Medicare Products

Transcription

1 Medicare Products Introduction The Health Care Delivery Policy Program at Harvard University s John F. Kennedy School of Government s Center for Business and Government tracks the health care delivery products offered by the Centers for Medicare and Medicaid Services (CMS). Sources of information include CMS publications, articles from major newspapers, consumer magazines and industry journals, published surveys, and print and Web-based reports and charts from governmental sources, non-profit agencies and health care industry foundations and consultants. Original articles and presentations by the Health Care Delivery Policy Program are also included in the research. In 2005, the Program s Customers by Market Segment project found estimates of million Americans receiving healthcare through the Medicare program. Pages 2-13 of this report display the description, eligibility criteria, covered benefits and costs of the array of Medicare products available in The products tracked for this report were available as of November This chart includes products that incorporate Medicare and Medicaid, and those that incorporate Medicare and private health insurance. Products available in 2005, but not available at the time of the posting of the report are displayed in gray. Medicare products included in this report are: Approved Drug Discount Card Cost Plan Demonstration Plan Extra Help HMO (Health Maintenance Organization) MSA (Medical Savings Account) Part A (Inpatient Services) Part B (Outpatient Services) Part C (Medicare Advantage) Part D (Prescription Drug Coverage) Part E (Medicare Extra) PFFS (Private Fee for Service Plan) PPO (Preferred Provider Organization) PSO (Provider Service Organization) Savings Program SELECT Special Needs Plan Medigap Original Medicare Plan PACE (Program of All-Inclusive Care for the Elderly)

2 Medicare Approved Drug Discount Card Medicare Cost Plan A temporary plan introduced in 2004 to help people with Medicare get a discount on prescription medications, until Medicare Part D. People can use the card until May 15, 2006, or until they enroll in a prescription medication plan, whichever comes first. There are over 30 approved cards in all states. A type of health maintenance organization (HMO) and Medicare Advantage plan. Can use primary care doctors, specialists, and hospitals on the plan s list. If one gets from a non-network provider, they are covered under the Original Medicare Plan. Must be enrolled in a Medicare plan If one qualifies for and after the 24th month Available only in certain parts of the US Must have Part B People with end-stage renal disease may not enroll (but may retain benefits if enrolled). Those with ESRD with a successful kidney transplant may be eligible Prescription medications, including generic medications Cards are through nationally or regionally CMS approved sponsors, or by special endorsements Physician and hospital care Emergency and urgent care Some post-stabilization Mammography Pap tests Influenza vaccinations Skilled nursing facility care May include prescription medication coverage Annual enrollment fees of $0-$30, based on sponsor 10%-75% discount off the cost of prescription medications <$600 cost assistance CMS found average monthly out-of-pocket costs ranged from $ $ in The Medicare Payment Advisory Commission (MedPAC) used Minneapolis/St.Paul as a cost example for a Medicare Cost Plan in There was a $202 monthly premium, a $500 limit on brand name medications and an $11 copay for generic medications. 13

3 Medicare Demonstration Plan Medicare Extra Help Special projects that test possible future improvements in Medicare coverage, costs, and quality of care. Many demonstrations have a set duration and some attain permanent status. Extra help paying prescription medication costs Specific groups of people determined by the Medicare program Hospitals, physicians, insurance companies and/or patients may be involved in demonstrations Must be enrolled in a Medicare plan Singles may qualify with resources less than $11,500 or married making less than $23,000 combined income 18 Beneficiaries with incomes under 150% the Federal Poverty Level may be eligible 20 Higher income thresholds for Alaska and Hawaii Note - these are only representative samples of demonstration plans. Many plans have a set duration and may no longer be active. End Stage Renal Disease Management Demonstration Hospital Quality Reporting Hospital Quality Incentive Data Demonstration Medicare Modernization Act 2003 Demonstration Program Medicare Premier Demonstration (for Premier hospitals) Hospice Demonstration Durable Medical Equipment Demonstration CABG Demonstration Medicare PPO Demonstration Generic and brand name prescription medications The Medicare PPO Demonstration was a 3- year demonstration started in Most plans charged premiums between $32-$184 per month. 9 Premiums not charged or charged at a discounted rate, deductibles $0 or $50, cost of drug $2 (generic) or $5 or 15%, based on income 18

