The phone is ringing and there are lots of people to see. Many of them are current clients who think they might want to change their Part D plan or their Medicare Advantage plan. Some definitely need to make a change.

Comparing Plans

One client, Nancy, was thinking of changing to the Medicare Advantage plan in which her husband is enrolled, so we compared her plan and his plan benefit by benefit.

It turns out Nancy’s plan MOOP is going way up in 2012.  The MOOP is the Maximum-Out-Of-Pocket she would pay each year in co-pays for Medicare-covered services. The MOOP is particularly important when people are treated for cancer, because radiation and chemo therapy have a 20% co-pay in every Medicare Advantage plan. And that 20% quickly adds up to five thousand dollars or even ten thousand dollars.  So the lower the MOOP, the better the financial protection for people enrolled in Medicare Advantage plans. The plan Nancy was considering has a lower MOOP,  but otherwise looked pretty comparable to her plan.

But when we got to diagnostic tests, we saw that the two plans are very different. Nancy’s plan covers many diagnostic tests for $0 co-pay, while her husband’s plan charges 20% per test. Nancy is going to get a series of tests early next year, but she is generally very healthy.  After some thought, she decided she should stay with her current plan.

Doctors not in the network

I met with a man who, last spring, changed to a Medicare Advantage plan with low co-pays and a low MOOP. But after a few months in the plan, he was surprised to discover that most of his doctors are not contracted with the plan. His primary doctor is in the network, but not his urologist, his dermatologist, or his opthalmologist.  Just some minor details that were overlooked by the agent who signed him up!

Part D plan changes

I have previously written about a Part D plan in which I enrolled a few people two years ago, when the premium was just $25.00 per month. It had gone up to $36 for 2011, and it will go up to over $71.00 for 2012!!  The plan is under the Unicare name. I name this plan because only one of my clients actually read the Annual Notice of Change (which everybody receives). I’ve gotten hold of  my other clients who are enrolled in this plan, and they had no clue about the outrageous premium increase.

The problem with Part D is that plans can change drastically from year to year.  And I would say that a majority of seniors do not read the materials they receive from their Part D plan.  But if they miss the Open Enrollment Period (October 15 – December 7) when they can change to another plan, they will be stuck paying an outrageous amount of money in 2012, because Medicare will say, “Too bad you weren’t paying attention”, or “You snooze, you lose”.

I looked up Part D drug plans for Arizona on Medicare.gov to find out how many stars they get. For 2012, there will be 30 Part D plans available in Arizona, and most of them get 2.5 or 3 stars, which is average. The star ratings go from 1 to 5, five being the best.

Only one Part D plan in Arizona gets 4 stars. This plan costs $47.20 per month and has a $320 deductible.  I don’t know if this 4-star plan is worth $47.20 per month when you can get a 3-star plan with the same deductible for $15.80.

The $320 deductible means you pay the first $320 of your drug costs, and then the plan kicks in.

To compare plans, I put two drugs into the Medicare.gov Plan Finder:  Crestor and Proventil HFA.   The $15.80 plan covers Crestor for 20% of the retail cost of the drug after the deductible is met. So, once the $320 deductible is paid (after two months), the cost of Crestor would be $27.20.  This plan doesn’t cover Proventil (which costs $57).

Most of the plans do not cover the Proventil inhaler. Most cover Crestor for a $45 co-pay (plans with a deductible and plans without). Only a couple of plans cover Proventil for a $27 co-pay.

The 4-star plan didn’t have any information on what its co-pays are, or what the drugs I entered would cost, so I can’t say if it’s worth $47.20 per month.

My conclusion is that 4 stars vs 3 stars is not a big deal. The key is:  Which plan covers your drugs at the lowest overall cost for the year?  The Medicare.gov Plan Finder will give you that info, but you need to figure out where to find it.

And I will say once again….”Why are there so many Part D plans? Why does it have to be so complicated? Is it saving Medicare money?”

Insurance companies manage Part D plans and negotiate prices with drug companies, but Medicare pays the bills – to the tune of $78 billion in 2010!!

Part D really bugs me because it is so complicated – and plans change each year. One of my clients called me to say her $25 plan premium is going to $71 for 2012.  I have left messages for two other clients who are enrolled in that plan, which seemed like a good deal two years ago.

Medicare handed Part D over to insurance companies and made it ridiculously complicated.  Why? Why? Why?

PS:  I know why.

Medicare has released  its grades for Medicare Advantage and Part D plans, and I was shocked.  Tucson finally has four-star Medicare Advantage plans.

The ratings go from one star to five stars and are based on more than 30 criteria such as: member complaints; members leaving the plan; surveys of members and their satisfaction with the plan; telephone customer service; managing chronic illnesses of members; how many members get screening tests and flu shots.

As an insurance agent, I can’t name names, lest someone think I’m promoting specific Medicare Advantage plans. But I will say that the newly-crowned 4-star plans in Tucson are relatively new to town – and they are all under one company. I have heard both positives and negatives about this company and its plans. This company has a very interesting model of care, especially for people with chronic illnesses.  Some doctor groups contracted with this company dropped out of the network in mid-year, leaving patients unable to see their doctor, who was then out-of-network. Many seniors enrolled with this company seem very happy with their plan and the attention they get from it. Some people have dropped, or will dis-enroll from these plans because they are unhappy with the network or the plan’s referral process. Please note that I am reporting what I have heard about these 4-star rated plans – both good and bad.

As with all Medicare Advantage plans, there are good things about them and  bad things. Choosing an Advantage plan based on the star rating system alone will not work for most people.

The rest of the Medicare Advantage plans in town, at least those that have been around for some time, have improved their ratings from 3 stars to 3.5 stars. The higher scores are due to concerted efforts by the plans to please Medicare. For example, plans have been calling and writing their members to encourage them to get annual preventive screening tests that are provided at no cost. Medicare wants Advantage plans to spend money on their members to try to keep them healthy – and this is a good thing.

Phoenix has three Medicare Advantage plans that get 4.5 stars.

MORE STARS MEAN MORE MONEY

In 2012, the star ratings will be very important because Medicare will pay bonuses to Advantage plans that get three or more stars. Five-star plans will be able to enroll new members all year long.  Unfortunately, Arizona doesn’t have any 5-star plans.

Fortunately for Arizona, 3-star and 3.5-star plans will get bonuses, because Medicare looked around and saw that most Advantage plans fall into this “average” range. The bonus rules were changed in order to keep the vast majority of Medicare Advantage plans in business. All Advantage plans are working hard to make improvements, with a goal of obtaining a 5-star rating  (and higher bonus payments from Medicare). This is a good thing for people enrolled in Advantage plans.

The summary rating gives an overall score on the health plan’s quality and performance 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.

To see how Arizona Medicare Advantage plans are rated, use this link:  Medicare.gov