Cambia Medicare Advantage Plans 2025

Choosing a Medicare Advantage plan is a critical decision, and you might wonder how Cambia’s offerings stack up. This focused article gives you the essentials: the specifics of Cambia Medicare Advantage plans, how they compare to alternatives, and what benefits they could bring to your healthcare experience.

 

Key Takeaways

  • Cambia Health Solutions offers Medicare Advantage Plans that aim to simplify, improve, and make healthcare more affordable, serving over 3.4 million people with various subsidiary companies.

 

  • Medicare Advantage Plans by Cambia, such as Asuris Northwest Health, provide not only the standard coverage of Original Medicare but may include additional benefits like vision, dental, and prescription drug coverage, with varying rules and costs.

 


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Understanding Cambia Health Solutions

 

Cambia Medicare Advantage Plans 2025, Understanding Cambia Health Solutions

 

Cambia Health Solutions aims to simplify the healthcare system, improve its quality, and make it more affordable for over 3.4 million people. Their strategic decision-making is deeply rooted in their mission to reshape healthcare into a system that is both economically sustainable and person focused.

Their companies includes:

  • Six regional health plans, among which Asuris Northwest Health operates

 

  • A health policy center

 

  • Echo Health Ventures

 

  • The Cambia Health Foundation

 

Cambia’s responsible corporate practices, such as community outreach, sustainable business operations, and diverse hiring strategies, have a positive impact on the regions they serve.

Exploring Medicare Advantage Plans

Medicare Advantage Plans, also known as Medicare Part C, are an alternative to traditional Medicare. These plans work with private health insurers who contract with the federal government to provide Medicare-covered benefits.

 

Health Care Coverage Options

 

Cambia Medicare Advantage Plans 2025, Exploring Medicare Advantage Plans

 

While Medicare Advantage Plans are required to cover all services provided by traditional Medicare, they often come with their own set of rules, costs, and restrictions. Additionally, these plans may impose a monthly premium, the amount of which can differ across various providers.

Coverage rules and premiums can vary significantly between Medicare Advantage Plans, requiring thorough comparison for informed decision-making. Approval from the plan is often a prerequisite for covering certain services or supplies, contrasting with the flexibility of Original Medicare.

Medicare Advantage Plans may offer additional benefits not traditionally covered by Original Medicare, such as dental, vision, and hearing services.

 

Access to Care Providers

Medicare Advantage Plans, including HMO, PPO, and PFFS, each have their own network rules that dictate which doctors, hospitals, and medical facilities plan members can access.

The provider network selection within a Medicare Advantage Plan can greatly influence the manner and timing of care members receive. It can also affect the costs related to accessing care from both in-network and out-of-network providers.

Provider networks are central to comparing Medicare Advantage plans because the network determines the availability and cost-effectiveness of care.

Therefore, individuals considering Cambia’s Medicare Advantage plans must check that their preferred doctors and hospitals are included in the plan network to ensure continuity and adequacy of care.

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Cambia’s Medicare Advantage Offerings

Asuris Northwest Health, part of the Cambia Health Solutions family, is dedicated to enhancing member and community health as a nonprofit health plan. Serving individuals in Eastern Washington, Asuris Medicare Advantage plans offer a diverse range of coverage, including:

  • Medical benefits

 

  • Prescription drug coverage

 

  • Vision benefits

 

  • Dental benefits

 

In the digital age, Asuris also provides members with a convenient way to access healthcare services and manage their health via mobile technology. The Asuris app makes healthcare more accessible and user-friendly.

 

Part D Prescription Drug Coverage

 

Cambia Medicare Advantage Plans 2025, Cambia's Medicare Advantage Offerings

 

Prescription drug coverage, known as Medicare Part D prescription, is customarily included in Medicare Advantage plans offered by Cambia, which ensures beneficiaries receive comprehensive healthcare coverage. This inclusion not only broadens the scope of healthcare coverage but also contributes to the overall quality and performance measures of the plan.

Medicare Advantage plans, such as Cambia’s MA-PD plans, which include prescription drug coverage, undergo evaluation based on up to 40 distinct quality and performance measures. The outcomes of these measures play a significant role in determining their overall star rating.

Some of the measures include:

  • Preventive care and screenings

 

  • Managing chronic conditions

 

  • Member satisfaction

 

  • Customer service

 

  • Drug safety and accuracy of drug pricing

 

These star ratings are an essential consideration for potential enrollees when choosing a Medicare Advantage plan.

 

Addressing Chronic Conditions

Special Needs Plans (SNPs) are a type of Medicare Advantage plan specifically designed to serve individuals with diseases or characteristics, often including chronic conditions. SNPs enhance care by coordinating services and tailoring benefits, as well as providing networks and drug formularies, to the needs of their members with chronic conditions.

To address the complexities of managing chronic conditions, SNPs may offer additional services such as more hospital stay days for severe conditions like cancer or congestive heart failure.

It’s important to note that individuals living with end-stage renal disease (ESRD) have specific eligibility requirements for SNPs. Therefore, they should contact the plan directly to confirm eligibility.