4 Medicare HMO (Health Maintenance Organization) Medicare MSA (Medical Savings Account) A component of Medicare Advantage. One generally must get care from primary care doctors, specialists, or hospitals on the plan s list, except in an emergency one can go outside the network. Special types of Medicare HMO can be an HMOPOS (Health Maintenance Organization with a Point-of- Service Option) and SHMO (Social HMOs) A 4-year demonstration plan started in 1999 for a health insurance policy with a high annual deductible that was limited to 390,000 Medicare beneficiaries. Medicare paid the premium for the Medicare MSA Plan and deposited money into a separate Medicare MSA the beneficiary establishes. The employee and/or the employer could add to the account. Enrollees could only enroll in November and had to remain in the plan for an entire year. This program is no longer offered through Medicare. and after the 24 th month People with end-stage renal disease may not enroll (but may retain benefits if already enrolled). Those with ESRD with a successful kidney transplant may be eligible to enroll. Those eligible for Part A and Part B Self-employed individuals and their spouses or those working for an employer with 50 or less employees during either of the past 2 years Federal Employee Health Benefit Plan members (FEHBP), and Department of Defense (DOD) and Veteran s Affairs (VA) employees were not eligible. Neither were individuals eligible for Medicaid, those with endstage renal disease or a kidney transplant in the past 36 months, or those residing in the US less than 183 days a year. Hospital and physician Primary care Emergency or urgent care Specialist care with PCP referral Annual mammogram Bi-annual preventive women s care visit Eyeglasses Home health care when medically necessary Most nursing home care Chiropractic care when medically necessary May include prescription drug coverage Physician and hospital Dental exams and care Vision care Prescription medications and insulin Laboratory fees Preventive care, such as mammograms Medical equipment, such as wheelchairs ordered by a doctor Long-term care insurance, continuation coverage, or coverage while receiving unemployment (but not other insurance premiums) Must pay Part B Premium ($78.20 in 2005) and may have to pay an additional HMO premium The California Healthcare Commission conducted a study of California Medicare HMOs in They found some plans with $10-$20 copayments for prescription drugs and annual premiums ranging from $0-$ Part B premium An annual high deductible of no more than $6,000 A minimum deductible of $1,500 and a maximum deductible of $2,250, plus a maximum out-of-pocket limitation of $3,000 for individuals A minimum deductible of $3,000 and a maximum deductible of $3,500, plus a maximum out-of-pocket limitation of $5,500 for families

5 Medicare Part A (Inpatient Services) Covers medically necessary inpatient. Part of the Original Medicare Plan. and after the 24 th month Inpatient care in hospitals for up to 90 days per spell of illness Critical access hospitals Skilled nursing facilities for up to 100 days per spell of illness following a 3+ day hospital stay Hospice care Some home health care Blood (as an inpatient) after first 3 pints Inpatient psychiatric care, up to 190 days per lifetime There is a $0 premium Part A for those eligible (99% of beneficiaries) 21 The premium for people who weren t eligible for premium-free Part A was $375 per month in The premium was $393 in 2006 and the deductible was $ Medicare Part B (Outpatient Services) Covers medically necessary outpatient. Part of the Original Medicare Plan. and after the 24 th month Physician Some preventive (bone mass, cardiovascular, colorectal cancer, diabetes, glaucoma, tests, pelvic, breast and prostate cancer screenings) Some immunizations (such as flu shots, hepatitis B shots, pneumococcol shots) Outpatient care Some ambulatory surgery center facility fees Clinical laboratory Durable medical equipment Some physical and occupational therapy The premium was $78.20 per month and the annual deductible was $110 in The premium was $88.50 and the deductible was $124 in There was a 10% annual lifetime penalty if one didn t sign up for Part B when first eligible. The Medicare Modernization Act of 2003 subjected beneficiaries with adjusted gross incomes of $80,000 (single) and $160,000 (joint) to higher Part B premiums. 25

6 Medicare Part B (continued) Home health care not following hospital stay and not covered by Part A Blood (as an outpatient) after first 3 pints Second, and sometimes a third, surgical opinion Welcome to Medicare one-time physical exam within first 6 months of enrollment Medicare Part C Medicare Advantage Formerly Medicare + Choice or Medicare Coordinated Care Program. Medicare Advantage is offered by a private company that contracts with Medicare to provide Part A and B benefits. Includes Managed Care Plans, HMOs, PPOs, Special Needs Plans, and Private Fee-for-Service Plans. Beneficiaries can enroll and disenroll anytime during In 2006, there will be a 6-month lock-in and in subsequent years an annual lock-in. and after the 24 th month One must have Medicare Part A and Part B Available only in certain parts of the US People with end-stage renal disease may not enroll (but may retain benefits if already enrolled). Those with ESRD with a successful kidney transplant may be eligible to enroll. Benefits covered under Medicare Part A and B May include prescription medication coverage See individual components of Medicare Advantage for more detail (Medicare Managed Care Plans, HMOs, PPOs, Special Needs Plans, and Private Fee-for-Service Plans) Monthly Medicare Part B premium of $78.20 in 2005, $88.50 in 2006 May be additional monthly premium, average cost $22 in 2005 May be $15+ copay for specialty visits AARP reported average annual out of pocket cost $1,917 in

