When Medicare cuts payments to Medicare Advantage plans, 11.5 million people around the country will see “their Medicare” change. This represents 25% of all Medicare beneficiaries. I recently came across a page on the Medicare website that breaks down Medicare Advantage enrollment in every county in the country.  I was shocked to see that in quite a few counties (mostly large urban areas) nearly 50 % of Medicare beneficiaries are enrolled in Medicare Advantage plans.

Throughout Arizona, 34% of Medicare beneficiaries are enrolled in Medicare Advantage.  However, in Pima County 44.83 % are enrolled in Medicare Advantage plans.  In Maricopa County it’s 43.45%.  In Pinal County over 49% of Medicare beneficiaries are enrolled in Medicare Advantage plans.

The numbers below are from the CMS website and were updated in April 2010.

The vast majority of Medicare Advantage enrollees are in HMO plans which require them to use doctors, hospitals, labs, and other providers in their plan’s network.

Here are numbers for counties around the country where Medicare Advantage enrollment is very high.

Total list can be found at:

http://www.cms.gov/MCRAdvPartDEnrolData/MASCPen/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=2&sortOrder=descending&itemID=CMS1234724&intNumPerPage=10

FOR MORE INFORMATION on Medicare in Arizona, check out my website.

The Health Care Reform Law will be cutting payments to Medicare Advantage plans, but some plans may actually get more money – if they are highly-rated, meaning they are the best of the best when it comes to patient care, illness prevention, and customer satisfaction.

Unfortunately, the Medicare Advantage plans we have in Tucson are not highly-rated.

If you go to Medicare.gov and click on “compare health plans”, you will be asked to enter a zip code.  Put in any Tucson zip code and you will get a list of  all the Medicare Advantage plans offered in Pima County (or any county in the country based on the zip code you use). The rating system is based on five stars:

5 = excellent
4 =  very good
3 = good
2 = fair
1 = poor

No Tucson Medicare Advantage plan is rated higher than 3 stars, meaning our plans are okay but not great.  Health Net and Secure Horizon plans get 3  stars, while Humana and Evercare get 2.5.

In Phoenix, the Cigna Medicare Advantage Plan gets 4.5 stars. This is better than Kaiser in California, which gets 4 stars.  I mention Kaiser because their plans, where doctors are employed by Kaiser, are supposed to be the standard bearer for managed care plans.

CareMore in California gets  4.5  stars for all  its Advantage plans, most of which are for people with chronic illnesses such as heart disease, diabetes, and breathing disorders. The CareMore plans in Tucson are too new to be rated as this is their first year in operation here.

I read somewhere that long-running Medicare Advantage plans tend to be the better plans, so I don’t know why our Tucson plans are merely “good”. Tucson has had Medicare HMO plans since the early 1990′s and in a March, 1996 article, The New York Times said Tucson’s Medicare HMO plans would be the model for saving Medicare.  I wonder what happened in Tucson?  Getting 2.5 and 3 stars is not going to gain our Medicare Advantage plans any favors from Medicare when it comes time for payment cuts.

The Medicare.gov website explains the ratings:

This summary rating gives an overall score on the health plan’s quality and performance on 33 different topics in 5 categories:

• Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
• Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
• Ratings of health plan responsiveness and care. Includes ratings of member satisfaction with the plan.
• Health plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan.
• Health plan telephone customer service. Includes how well the plan handles calls from members.

The information described above is gathered from several different sources. In some cases it is based on member surveys, information from clinicians, or information from plans. In other cases it is based on results from Medicare’s regular monitoring activities.

FOR MORE INFORMATION ON MEDICARE CHOICES IN ARIZONA check out my website.

I hit the trifecta this week by meeting three women who will turn 65 in July.  All three of them told me they have not had health insurance for many years. They are thrilled to be turning 65 so they can get on Medicare.

Linda told me that she and her husband have spent most of their retirement savings on her health issues over the last ten years.  Karen said she has had pain in her left leg for quite a while and worries what  a doctor might find when she gets her Medicare and goes for a physical exam. Gayle looks like she’s 55, not 65.  She has no health problems and takes no medications.

As an insurance broker I have met too many women in their 50′s and 60′s who cannot get health insurance – and it’s just not right.

I have also met men who have continued to work well into their 70′s  so they could keep their employer health insurance for their younger wife – who was uninsurable because of some health problem.

Earlier this year I met with a man who was 68 years old and finally leaving work and signing up for Medicare.  His wife was sitting at the kitchen table with us and she was trembling. I couldn’t help but ask her what her medical problem was.  She told me she has Parkinsons and she no longer had health insurance.  She is 62 years old.

About two years ago I met a  woman who was 64  and had lost her group coverage because her artists’ co-op had disbanded.  She wanted to buy health insurance, but was refused because her cholesterol was too  high.  When I talked to her last fall I said, “You’re gonna make it to 65 in one piece!  Now let’s get you signed up for your Medicare coverage!”  Turning 65 was a blessing for her.

Yesterday I met Karen, the woman who has had pain in her leg for a while. After we discussed her Medicare options,  she turned to her disabled daughter and shouted gleefully, “Mommy’s getting health insurance! Mommy’s getting health insurance!”

I’ve had a busy week and, amazingly, every woman I met was overjoyed to be turning 65 – and getting Medicare.