I have decided to write about insurance agents who work in the Medicare market because I have been critical of agents/brokers who seem more interested in making money than helping their clients.  There are insurance agents who swoop into Tucson from Phoenix, sign people up for a Medicare Advantage plan, and are never heard from again. But there are many insurance agents/brokers who work very hard to match their clients to the appropriate Medicare coverage.  There are many agents/brokers who are there for their clients when they have problems with their Medicare Advantage or Part D plan.  There are even agents/brokers who help their clients get social services help – acting like social workers.

If you have your agent’s card and you have questions about your current coverage – and you are thinking of shopping around….please call your agent.  If the insurance agent who signed you up for your Medicare Advantage plan is not from Tucson…..find someone local who can help you evaluate your coverage.

Trying to sort through the details of four or five Medicare Advantage plans is complicated and confusing – but a good insurance agent/broker can help you in the following ways.

A good insurance agent will tell you a Medicare Supplement might be better for you than a Medicare Advantage plan and will explain the difference in coverage and cost.

If you are looking at Medicare Advantage, a good agent will tell you which plans your doctors are contracted with.

In evaluating an Advantage plan, a good agent will take the list of your medications and tell you what your co-pays will be.

A good insurance agent will not push you toward one plan, but will match you to a plan (or plans) based on your doctors, your prescriptions, and how you feel about having low co-pays vs a big network of doctors and hospitals.

A good insurance agent will tell you to call him/her if you have any questions at any time during the year.

Medicare choices are many and confusing.  A good insurance agent can help you through the Medicare maze. Be sure to choose an agent who seems more concerned with your interests than with his/her opportunity to make a commission.

FOR MORE INFORMATION, SEE MEDICARE CHOICES OF ARIZONA.

Someone seems to have gotten wind of big rate hikes coming for Medicare Supplement premiums. Nevada Senator Harry Reid announced, “We are hearing disturbing stories from beneficiaries across the country about excessive premium increases for Medigap supplemental insurance policies”.  Reid and other top Democrats have asked Health and Human Services Secretary Kathleen Sebelius to stop the increases or find a way to keep them under control.

According to The Hill:

The lawmakers cited some Medigap plans offered by United of Omaha, which will see premiums increases around 40 percent next year.

“An increase of this magnitude raises serious concerns about premium-setting practices and rate review procedures in place for Medigap policies,” the Democrats wrote.

Although the new health reform law includes $250 million for states to monitor rate changes, the reviews don’t explicitly cover Medigap plans, the lawmakers note.

They’re calling on HHS to “work with Governors and State Insurance Commissioners to help them gain this authority where it does not exist today.”

The lawmakers are also requesting “a study of Medigap trends and costs to provide a benchmark against which proposed rates can be measured.”

Possible reasons for large premium increases could be:

1)  Medicare Supplement companies entering a market purposely offered low premiums to attract cost-conscious seniors.  The rates were not realistic and so must be raised in a year or two in order for the plan to be profitable.

2)  In June of this year, “modernized” Medicare Supplement plans began. With changes required for new “modernized ” plans,  each Medicare Supplement company was starting over with a “new book of business” as of June 1.  This meant that premiums for plans starting in June 2010 could be lower because they had no claims history.  But the older plans – sold before June 2010 – now have no new, younger, healthier members paying premiums.  Plans with older, sicker  people will likely have higher expenses and lower profits, requiring higher premiums next year.

Each state is responsible for regulating their insurance market and some states are more active in overseeing insurance companies and their rate increases. Whatever the reason for the rate increases, seniors may get sticker shock when they see their premiums for 2011.

FOR MORE INFORMATION, SEE MEDICARE CHOICES OF ARIZONA.

Medicare Advantage shopping season is upon us.  Seniors have heard about major changes coming to Medicare Advantage and they are trying to figure out what to do about their Medicare Advantage plan for 2011.  I have attended training with each of the Medicare Advantage plans offered in southern Arizona and, at first glance, there aren’t lots of changes to most plans….unless you are in a plan that is being discontinued or canceled. 

Because I am an insurance agent I am not allowed to go into plan-specific details here because it might be  construed as advertising.  But I can advise people enrolled in Medicare Advantage plans to review their plan and decide if it is working for them.  If not, they need to take a look at other plans to see if something else might be a better fit. 

Everyone enrolled in a Medicare Advantage plan will receive an Annual Notice of Change (ANOC) by the end of October.  This usually comes in the form of a 20 – 30 page document that details your plan for the coming year as well as other benefits like optional dental coverage.  The important information in this document will have two columns listing 2010 benefits and how they are changing in 2011.

Some people will get a letter saying their Advantage plan is being canceled (Evercare Chronic Illness and AARP Medicare Direct private-fee-for-service).  Some people will get a letter from Health Net saying their Ruby 3 plan is being rolled into Ruby 1.  Amber plan enrollees should get a letter explaining the change in co-payments from $2o to 20%.  All of these people will want to look at their options for other coverage.

Here is what is important when evaluating a Medicare Advantage plan:

Are your doctors in the plan’s network?  Your primary care doctor might be in one plan’s network, but your cardiologist might not be.  Are you willing to change doctors to get lower co-pays in another plan?

What hospitals are in the plan’s network?  Is it important to you to be able to go to TMC, UMC or Northwest Hospital? Not every plan has these hospitals in their network.

Is a large network more important to you than low co-pays?  If you have five doctors you don’t want to give up, you may have to pass on a plan with the lowest doctor visit and hospital co-pays.

How are your drugs covered by the plans you are considering?  I have seen certain drugs that are a tier 2 on one plan and a tier 3 on another plan.  This means your co-pay could be $42 or $79 for the same drug, depending on the plan you choose.

Every plan has a an annual MOOP (maximum-out-of-pocket), but $6,700 is the  highest and $3,400 is the lowest.  Is this important to you?

How does the plan treat “prior authorization” for diagnostic tests?  Some plans rarely require prior authorizations while other plans are known to refuse to authorize tests like CT scans or MRIs.

You should decide how you would answer each of the questions above, especially the ones about doctor and hospital networks.  Your answer to the network question will quickly limit (or expand) your Medicare Advantage options. Some people want and need the lowest co-pays, and this will direct them toward one or two plans.  People with diabetes, COPD, or chronic heart failure might consider special needs plans that offer benefits specific to their illnesses as well as lower prices for drugs to treat their illnesses.

The Medicare Annual Election Period is November 15 to December 31, and this is when you can apply for a new Medicare Advantage plan or a stand-alone Part D plan.  Once you have selected a plan for 2011, you will not be able to change Advantage plans after January 1.  In past years, people had one more chance to switch Advantage plans from January to March.  That option is no longer available. So do your homework – or have an insurance broker do the work for you – and make an informed decision about your Medicare coverage.

FOR MORE INFORMATION CHECK OUT MEDICARE CHOICES OF ARIZONA.