? One reason, he learned, was because AARP was taking a cut out of his premium before sending the money to Hartford Financial Services Group, the provider of the coverage.

Laupus stumbled onto something that many members of the world’s largest seniors organization don’t know: The group, formerly called American Association of Retired Persons, collects hundreds of millions of dollars annually from insurers who pay for AARP’s endorsement of their policies.

The insurance companies build the cost of these so-called royalties and fees, which amounted to $497.6 million in 2007, into the premiums they charge AARP members, according to AARP’s consolidated financial statement for that year.

AARP uses the royalties and fees to fund about half the expenses that pay for activities such as publishing brochures about health care and consumer fraud — as well as for paying down the $200-million bond debt that funded the association’s marble and brass-studded Washington headquarters.

In addition, AARP holds clients’ insurance premiums for as long as a month and invests the money, which added $40.4 million to its revenue in 2007.

“At the end of the day, it’s all about fattening the coffers of the organization,” says Thomas Orecchio, who was chairman of the Arlington Heights, Ill.-based National Association of Personal Financial Advisors until September. AARP, he says, is sponsoring insurance for its members at inflated prices.

“It’s the dirty little secret,” he says.

During the past decade, royalties and fees have made up an increasing percentage of AARP’s income, rising to 43% of its $1.17 billion in revenue in 2007 from 11% in 1999, according to AARP data.

Laupus, a former teacher in Baltimore, and millions of others joined AARP in the belief it would provide discounts, services and publications. The organization ranks behind only Consumer Reports and the American Red Cross as the most trusted large group that influences U.S. politics and business, a 2007 Harris Poll found.

AARP has helped millions with tax returns, estate planning and health care advice.

With stock markets around the world plunging, savings plans in turmoil and medical costs soaring, older Americans need an advocacy organization in their corner.

“The turbulent economy puts more people in the difficult situation of being under- or uninsured,” says U.S. Sen. Charles Grassley, R-Iowa. “That’s why we need to make sure individuals aren’t taken advantage of with misleading marketing, especially by a name brand advocate who carries a high level of trust.”

Grassley sent letters to AARP CEO William Novelli and state insurance commissioners Nov. 3 inquiring into whether the AARP misrepresented what is covered by some health insurance policies it sold. Four days later, Novelli announced AARP would review its marketing and suspend sales of those policies.

AARP’s mission to help seniors has been compromised by its reliance on royalties and fees, says Marilyn Moon, who was director of AARP’s Public Policy Institute from 1986 through 1989.

“There’s an inherent conflict of interest,” she says. “A lot of people there are trying to do good, but they’re ending up becoming very dependent on sources of income.”

Moon is now vice president and director of the health program at American Institutes for Research in Washington.

Novelli, 67, has broadened AARP’s reach and increased its clout in Washington. He has expanded AARP’s marketing to include 17 types of insurance.

The association collects royalties on each of those products. Its membership rose to 40 million from 35 million, and its total revenue grew to $1.17 billion in 2007 from $520 million when Novelli took charge.

Nowhere were AARP’s conflicting roles more evident than in its lobbying in support of a 2003 bill proposed by President George W. Bush to expand Medicare, the federal health insurance program for people older than 65.

The bill, which for the first time added a prescription drug plan to Medicare, passed by a vote of 220-215 in the House of Representatives and 54-44 in the Senate. Thousands of AARP members complained that the legislation was a bad deal for seniors because it provided incomplete coverage and raised costs for seniors with low income.

After the Medicare bill was signed into law by Bush in December 2003, AARP was able to expand its contract with Minnetonka, Minn.-based UnitedHealth Group Inc., which underwrites AARP’s Medicare supplemental insurance plan.

AARP advertises that its Medicare supplemental insurance can save people thousands of dollars.

While every type of supplemental policy sold by all companies must offer the same coverage under federal rules, AARP doesn’t sell the least expensive.

The AARP/UnitedHealth basic policy costs $582 a year more than a lower-cost competitor in New York and $428 more in Los Angeles, according to data on Medicare’s Web page.

AARP’s muscle on Capitol Hill is vested in the size and geographic reach of its membership, as well as its lobbying budget. The association donated no money to candidates in 2007, federal election records show.