7 Medicare Part D - Prescription Drug Coverage Medicare Part D replaces prescription medication coverage for patients with both Medicare and Medicaid medication coverage. A stand-alone plan, offered by insurance and other private companies to add prescription medication coverage to the Original Medicare Plan, Medicare Private Fee-for-Service Plans that don t have prescription medication coverage and Medicare Cost Plans. Retirees already covered by an employer prescription medication plan may not need Medicare Part D. month one turns age 65 and after the 24th month of cash disability benefits Everyone with the Original Medicare Plan, Medicare Part A and/or B, a Medicare Private Fee-for-Service Plan that doesn t offer prescription medication coverage or a Medicare Cost Plan may enroll People with end stage renal disease covered by the Original Medicare Plan Duel eligibles for Medicare and Medicaid are automatically enrolled. Prescription medications, including generic Catastrophic coverage once total out of pocket drug costs reach $3600 Does not pay for barbituates, benzodiazepines, weight loss or weight gain medications. 20 First CMS-approved plans: Aetna life Insurance Co., Connecticut General Life Insurance Co.,Coventry Health & Life Insurance, Medco Containment Life Insurance Co., MemberHealth, Pacificare Life and Health Insurance Co., Silverscript Insurance Co., Unicare, UnitedHealth Care Insurance Co., Wellcare Health Plans 6 Estimates of $ a month in premiums. Premiums automatically increase by 1% each month someone delays enrolling beyond enrollment period, up permanent 12% higher premium for beneficiaries who delay enrolling one year beyond enrollment period. About 40% of plans offered have a no premium option for lowincome beneficiaries. 24 Average annual deductible of $250. Some plans have no deductible. Pays 75% of prescriptions, up to $2,250 per year. Benefits stop until costs reach $3,600, then Medicare pays 95% costs. Between $2250 and $5100, the patient is responsible for full cost of medications. Kaiser Family Foundation projects that the average annual out of pocket costs will be $ New York plans have started at premiums of $4.10 per month. 24 Monthly premiums reported in 2005: Aetna - $27-$68, Cigna - $30-$52, Medco - $27-$35, Humana - <$20+, Pacificare - $19.02-$47.61, UnitedHealth Group - $23- $31, Wellcare - $ $54.21 (reported on insurer product description brochures)

8 Medicare Part E Medicare Extra Medicare PPO (Preferred Provider Organization) Proposed Medicare Cost Plan with comprehensive benefit with carriers approved by CMS 10/10/05 A component of Medicare Advantage. One can go to any doctor, specialist, or hospital not on the plan s list, but it will usually cost extra. CMS began Regional Preferred Provider Organizations (RPPOs) for Washington state, Oregon and Tennessee residents and after the 24th month People with end-stage renal disease may not enroll (but may retain benefits if already enrolled). Those with ESRD with a successful kidney transplant may be eligible to enroll. Can join local or regional (beginning in 2006) PPOs. Hospital and physician Home health care Skilled nursing facility care Prescription medication coverage Hospital and physician Specialist care May provide prescription medication coverage $250 annual deductible, 25% coinsurance (Davis, Health Affairs), $3,000 ceiling 5 Anticipated annual beneficiary premium of $1,103 5 Providence Medicare Extra (Washington and Oregon) would offer a total monthly premium of $0-$115, prescription medications premium of $0-$30; Windsor Medicare Extra (Tennessee) would offer a total premium of $0-$57 and a prescriptions medication premium of $0- $ Must pay Part B Premium ($78.20 in 2005 and $88.50 in 2006) and an additional PPO premium CMS analyzed results of a Medicare PPO demonstration in 2003 and found average monthly out-of-pocket expenses of $391 and average monthly premium of $100. They also analyzed Medicare + Choice PPOs and found average out-of-pocket costs of $340 (including an average of $35 a month for premiums). 14 Between , most plans charged premiums between $32-$184 per month. 9

