In 2011 Medicare Advantage Must Cap Patient Expenseby Denise Early on May. 14, 2010, under Health
In 2011, Medicare will require every Medicare Advantage plan to have an annual maximum-out-of-pocket (MOOP). This is good news for 30,000 or so seniors in Tucson whose Advantage plan does not have a MOOP.
A MOOP is a cap on expenses for co-pays and co-insurance, and the maximum limit is expected to be $6,700. However, CMS (Centers for Medicare and Medicaid) encourages Advantage plans to have lower MOOPs and will reward plans that voluntarily cap members’ expenses at a lower amount, such as $3,400.
A MOOP is important when someone has a chronic illness or multiple hospitalizations during a given year. Co-pays for specialists ($35-$45 for each visit), co-pays for MRIs ($150), and hospitalization at $200 per day, can add up. So Medicare is going to require every Advantage plan to set a cap for its members’ annual co-pays.
Cancer is an illness that requires large co-pays for chemo and radiation treatment (20% of the bill) and can quickly add up to five or even ten thousand dollars. An Advantage plan with a MOOP of $3,400 means that after the member has paid this amount “out of his own pocket”, he will have no more co-payments or co-insurance for the rest of the year. (Some plans have a MOOP but still require co-pays for doctor visits and labs after the MOOP is met.)
The Medicare Advantage plan with the largest enrollment in Tucson (over 28,000 members) does not have a MOOP. I recently got a call from a woman whose mother-in-law is in this plan and is being treated for breast cancer. The co-pay for chemotherapy under every Medicare Advantage plan in Tucson is 20% of the bill. So a person enrolled in a plan with a $3,400 MOOP would have their chemo cost capped at $3,400 through the end of the year. A person in a plan with a $5,000 MOOP will stop paying at $5,000. A person in a plan with no MOOP can only wait and see what their total bill will be. I have heard of people whose 20% co-pay was $10,000.
I have a client who paid $7,000 for radiation treatment for cervical cancer. That was three years ago. She told me she charged her payments on her credit card. She said she is almost finished paying off that credit card bill – three years later. I cringed when I heard this, realizing she probably paid twice that $7,000 amount with all the interest she incurred over three years.
FOR MORE INFORMATION ON COMPARING MEDICARE ADVANTAGE PLANS, YOU CAN GO TO MEDICARE CHOICES OF ARIZONA.