Medicare Advantage members will have only one chance to change their Advantage plan later this year, between November 15th and December 31st. After January 1, they will be locked into their Advantage plan for 2011 unless they decide to dis-enroll from their Advantage plan and go back to Medicare.  From January 1st to February 15th,  seniors enrolled in Medicare Advantage plans will be allowed to sign up for a stand-alone Part D plan if they drop out of their Advantage plan.

For the past several years (and in 2010) people enrolled in Medicare Advantage plans were able to switch from one plan to another during the months of January, February, and March.  This “Open Enrollment Period” will not be available in 2011.  I had previously reported that changes would not take place until 2012, but I have read that changes will start sooner.

In November this year, it will be very important for seniors to review the materials they receive from their Medicare Advantage plan, in case their plan makes some big changes.  If they want to shop around for another Advantage plan, they will only have November 15th to December 31st to do so.  If they discover in January that their plan no longer works for them, they will be unable to change to another Advantage plan. Their only recourse will be to dis-enroll from their Advantage plan and go back to Medicare (and pick up a Part D plan).

This past January, February and March, quite a few seniors realized their Health Net plan had introduced a $36 monthly premium.  Several thousand people did not realize this until the company sent them a coupon book at the very end of December. Everyone had  received the notice at the end of October, but many people had not read the mail from their plan.  Health Net sent out a letter in January warning people that they would be dropped if they did not pay the monthly premium and shocked folks into action. These people had the opportunity during the first three months of the year to shop around and change their plan.  They will not have the same opportunity next year.

I also heard from a number of people who did not realize until the new year that their Advantage plan was no longer covering one of their drugs.  They had missed the notification that had been sent to them at the end of October (as required by Medicare) and when they went to refill their prescription in January or February, the pharmacy informed them that their plan did not cover the drug.  These seniors were able to shop around in February or March 2010.  But in 2011, they will be stuck with their Advantage plan.

Things are going to be interesting later this year and early next year.

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

A recent post by Compound Captive on Tucsoncitizen.com (April 15th) was a good example of the misinformation that is out there concerning the Health Care Reform Law and Medicare in general. Included in the post were several claims about Medicare that were incorrect.  I replied to that post yesterday and thought it would make a good post for my own Medicare and More blog.

The main point of the Compound Captive post was that Mayo Clinics in Arizona are no longer accepting Medicare patients.  This is incorrect.  On January 5th, the Mayo Clinic Health Policy Blog corrected the misconception and misinformation that had been widely reported. Here is the first part of the Mayo Health Policy Blog post:

Mayo Clinic in Arizona Continues to Provide Care for Thousands of Medicare Patients

Some recent media reports have inaccurately stated that Mayo Clinic in Arizona is no longer seeing any Medicare patients. This is not true.

Rather, a five-physician Mayo Clinic Arizona family practice clinic in Glendale, Ariz., has opted out of Medicare as part of a Mayo Clinic time-limited trial that will be reviewed at its conclusion. This means that Medicare will no longer reimburse Mayo Clinic for primary care services at this specific primary care facility, not at Mayo Clinic in Arizona overall. This affects only primary care office visits for the five Mayo family practice physicians at this site.  Specialty care, laboratory services, imaging studies and ancillary services at Mayo Clinic are still covered by Medicare. Current Medicare patients may continue receiving primary care at the Glendale clinic but will be required to pay out-of-pocket for office visits.  ( see http://healthpolicyblog.mayoclinic.org/2010/01/05/medicare-and-mayo-clinic-in-arizona/ )

In a previous post on this Medicare and More blog,  I reported that under the Health Care Reform Law, primary doctors will get a 10% increase in their Medicare payments.  Across the country, it is primary care doctors who are limiting the number of Medicare patients in their practices.  The Heath Care Reform Law addresses this problem.

Compound Captive wrote in his blog that “a year ago federal officials confirmed that fraud, waste and abuse was habitual in several specific areas of Medicare, but to date have taken no action to fix these known problems”.   In fact, the The Health Care Reform Law commits the government to finding and prosecuting Medicare fraud.  Under the law, funding will  be increased to expand efforts to find and prosecute Medicare fraud.  Medicare will double the number of investigative offices it has across the country so the agency will have the people and resources to address this serious problem.  No other administration has taken such an aggressive approach to fighting fraud and abuse in the Medicare system.

Compound Captive also wrote that the Medicare “program’s reimbursement to medical providers is so slow…“  This is absolutely incorrect.   In fact, Medicare pays claims as quickly as or faster than insurance companies.  I have heard this from many sources, but just last week I had a conversation with my own doctor about Medicare.   This doctor is a specialist and he doesn’t like the Health Care Reform Law, but he told me that Medicare pays claims quickly and consistently.  He also told me stories about insurance companies and how they delay payment for months by  rejecting claims and requiring doctors to submit more and more paperwork. This doctor doesn’t like the new law, but he doesn’t like insurance companies either.  He did say that insurance companies pay from 10% to 20% more than Medicare for the same procedure – but Medicare doesn’t deny claims and delay payment, so doctors at least know they can count on timely payment from Medicare.

The many myths about Medicare and the Health Care Reform Law are repeated so often that it is difficult for people to know what is true and what is false.  Compound Captive got it wrong on just about all the points in his April 15th post.

The Community Living Assistance Services and Supports (CLASS) Act is part of the Health Care Reform Law that was passed in March. Taxpayers can choose to pay into the program, and after contributing for five years, participants who are disabled and meet certain criteria will be eligible for a cash benefit of at least $50 a day. The program is geared toward helping people stay in their homes when they need assistance for activities of daily living and supplementing help they receive from family members.  The program would act like long term care insurance, but on a smaller budget. A big difference from long term care insurance is that there will be no screening for preexisting conditions when people sign up for CLASS and no lifetime benefit limit for participants.

Kaiser Health News has a story on the program  which you can read here:

http://www.kaiserhealthnews.org/Stories/2010/April/15/CLASS-act-long-term-care-insurance.aspx