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Centers for Medicare & Medicaid Services (CMS) Star Ratings

The CMS Star Ratings serve as a vital instrument for Medicare consumers to assess and compare the quality of Medicare health and drug plans. This rating system uses a scale from 1 to 5 stars to indicate quality.

CMS measures the quality of health and drug services provided to consumers by assessing over 40 quality measures in Medicare Advantage and Prescription Drug Plans.

CMS Star Ratings incentivize health plans to improve health outcomes and the quality of patient care due to their transparency and competitive nature. This encourages plans to strive for better performance in delivering healthcare services.

The methodology for CMS Star Ratings was refined for 2024 by adding new measures and applying Tukey outlier deletion, aiming for more predictable and stable ratings.

 

Cambia’s 2025 Star Ratings

 

Cambia Medicare Advantage Plans 2025, Centers for Medicare & Medicaid Services (CMS) Star Ratings

 

Cambia is pleased to announce that the Asuris Northwest Health Medicare Advantage plan has received a top-tier 5 out of 5-star rating from CMS for 2025.

High CMS Star Ratings for Cambia’s Medicare Advantage plans exemplify their effectiveness in providing accessible healthcare services, especially for managing chronic conditions.

 

Factors Contributing to High Ratings

Asuris Northwest Health secured high CMS Star Ratings for its Medicare Advantage plan, credited to outstanding member experiences, reduced member complaints, and proactivity in addressing the needs of Medicare beneficiaries through their call centers.

The CMS Star Ratings incorporate performance measures related to managing chronic conditions, an area where Asuris Northwest Health’s Medicare Advantage plan excelled.

Comparing Cambia’s Plans with Competitors

Cambia’s Asuris Northwest Health distinguishes itself from competitors through its dedication to enhancing member and community health. It does so by providing award-winning local customer service that assists members with coverage options and finding health and well-being resources.

Government Programs and SupportCambia Medicare Advantage Plans 2025

Medicare and Medicaid support Medicare Advantage plans through payments, regulatory oversight, and the establishment of quality incentives and standards. CMS administers Medicare Advantage plans and has strengthened oversight of plan networks to ensure they meet network adequacy standards.

Special Needs Plans are designed for individuals with high healthcare needs, including those eligible for both Medicare and Medicaid.

The government utilizes a complex payment system for Medicare Advantage plans, involving:

  • Benchmarks

 

  • Bids

 

  • Rebates

 

  • Adjustments based on quality.

Enrolling in a Cambia Medicare Advantage Plan

For eligibility in a Cambia Medicare Advantage Plan, individuals need to be enrolled in Medicare Part A and Part B and reside within the plan’s service area. The Annual Election Period, known as the Fall Open Enrollment Period, runs from October 15 to December 7, allowing for changes to Medicare coverage, which become effective on January 1 of the following year.

The Medicare Advantage Open Enrollment Period from January 1 to March 31 permits individuals to switch Medicare Advantage Plans or to Original Medicare, with the new choice effective the first day of the following month. Special Enrollment Periods enable beneficiaries to change their health and/or drug coverage under specific circumstances, such as relocation or if a plan exits the service area.

To make changes during the Medicare Advantage Open Enrollment Period, beneficiaries should call 1-800-MEDICARE or submit simultaneous disenrollment and enrollment requests to the plan to prevent errors.

Summary

This article has taken a deep dive into Cambia Health Solutions and its Medicare Advantage offerings, detailing their commitment to improving healthcare coverage, managing chronic conditions, and providing comprehensive healthcare services.

We’ve also explored the CMS Star Ratings system, with Asuris Northwest Health’s Medicare Advantage plan proudly holding a top-tier 5-star rating.

Choosing a Medicare Advantage Plan can be a complex decision, but with a thorough understanding of the offerings, benefits, and support available, you can make an informed choice that best suits your healthcare needs. Remember, the right plan for you is one that aligns with your healthcare needs and financial capabilities.

 

Frequently Asked Questions

 

Why do doctors not like Medicare Advantage plans?

Doctors often have issues with Medicare Advantage plans due to onerous pre-approval requirements and frequent claim denials, leading to challenges in providing necessary medical care.

These issues can impact the quality-of-care doctors are able to deliver to their patients.

 

What are the 4 types of Medicare Advantage plans?

Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service Plans (PFFS), and Special Needs Plans (SNPs). Each plan has its own unique features and benefits.

 

What is Cambia Health Solutions?

Cambia Health Solutions is a healthcare company that aims to simplify, improve, and make healthcare more affordable. They provide a range of health plans, including Medicare Advantage plans through Asuris Northwest Health.

 

How are Medicare Advantage plans rated?

Medicare Advantage plans are rated using a Star Ratings system by the Centers for Medicare & Medicaid Services, which ranges from 1 to 5 stars to denote quality. This helps individuals assess the quality of health and drug services provided by these plans without difficulty.

 

How can I enroll in a Cambia Medicare Advantage Plan?

To enroll in a Cambia Medicare Advantage Plan, you need to be enrolled in Medicare Part A and Part B, and live in the plan’s service area. You can make changes during the Annual Election Period from October 15 to December 7, or the Medicare Advantage Open Enrollment Period from January 1 to March 31.

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Speak with a licensed insurance agent

1-844-350-0776
TTY 711

Mon-Fri : 8am-9pm ET