9 Medicare PFFS (Private Fee for Service Plan) Medicare PSO (Provider Sponsored Organization) A component of Medicare Advantage. Private FFS contracts are now called local MA plans as a result of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of PFFS plans have been offered since One can go to any primary care doctor, specialist, or hospital that accepts the terms of the plan s payment. The private company, rather than the Medicare Program, decides how much it will pay and how much the beneficiary pays. A component of Medicare Advantage. PSO s are a group of doctors, hospitals, and providers that agree to give health care to Medicare beneficiaries for a set amount of money from Medicare every month. This type of managed care plan is run by the doctors and providers themselves, and not by an insurance company. Initially a demonstration project with 4 PSOs started in 1998, there was only one operating Medicare PSO in Participants with both Part A and Part B are eligible. Eligibility begins 3 months before and after the month one turns age 65 and after the 24th month People with end-stage renal disease may not enroll (but may retain benefits if already enrolled). Those with ESRD with a successful kidney transplant may be eligible to enroll. Only available in some geographic areas If a person qualifies due to disability, can join 3 months before and after the 24th month of cash disability benefits People with ESRD may not enroll (but may retain benefits if enrolled). Those with a successful kidney transplant may be eligible Only available in certain geographic areas All covered under Medicare Part A and B May pay for extra days in the hospital (Medicare & You) Services available outside of service area May provide prescription medication coverage May provide additional benefits, such as skilled nursing facility care, home health care, outpatient therapy, ambulance trips, diagnostic testing, durable medical equipment, hearing, vision and physical exams, and foreign travel emergency or urgent care All that Medicare considers medically necessary 30 Medicare Part A and Part B May include prescription medications May include extra benefits, such as wellness programs Must pay Part B Premium ($78.20 in 2005 and $88.50 in 2006) and may have to pay a separate plan premium Average copayment $10- $20 for each doctor visit 30 Providers participating in PFFS plans may charge members 15% over the plan's payment for their. Enrollees costs may vary depending on the quantity and mix of and their geographic location. In 2003, Sterling enrollees paid between $88-$108 in monthly premiums, plus Part B premium. Humana enrollees paid $19-$89 in monthly plus Part B premium. Humana enrollees had an out-ofpocket limit of $5,000 in Medicare paid its minimum reimbursement rate, which was projected to be $378 per PSO enrollee per month in Medicare payment rates were projected to a high of $800 per PSO enrollee in 1999, based on geographic location. 27 CMS approved one PSO contract in Preferred Care Partners, Inc. of Florida offered a $0 premium PSO in

10 Medicare Savings Program Medicare SELECT Formerly called Medicare Cost Sharing Program or Buy-In Program. State programs subsidize Medicare deductibles, coinsurance and premiums through Medicaid funds. These programs were enacted in A Medigap policy where one must use specific hospitals and, in some cases, specific doctors to get full benefits (except for emergency care). The plan began as a demonstration in 1990 and was made permanent in Qualified Medicare Beneficiaries (QMBs) with incomes below 100% of the federal poverty level and assets limited to $4,000 for individuals and $6,000 for couples (higher in Alaska and Hawaii). Must have Medicare Part A, unless one has a disability and lost Medicare benefits through return to work. CMS posts brochures for Medicare Savings Programs for African Americans, American Indians, Alaska Natives, Asian Americans and Pacific Islanders. Must be enrolled in the original Medicare Plan Available in limited geographic areas Savings on Medicare Part A, B and C expenses, including deductibles, premiums and coinsurance May include savings on prescription medications Benefits are the same as in a Medigap policy, but enrollees may be limited in choice of providers Hospital and physician Emergency, urgent care May offer case management, nurse advice lines, or drug formularies 13 May offer skilled nursing May offer at-home recovery May offer preventive care Medigap will not cover prescription medications once Medicare Part D is in place 11 Savings of up to $938 per year (or more) on Medicare expenses In a 2003 study, CMS found out-of-pocket costs for enrollees in Medicare Savings Programs ranging from $400 to $2,200 per year. 8 The NY State Insurance Department reported 2005 Medicare SELECT monthly premiums between $ $ The Illinois reported 2005 Medicare SELECT annual premiums between $713-$2, Costs can vary by age of beneficiary.

