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Extended Health Coverage for Unconventional Expenses
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
A social HMO offers extended coverage for some of the unconventional expenses associated with senior healthcare, such as transportation and in-home day care not covered by traditional MCOs.
AAHP Definition
According to the American Association of Health Plans (AAHP), social HMOs provide coordinated services by uniting federal and state funds and services, to benefit the elderly.
Real Life Example:
One such social HMO is the 21 year-old Elderplan, based in Brooklyn, New York.* It is a Medicare Advantage Plan (MA-PD) with the following characteristics:
Elderplan Classic:
- $0 monthly premium
- $0 to see a doctor
- Unlimited brand name drugs
- Unlimited generic drugs
- $0 for approved generic drugs
Elderplan Extra:
- $0 plan premium
- Low prescription co-payments
- $40 reduction in Part B premium every month
- Coverage for dental, hearing and vision services
Elderplan Access:
- $0 regular doctor visits
- $0 monthly premium for you
- Unlimited brand name drugs
- Unlimited generic drugs
Elderplan Advantage:
- Coverage designed for individuals living in a skilled nursing facility
- A personal registered nurse care practitioner
- Complete coordinated care
- Treatment for some medical issues at residence
- $0 co-payment for skilled nursing facility stays
Assessment
Are you familiar with the social HMO concept and what has been your experience with it? Please comment and opine.
*illustrative purposes only. Not an endorsement of http://www.Elderplan.org.
Conclusion
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Filed under: Managed Care, Retirement and Benefits |
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Increased Ambulatory Care Co-payments and Hospitalizations for the Elderly
Dr. Marcinko, according to a new study published in the New England Journal of Medicine, in plans that increased co-payments for ambulatory care, mean co-payments nearly doubled for both primary care ($7.38 to $14.38) and specialty care ($12.66 to $22.05).
In control plans, mean co-payments for primary care and specialty care remained unchanged at $8.33 and $11.38, respectively.
http://content.nejm.org/cgi/content/short/362/4/320
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