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.
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”.