11 Medicare Special Needs Plan Medigap Provides Medicare health care and to people who can benefit most from things like special expertise of the plan s providers and focused care management. A Medicare supplemental insurance policy sold by private insurance companies to fill gaps in Original Medicare Plan coverage. Except in Massachusetts, Minnesota, and Wisconsin, there are 12 standardized plans labeled Plan A through Plan L. People in certain longterm care facilities (like a nursing home), eligible for both Medicare and Medicaid, or with certain chronic or disabling conditions, such as end stage renal disease. 18 Available in limited geographic areas Must be 65 or over Must be enrolled in Medicare Part A and B Spouses must buy separate Medigap policies Those enrolled in Medicare Advantage may not buy a Medigap policy Most Medicaid enrollees may not buy Medigap policies Prescription drug coverage May include focused special education or counseling, nutrition and exercise programs Focused care management May include help with accessing community resources Blood May cover emergency health care while traveling outside the US May cover mental health, hospice care, skilled nursing facility care, at home recovery May cover preventive May cover prescription medications in Will not cover prescription medications once Medicare Part D is in place Will not cover long-term care, vision or dental care, hearing aids, or private-duty nursing May help save on out-ofpocket costs. CMS reported 2005 monthly premiums for Medicare Special Needs plans ranging between $0.03 (Florida) and $79.62 (Oregon) 16 Must pay Part B premium ($78.20 in 2005 and $88.50 in 2006) Average monthly premium $144-$230 in In 2005, plans A-L paid $228 per day for days of a hospital stay and $456 for days Plan K paid 50% Part B coinsurance after the Part B $110 yearly deductible. It paid 100% coinsurance for Part B preventive. Plan L paid 75% Part B coinsurance after the Part B $110 yearly deductible. It paid 100% coinsurance for Part B preventive. Plan K had a $4,000 out-ofpocket annual limit. Plan L had a $2,000 out-of-pocket annual limit. 2 Insurance companies may offer a high-deductible option on Medigap Plans F and J. One must pay the first $1,730 (in 2005) in Medigap-covered costs before the Medigap policy pays. 2

12 Original Medicare Plan Includes Part A (Hospital Insurance) and Part B (Medical Insurance). A feefor service health plan that lets enrollees go to any doctor, hospital, or other health care supplier who accepts Medicare and is accepting new Medicare patients. and after the 24th month Physician and hospital care, emergency, urgent care, skilled nursing facility, home health care Preventive screenings Ambulance Chiropractic Durable medical equipment Eyeglasses Clinical trials Diabetic self-management training and supplies Foot exams and treatment, hearing and balance exams Kidney dialysis Medical nutrition therapy Some mental health care Some prescription medications until Part D Prosthetic/orthotic items Some second surgical opinions Surgical dressings Some telemedicine Diagnostic tests Transplant Healthcare in US territories (Puerto Rico, Virgin Islands, Guam, Northern Mariana Islands, American Samoa) and received on board ship in US territory. Services when traveling between Alaska and Canada. $ Medicare Part B deductible $ for hospital stay of 1 60 days each benefit period $ per day for days of a hospital stay each benefit period $ per day for days of a hospital stay each benefit period All costs for each day of hospital stay over 150 days $ per day for days of a skilled nursing facility stay each benefit period All costs for each day of a skilled nursing facility stay after day 100 in the benefit period 20% of Medicare-approved amount for most doctor, outpatient therapy, preventive, and durable medical equipment 50% for most outpatient mental health All costs for first three pints of blood (as inpatient), all costs for the first three pints of blood as an outpatient, then 20% of the Medicare-approved amount for additional pints of blood (unless someone else donates blood to replace what was used) Copayments and coinsurance (Source: all from Medicare & You 2006)

