New Accountable Care Collaboration Between Aetna & Zoom+Care in Oregon

Aetna Teams Up with Zoom+Care for Innovative Employer Plans

Aetna, one of the largest health insurers in the United States, is hoping to disrupt the employer-based health insurance market in the Portland area by teaming up with Zoom+Care.

As medical costs around the country continue to rise exponentially, and our dysfunctional Congress remains deadlocked and unwilling to address the issue, insurers and providers alike are seeking out alternative models to lower costs and provide better medical access to their customers.

Aetna and Zoom+Care are hoping their partnership in the Oregon counties of Washington, Clackamas, and Multnomah, encompassing the Portland metro region, will provide a successful blueprint that can be reproduced nationwide.

Norm Seabrooks, President of Aetna’s Northwest operations said “Aetna is pleased to work with ZOOM+Care to provide a simpler and more efficient health care experience for our members in Oregon.

Who are Aetna and Zoom+Care?

Aetna, headquartered in Hartford, Connecticut, covers almost 40 million Americans with an array of insurance plans and health services, including medical and dental services, and with a foothold in pharmacy, healthcare IT, workers’ compensation, Medicaid, and behavioral health. Their health insurance plans are available to both employers and are sold on an individual basis.

Zoom+Care is based out of Portland, providing retail and digital medical services across 36 clinics, serving neighborhoods in both Portland and Seattle. The company currently provides care to over 200,000 patients each year, with locations for urgent needs, primary and secondary care, and mental health services, along with a robust and growing presence in the field of telemedicine.

Zoom’s mission, as established by its founders, both doctors, is known as Twice. ½. Ten. It is a pledge to Zoom’s customers and patients to provide twice the health, at half the cost, and with ten times the delight.

Zoom was the original neighborhood, retail clinic, pioneering online scheduling for same-day appointments, transparent pricing available online, and spearheading the legal challenge to allow clinics to dispense prescriptions. The company was also instrumental in encouraging insurance companies to reimburse for telemedicine and online health exams.

What is the Aetna Whole Health – Zoom+Care Plan?

The new and innovative accountable care plan created by the two companies, known as the Aetna Whole Health℠ – ZOOM+Care plan, will be rolled out in July. Initially, the plan will only be available to large employers, headquartered in the three Portland-area counties. The plans are bespoke, individualized to each employer, but Aetna and Zoom are promising savings of up to 15% annually, over more traditional insurance plans.

The idea of the plan, and the reason for Aetna insurance company to team up with Zoom’s provider network, is to create a more coordinated, easier to manage health network for customers and patients.

Members of the plan will be able to coordinate all medical needs from their phone. Online access will include scheduling, lab results, and the entirety of the patient’s medical record. Zoom+Care will also provide members of the plan with emergency access, when and as needed, at its Zoom+Care Super Clinic, in addition to a large network of local hospitals and specialty doctors.

It is Aetna’s hope that by utilizing Zoom’s well-established network, its members will find navigating the, at times challenging, ropes of modern healthcare to be easier and less stressful than in the past.

How Does the Plan tackle Soaring Healthcare Costs?

This is the big question, and ultimate goal, of this innovative partnership between insurer and provider. Aetna hopes the alliance with Zoom will allow the insurer to spearhead the charge towards a value-based healthcare system; one that pays for quality over quantity.

The reimbursement model between Aetna and Zoom will be based on a number of factors, including efficiency, patient satisfaction, preventative screenings, chronic disease management, and a decrease in emergency room utilization and hospital readmissions.


California Medicare

California Medicare Supplement plans work together with Medicare to reduce your medical costs you pay out-of-pocket. The best Medicare Supplemental insurance in California offers a range of coverage. These policies come in ten different letter plans. To enroll you must sign up for Part B of Original Medicare and be at least 65 years old.

California Medicare Supplement Plans

Medicare Part A and Part B pay about 80 percent of medical cost. It helps pay various percentages of the balances, depending on which policy you choose. Medicare is available for citizens who receive Social Security benefits. Disabled persons are eligible for Medicare two years after the date that their disability began, as declared by the Social Security Administration.

Remember that spouses who are younger than 65 need private insurance to cover them until they are also eligible for Medicare. Even if you are in excellent health now, this may change as you age. Carefully consider what Medicare pays, and then consider all the options available among Medicare Supplement plans in California.

California Medicare Supplement Under 65

California does offer certain supplement plans to those Medicare beneficiaries under 65 years old as long as they don’t have ESRD, the letter plans offered are A, B and F. Please keep in mind that the rates will not be the same as those older than 65.

California Medicare Birthday Rule

The California Medicare birthday rule allows beneficiaries to switch their supplement plan or carrier during the first 30 days after the insureds birthday. Unlike most states, in California you’re allowed to switch carriers within 30 days of your birthday. To qualify you must be a California resident, currently be enrolled in a supplement plan, be within 30 days of your birthday and switch to a plan with lesser or the same benefits.

Do I Need Supplement Insurance

If you are covered by an employer-provided health plan that works as a supplement to your Medicare benefits or if you receive Medicaid, you don’t need to buy an additional policy. Otherwise, purchasing a Medigap plan in California to protect you financially from high medical hosts is highly recommended.

Medicare Part A Hospital Insurance

There are no premiums charged for Medicare Part A. The U.S. government provides this coverage for free to eligible citizens. Medicare Part A pays for stays in inpatient hospitals, skilled nursing facilities and hospices. Under Part A, Medicare pays for in-patient semi-private (including nursing and other medical services) hospital rooms for up to 60 days. You will be responsible for the deductible. Part A pays for longer stays at differing rates.

Medicare Part B Medical Insurance

You must pay monthly premiums for Medicare Part B coverage. This coverage is a choice for each Medicare recipient. Premiums would be deducted from your Social Security check each month.

If you choose to carry Medicare Part B, your coverage will include:

Medicare Part B pays 80 percent of approved fees & you must be enrolled to be able to sign up for a supplement plan.

You have a choice of ten policies, identified by letters A through N. Each insurance company offers identical policies with these ten plans. While you will pay a lower premium, you will also receive fewer benefits. Our supplement experts can help you check each of these ten plans to find the right one for you. You can find more information on what medical services are not covered by Original Medicare here.


How to Compare Medicare Supplement Rates

Medicare Supplement rates tend to go up every year or so to keep up with inflation. Also because of rising healthcare costs or changes in state and federal regulations. Depending on your insurance company, you can expect to see these rate increases on your policy anniversary or around your birthday. If a rate increase feels…

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Does Medicare Pay for Long Term Care Facilities?

It depends on your situation. Medicare does not pay for lengthy stays in nursing homes and other long-term care facilities. It also does not pay for short-term stays unless you were hospitalized first. This is because most nursing homes and other long-term care facilities provide custodial services that aren’t covered. This includes help with bathing,…

The post Does Medicare Pay for Long Term Care Facilities? appeared first on MedicareFAQ.