“They don’t even have to give any campaign contributions,” says James Thurber, director of the Center for Congressional and Presidential Studies at American University in Washington. “AARP’s enormous clout comes from the threat they could defeat people in Congress who don’t do what they want. They are the most powerful interest group in Washington.”

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Tags: aarp, Medicare, medicare supplemental insurance, united healthcare aarp

The 2009 Medicare annual Open Enrollment Period for prescription drug plans runs from November 15th through December 31, 2008. Medicare beneficiaries will be able to begin making enrollment changes in their health and prescription drug coverage for 2009 if necessary during this time.

In addition, for Medicare Advantage (MA) plans only, beneficiaries can make one change in enrollment—enrolling in a new plan, changing plans or canceling a plan—between January 1 and March 31, 2009.

Now is the time for beneficiaries to prepare and compare their health and prescription drug coverage options and choose the plan that best meets their needs. Beneficiaries should take time to compare their current plan with the new plan options available in 2009. If they are satisfied with their current plan and the current plan does not intend to significantly change coverage benefits, they do not need to do anything in order to maintain that coverage.

Beneficiaries are encouraged to review their prescriptions and other health needs when assessing the plan options described in the Medicare & You handbook or on www.medicare.gov. Beneficiaries who feel they need assistance when reviewing the plan options can call Illinois Health Agents at (630) 930-9364 or any other Medicare Certified agency.

People comfortable with navigating the Internet should take advantage of the enhanced online Medicare Prescription Drug Plan Finder options available on www.medicare.gov. This feature offers information on available drug plans, including out-of-pocket costs and pharmacy networks. The enhanced online Medicare Prescription Drug Plan Finder and Medicare Options Compare tools enable beneficiaries to compare drug plan options for prescription drug plans and Medicare Advantage plans in their area.

The 2009 Medicare & You handbook, mailed to beneficiaries in October, includes tips on selecting a plan and an overview of plan options. Beneficiaries already enrolled in a Part D plan will also receive an Annual Notice of Change describing any changes in the benefits of their current drug plan.

Another focus for this year’s open enrollment period involves signing up beneficiaries eligible for extra help, known as the Low Income Subsidy (LIS), to pay for their drugs. This benefit is not only about providing affordable prescription drug coverage; it’s also about promoting better health. For millions of beneficiaries, prescription drug coverage is a critical component in maintaining a healthy lifestyle. Income and resource limits apply. If you or a loved one feels they may be eligible for the LIS, contact KIPDA or the Social Security Administration at 1-800-772-1213.

This is an important time for beneficiaries to review their current coverage and make a decision that will give them peace of mind for the rest of the year. We encourage everyone to make a decision by early December, to ensure a smoother transition into the Part D benefit.

Beware of Medicare Fraud:

Unfortunately, not everyone who contacts you about switching to a Medicare drug plan has the best intentions. To protect yourself from scam artists intent on taking advantage of your situation, here are some additional tips to avoid becoming a victim:

Beware of door-to-door sales people. Remember, agents cannot solicit business at your home without an appointment. Do not let uninvited agents into your home.

Do not give out personal information, such as Social Security numbers, bank account numbers or credit card numbers to anyone you have not verified as a licensed agent. People are not allowed to request such personal information in their marketing activities and cannot ask for payment over the Internet. They must send you a bill. Once you decide to purchase a plan and have verified that the agent is licensed, you may give the agent personal information to assist in enrollment and billing.

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Tags: Medicare, Medicare Part D, medicare prescription drugs

Seniors enrolled in Medicare’s drug benefit will pay average monthly premiums of $28 next year, government officials announced today.

That’s about $3 higher than the 2008 average premium, or a 12 percent increase.

“Average plan bids have increased at roughly the same rate as drug costs,” said Paul Spitalnic, an official with the federal Centers for Medicare & Medicaid Services.

Premiums are set by the private plans that offer drug benefits under Medicare and will vary depending on the plan and location.

The average increase affects nearly 25 million Medicare beneficiaries — 7.6 million in Medicare Advantage plans with comprehensive coverage and 17.4 million plans that cover only drugs.

