Health Net’s Amber plan, a Medicare Advantage plan for low-income Medicare beneficiaries, is changing drastically for 2011.  I haven’t talked to one person enrolled in this plan who knew about the changes and understood that they had to find a new plan.  My question to Health Net and Medicare is:  How can you get away with this?

Health Net’s Amber plan has been a God-send for many of my clients who have incomes below $1,240 per month. The plan is also open to Medicare beneficiaries who make less than $930 per month and get cost sharing help from AHCCCS (Arizona Health Care Cost Containment System, Arizona’s Medicaid). Health Net is changing the Amber plan for 2011 such that it will only serve this lowest income group whose cost sharing is paid by AHCCCS (pronounced “access”).

I have been able to get in touch with most of the people I enrolled in this plan over the last three years whose income (above $930 per month) will require them to enroll in a new plan.  I have had to explain that the Amber plan will require them to pay 20% of the cost of any medical service.  This is just like having only Medicare.  Just about everybody I’ve told this to has looked back at me with a blank look that tells me that don’t fully grasp why they need to leave this plan. The Amber plan has worked so well for them because it has had no, or very low co-pays and $1,500 of dental coverage each year.

The vast majority of my low-income clients are challenged to understand what the plan changes mean for them. And none of them can afford the co-pays that come with standard Medicare Advantage plans:  $40 co-pays for specialists; $250 per day for a hospital stay; no dental or transportation benefit.

So why has Health Net made this change?  Medicare pays Health Net a lot of money for each person enrolled in the Amber plan, and the payment is higher than what Health Net receives for enrollees its “standard” Ruby plans.  With this change, Health Net can dump enrollees who have paid only a $20 co-pay to see a doctor or $100 per day for a hospital stay.   Instead Health Net can get more money from the state of Arizona (AHCCCS) which will pay 20% of the charge for all services.  While this benefits Health Net, thousands of people enrolled in the plan, whose 20% co-pays will not be covered by AHCCCS, must move to another plan – if they have figured this out.

Because so many people enrolled in the Amber plan are old, sick, and sometimes mentally challenged, I do not understand why Medicare is allowing Health Net to force these vulnerable people to change plans.  I have a client on the Amber plan who is on a transplant waiting list at University Medical Center, and Health Net is the only Advantage plan that contracts with UMC.  There is no good second choice for this man, yet he’ll be thrown off the transplant list if he has to pay 20% of his medical bills.

The big change to the Amber plan is probably a good business decision for Health Net, but it’s a very bad deal for thousands of people enrolled in the plan whose higher than $1,240 monthly income will force them off the plan – if they even know they need to change to another Advantage plan.

UPDATE:   Humana is now contracted with University Medical Center, so their Medicare Advantage plan is the one alternative for my client on the heart transplant waiting list – if he can afford all the co-pays that come with this plan.

Thousands of Medicare beneficiaries are enrolled Medicare Advantage plans and Part D drug plans that are being canceled or drastically changed for 2011.  Unless these people have carefully read the information sent to them by their plan, they will be in for a rude surprise in January.

UnitedHealthcare Drug plan

Over the last two years, I have enrolled many people in Medicare supplements who took  no prescription drugs.  These people did not want to pay $30 or more for a Part D plan they didn’t need, but they did not want to face a premium penalty in the future when they need a Part D plan.  My suggestion was that they call up UnitedHealthcare and enroll in their Part D plan that cost just over $10 per month.  This allowed them to be in the Part D system for a minimal cost.   That United plan is being canceled for 2011 and these folks received a letter saying they will be automatically enrolled in the AARP Medicare Rx plan that costs $28.60 per month.

I talked to one of my clients yesterday who had already enrolled in the $14  Humana-Walmart plan for 2011.  Maryann told me she had just received a letter from Social Security informing her that $28.60 per month will be deducted from her Social Security check to pay for her Part D plan.  Uh oh.

I told Maryann to call Medicare to ask them what Part D plan is in her record for 2011.  Medicare said she’s in the Humana-Walmart plan.  Next I told her to call Social Security to ask why she’s paying for a plan she is not enrolled in.  The Social Security representative could not answer her question and said he would change her record to stop the $28.60 monthly payment – but this could take three months. (!!!)

So Maryann will be paying for two Part D plans for at least three months in 2011 – even though she doesn’t even need a Part D plan.

My question is why Medicare allowed this automatic enrollment from a $10 plan to a $28.60 plan.  I suppose they didn’t want people who don’t read their mail to end up without a Part D plan in 2011.  But it seems the Medicare and Social Security information systems are not connected, resulting in mix-ups that may affect thousands of people like Maryann.

Next:  Why did Medicare allow Health Net to drop thousands of low-income people from the Amber plan?

FOR MORE INFO SEE ARIZONAMEDICARENEWS.COM

I met with a man who recently lost his wife to a long illness. He was still getting over his loss when he received a letter from his credit card company informing him that his card had been canceled.  He called the credit card company and was told his account had been closed because he was dead.

It seems Social Security made a mistake when his wife died and instead put into his record that he was deceased.  This information probably goes to credit reporting agencies and was picked up by his credit card company.  He told the company he was alive and well and would like to pay his last bill, which had been held by the company.  The company would not send him the bill so he could pay it because, according to their records, he was deceased.

This man called Social Security and pointed out their error.  He was told his record would  be corrected. That was three weeks ago.

This man has a Medicare Advantage plan that is being canceled and he needs to enroll in another plan, so I submitted an application for him to the AARP Medicare Complete Plus plan by UnitedHealthcare.  I checked the next day on my computer to see that his application had been received and I saw the notation, “Denied due to death”.

I’ve decided to mention the name of the company because I know they read everything that is written about them, and I mght need some help from higher up to fix this problem.

Medicare Advantage companies check the Medicare record of each applicant to make sure the information on the application is correct before they send the file to Medicare.  Medicare had gotten the report of this man’s death from Social Security, but two weeks after Social Security corrected his record, Medicare had not received the correction.

This should be an interesting case to see how two large government bureaucracies work. And UnitedHealthcare is so large that I have often said it is like the government.  We’ll see how this turns out. And hopefully it gets resolved soon because this man only has until the end of December to get enrolled in a new Medicare Advantage plan. If he misses that deadline there will be another bureaucratic mess to deal with.