Back in September, I wrote about free gym memberships that are part of many Medicare Advantage plans. Yesterday I had lunch at the Tucson Racquet and Fitness Club, which is one of the clubs seniors can join for free if they enroll in certain Advantage plans.  I learned that while free memberships are attractive, many seniors are willing to pay to stay fit.

I talked with the club’s Program Director, Renee Sitter, who told me aerobics and fitness classes are very popular with members who are over 65. Renee gave me a list of 40+ classes in which many seniors participate:  Water aerobics; Tai Chi; Pilates; Yoga; and Zumba, which is a cardio workout to salsa music.  Belly dancing is the latest addition to a long list of classes offered at the club as part of the fitness membership.

Renee said many older members make the club part of their daily routine, taking one or more classes and then having lunch at the club restaurant. The club becomes the center of their social life, so I guess you could say they stay fit physically, mentally, and socially.  Sounds like fun.

Free gym memberships offered through Medicare Advantage plans have been the target of criticism, but I think this is sorely misplaced. As it turns out, this benefit only costs the plans a few dollars per enrollee each month. The minority of Medicare Advantage plan enrollees who use the gym benefit are supported by the majority who don’t use the benefit. This is how most insurance works, whether it is health insurance, dental insurance, or gym membership insurance – everybody pays into the system while a minority uses the services.

For seniors who use the free gym memberships (and those who pay), it is clear they stay healthier than the far-too-many couch potatoes. With obesity, diabetes, and heart disease so widespread in America, the government should be encouraging people to stay fit and stay healthy. 

So I heartily agree with those who say, “Don’t touch my (free) gym membership!”

When, or if, a final healthcare bill is passed in Washington, there will be changes involving Medicare that will help seniors and Medicare beneficiaries with high drug costs. The changes would take effect this year:

Both the House and Senate bills included provisions to help people who fall into the donut hole in their Part D coverage. The Part D initial coverage limit would be raised by $500 for 2010. The current level at which people with high drug costs will fall into the donut hole in 2010 is $2,830. This would be raised to $3,330, allowing some seniors to stay out of the donut hole a bit longer. The initial coverage limit would be raised each year until there is no donut hole in 2019.

The bills also require pharmaceutical companies to agree to discount the cost of their drugs by 50% for Medicare beneficiaries who find themselves in the donut hole. It looks like this change will also take effect for 2010. If pharmaceutical companies do not agree to provide this discount, they would not be allowed to sell their drugs through Part D prescription plans.

These two elements of “reform” have been agreed to by just about everyone, including the drug companies, so I don’t think they will be changed in the final bill.

Other Medicare-related changes that have been in both House and Senate bills are:

In 2011, the Open Enrollment Period from January 1st to March 31st would be eliminated. This would limit the period for switching Medicare Advantage and Part D plans to the period of November through mid-December each year.  If this action is included in the final bill, seniors will have just one opportunity to change their Medicare coverage during the Annual Election Period (AEP).  The AEP would also begin and end earlier to avoid the end-of-the-year rush to process changes that take effect on January 1.  Dates I have seen put the AEP starting on November 1 and ending on December 15.  

Payment cuts to Medicare Advantage companies will take effect for 2011.  Cuts could be around 5% from 2010 levels and will certainly be passed on to seniors enrolled in these plans.  My guess is that the Medicare Advantage plans will all have monthly premiums in 2011.  I have written previously that Tucson is one of the few places where most plans are”zero premium”. We can’t say they are “free” because Medicare is paying the companies $800 or more per month for each person enrolled in the plans.

I shake my head when I see opinion polls showing a majoritiy of Americans are against the healthcare reform legislation that will soon be finalized.  I doubt many people even know what’s in the legislation, so why ask them if they are for or against it?  When seniors see the relief they will get from the Part D changes, they will be for it. And when I have talked to seniors enrolled in Medicare Advantage plans and told them they will likely have to pay a monthly premium next year, they don’t seem to have a problem with that.  Maybe I should take my own poll……I think I will do just that….and I’ll report back next week.

Harold and Lilo are in their eighties and came to America from Germany many years ago.  They had complained to me about having to wait an hour every time they had an appointment with their primary physician. I had suggested they find a new doctor, but they were reluctant to make a change at their age.

In October, Lilo got really upset over her experience at the doctor’s office and she told me why.  On her last visit to the doctor, she was put in an exam room and told to wait there.  Ten minutes passed.  Then twenty minutes, then forty minutes passed until the doctor came into the room.  Lilo, with her thick German accent, said to the doctor, “I cude haf bin dead in here and you vould not know eet!” And the doctor replied, “If you don’t like it you can find another doctor.” 

Lilo told me this story, so I showed her the directory for her Medicare Advantage plan’s network. We found a doctor’s office just around the corner from her house, so I said I would check to see if the doctors there were taking new patients.  I visited the office and the waiting area only had two people in it.  It is a small office with just two doctors. I asked the receptionist if the doctors were taking new patients and was told that they were. 

I went back to Lilo and Harold and we called the Medicare Advantage plan to say they wanted to change their primary doctor.  There was no problem doing this, so we then called the new doctors’ office and set up an appointment for Harold and Lilo to meet their new primary physician.  If they didn’t like the doctor, they could look for someone else, but things turned out pretty well.

When I saw Harold and Lilo in December, they told me that changing to the new doctor had saved Harold’s life.  I guess Harold didn’t like the old, too-busy doctor, so he hadn’t seen him in a while.  Because Harold had to meet his new doctor and get a basic physical exam, the new doctor found that Harold had a dangerous aneurism in his lower abdomen.  A few days later, Harold was admitted to the hospital and his aneurism was treated.  Had he waited much longer and the aneurism burst, Harold might have died.

The lessons from this story are: 

1) If your doctor is too busy, maybe you should find one who isn’t so busy.  I think people see a doctor in a big, fancy office with lots of patients lined up and think he must be really good. But if he/she hasn’t got time for you, what good does it do you?

2) Medicare Advantage plans encourage seniors to get a physical every year, generally with no co-pays.  As you get older, things are going to break down.  Why not catch problems early by seeing your primary doctor at least once a year?  If you don’t like going to your doctor because of his or her style or personality, find another doctor.