While officials said the premium increase was well below projections, advocates noted that it exceeds the annual cost of living increase for Social Security, which remains under 3 percent.

The problem is “the government is failing to do anything about the runaway prices that Americans pay for drugs” because it won’t negotiate price discounts directly with drug companies, said Robert Hayes of the Medicare Rights Center.

The annual enrollment period for Medicare Part D begins Nov. 15 and extends through the end of the year. This is the only time of year that seniors can elect to change their plans.

For 2009, the annual deductible for Part D plans (the amount consumers pay before coverage kicks in) will be $295. Once you pay the deductible, your Medicare Part D plan will pay 75 percent of your drug costs up to $2,700.

Then, you enter the so-called “donut hole,” and you’re responsible for 100 percent of your drug costs up to $6,153.75. After that, the government will pay 100 percent of your drug bills.

In other words, you could end up paying $4,350 in 2009 out-of-pocket for drug expenses before Medicare will take over paying for all your drugs.

In Illinois, seniors with low incomes will want to make sure they consider applying for assistance that can help cover these extra expenses. For more information about Illinois Cares Rx, one of these programs, click here. To obtain this assistance, you have to work with a Medicare drug plan that partners with Illinois Cares Rx.

If you’re very low income, you probably qualify for a program known as Extra Help. For more information about Extra Help, click here. To qualify, you’ll have to apply and be approved by the Social Security Administration.

For help figuring out how Medicare Part D works, counselors are available at the organizations listed below.

Illinois Department of Aging Senior Help Line 1-800-252-8966

Illinois Senior Health Insurance Program 1-800-548-9034

AgeOptions, suburban Cook County 1-800-699-9043

Chicago Department of Senior Services 1-312-744-4016

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Tags: Medicare, Medicare drug plan, Medicare Part D

HARTFORD, Conn. – September 3, 2008. – Aetna announced today that it has made its CareEngine-powered Personal Health Record (PHR) available to current Aetna Medicare members who purchased their Medicare plans individually. This unique, interactive tool is designed to better engage Medicare members in managing their own health, as well as make it easier for members to share health information with their physicians.

Aetna’s PHR combines a wide variety of health information gathered from across the health care spectrum — such as physician offices, labs, diagnostic treatment and pharmacies — with user-entered information such as family history or allergies, and houses it in a secure, online location. This type of tool is especially important to Medicare members as more and more of them use the Internet. A May 2008 study from the Pew Internet & American Life Society estimates that 35 percent of individuals age 65 and over use the Internet, and the percentage increase for this age group has been greater than any other since 2000.

“This is a great example of the value that we provide to our Medicare members,” said Frank McCauley, head of Aetna’s Consumer Business Segment. “Instead of storing medical records in a file cabinet or a shoe box, Aetna’s PHR allows members to access their medical information any place an Internet connection is available.”

With permission from the member, the Personal Health Record can be shared online with physicians and other health care professionals. In addition, members can easily print copies to bring to office visits to help fill out forms. They also have the ability to create and print a wallet-sized Emergency Information Card that contains important information such as name, date of birth, blood type, emergency contacts, allergies, medications, and physician and insurance information.

Aetna’s PHR also uses patented CareEngine technology that continuously scans an individual’s health data and claims information and compares it to current, established medical best practices. It can then alert members and doctors about possible urgent situations and opportunities to improve care.

Recent Enhancements

Through a recent pilot program that made the PHR available to more than 750,000 members, Aetna discovered that members with an ongoing health condition were twice as likely to use their PHR as those without one. In part because of this finding, Aetna added Health Trackers to the PHR to help members better follow their health data. With this new feature, members can more effectively monitor their blood glucose levels, blood pressure, cholesterol, BMI and more.

Aetna has also made the PHR available online to treating physicians’ offices (if given access by the member) through Aetna’s secure provider website via NaviNet®.

“With age usually comes an increased need for health care services, and our Medicare members are more likely to have chronic conditions they need to monitor on an ongoing basis,” McCauley said. “These new features will give them the ability to better track their own health information and share it with their physicians. Improvements in both of these areas can help our members make better decisions concerning their health care.”

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Tags: Aetna, Aetna Medicare, Medicare, monitor health, Organize medical information, Personal Health Record