13 Medicare PACE (Program of All-inclusive Care for the Elderly) There is also a Needs Enhancement Tier (PACENET) PACE is a demonstration program that began in 1990 that combines medical, social, and long-term care. PACE is also included as an option under Medicaid. PACENET provides benefits to seniors with higher incomes than those who participate in PACE. Frail 18 elderly people Beneficiaries must voluntarily enroll Must be at least 55 years of age Must be screened by a team of doctors, nurses, and other health professionals as meeting that state's nursing facility level of care. At the time of enrollment, must be able to safely live in a community setting Not available in all states Medicare and Medicaid Adult day health center Medical and hospital care Social Long term care Respite care Prescription drug coverage (PACE organizations will be required to provide Medicare Part D prescription drug coverage to their eligible enrollees beginning January 1, 2006.) Primary care, restorative therapies, personal care and supportive, nutritional counseling, recreational therapy and meals. Any service deemed necessary by the PACE team May include home health care May include in-home and other referral Enrollees may have a monthly premium. The amount that a PACE organization can charge a participant as a monthly premium depends on the participant's eligibility under Medicare and Medicaid and is determined by Medicare and Medicaid capitation rates. A PACE organization may not charge a premium to a participant who is eligible for both Medicare and Medicaid, or who is only eligible for Medicaid. 26 In Pennsylvania, PACE contained no deductible in 2005; in PACENET there was a $40 monthly deductible. The income ceiling for PACENET was about 250 percent of the federal poverty level, $23,500 for singles and $31,500 for couples. For PACE the income limits were $14,500 and $17,700 single or married. Copayments under PACE were $6 for generics and $9 for brand-name drugs, and in PACENET $8 and $15 in

14 Bibliography Green Book. Washington, D.C., Committee on Ways and Means, U.S. House of Representatives, March Choosing a Medigap Policy: A Guide to Health Insurance for People With Medicare. Washington, DC, Centers for Medicare and Medicaid Services, Medicare Supplement Premium Comparison Guide. Department of Financial and Professional Regulation-Division of Insurance, State of Illinois, CMS Studies Confirm Significant Savings Through Medicare-Approved Drug Discount Cards, Centers for Medicare and Medicaid Services, October 12, Davis, K., et al. "Medicare Extra: A Comprehensive Benefit Option for Medicare Beneficiaries." Health Affairs W5: , October 4, Frederick, J. New Medicare Drug Plans Spawn Complex Coverage Network. Drug Store News. 27: 3(2), October 10, Guadagnino, C. "Navigating the PACE and Medicare Part D programs." Physician's News Digest, October Haber, S. G., Sc.D., et Al. Evaluation of Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB) Programs, Prepared for Centers for Medicare & Medicaid Services. Waltham, MA, RTI International Health, Social, and Economics Research, October 1, Health Insurance Choices for Medicare Beneficiaries. Washington, DC, Medicare Payment Advisory Commission (MedPAC), March Lueck, S. Medicare Maneuvers. Wall Street Journal, September 29, Lueck, S. and V. Furmans. Medicare Names Approved Drug Plan Providers. Wall Street Journal, September 24, MA Payment Increases Have Positive Effect on Plan Benefits. CCH NetNews, May 17, Market Variations and Medicare Supplementation: Looking Ahead. Washington, DC, Medicare Payment Advisory Commission (MedPAC), April Medicare Demonstration PPOs: Financial and Other Advantages for Plans, Few Advantages for Beneficiaries, United States Government Accountability Office, September Medical Savings Accounts (MSAs), Department of the Treasury, Internal Revenue Service, October Medicare Advantage, Cost Plans, and Demonstrations, Washington, DC, Centers for Medicare and Medicaid Services, October 17, (Reports accessed for Washington, Florida, Oregon and Tennessee) (URLs follow suit for other states) 17. Medicare and Medicaid Statistics, Henry J. Kaiser Family Foundation, July Medicare & You Washington, DC, Centers for Medicare and Medicaid Services, Medicare Part B Premiums to Increase, Blue Cross Blue Shield Organization, September 19, Medicare Part D: The Basics, Volunteers in Health Care, August 10,

15 21. Medicare Premiums and Deductibles for 2006, Washington, DC, Centers for Medicare and Medicaid Services, September 16, New York State Insurance Department. Medicare Select Plans, Ochs, R. Medicare Part D... a few answers. Newsday: B4-5, October 15, Ochs, R. Prognosis Perplexing. Newsday: A7, October 22, Pauly, M. V. "Means-Testing in Medicare." Health Affairs, W , December 8, Programs of All-Inclusive Care for The Elderly (PACE); Subpart J--Payment; Sec PACE premiums. 42CFR Weissenstein, E. "Stage Set for Premiere: Medicare+Choice Plan to Debut in '99 in Rural Oregon." Modern Healthcare: 12, November 16, What's the Best Drug Coverage? Comparing Medicare HMO's and Supplemental Policies. Oakland, CA, The California Healthcare Foundation, March Your Guide to Medicare Medical Savings Accounts, Washington, DC, Health Care Financing Administration, September Your Guide to Medicare Private Fee for Service Plans. Washington, DC, Centers for Medicare and Medicaid Services, July Updated November 13, 2005