Everyone enrolled in a Medicare Advantage plan or Part D drug plan should have received a package of information that includes the “Annual Notice of Change”.  Somewhere in this material is a comparison of the plan’s premium and co-pays for 2010 and 2011.   My neighbor is enrolled in Health Net’s Amber plan and she showed me what she received.  It is a “book” about half an inch thick.  Most of the information in this “book” is the evidence of coverage for her 2011 plan.  Also included, near the front of “the book”, is the Annual Notice of Change which is extremely important for people enrolled in the Amber plan.

AMBER PLAN CHANGES ARE BIG

I was curious to see if the changes to the Amber plan are highlighted in a way to alert many Amber enrollees that YOU MAY HAVE TO DROP THIS PLAN!! I’m sorry to say there is no major notification or explanation of what the changes mean for many Amber Plan members.  For 2010,  a visit to a specialist has a $20 co-pay.  In 2011, the co-pay will be 20% of the fee.  If an Amber member goes to the hospital in 2011, there is an $1100 deductible.  The charge for an emergency room visit has been $50 for Amber enrollees, but it will be 20% of the total bill in 2011.

What these changes mean is that the Amber plan will be only for “dual eligibles” in 2011. These are people who have Medicare and AHCCCS/Medicaid. This is actually a big change and will require people with limited incomes to find a new plan.

Amber Plan members who make less than $930 per month can remain on the plan because AHCCCS (Arizona Health Care Cost Containment System) will pay their co-pays.  But Amber members whose incomes are between $930 and $1,260 per month will have to find a new plan because they will pay a 20% co-pay for all services.  People who are “full duals” will have their co-pays paid by their AHCCCS plan. People in the higher low-income bracket mentioned above will have to find another plan to avoid 20% co-pays.

The information sent by Health Net leaves it up to the Amber enrollee to figure all this out on their own.  That is scary.

MEDICARE.GOV STILL NOT WORKING PROPERLY

I went on to Medicare.gov to look at Advantage plans in Pima county (where I know every plan). Health Net Ruby 1 is not appearing on the Medicare.gov Plan Finder list.  When I tried to email a comparison of two plans to a client, the link to the plan comparisons did not work in the email that was received.

In summary, the Medicare.gov Plan Finder is very broken. It has been broken for a while and has not been fixed.  Very odd.

INSURANCE AGENTS ARE VERY PUSHY THIS YEAR.

I have heard from my own clients and other insurance agents that some agents are being very pushy and don’t want to take “no” for an answer.   Agents are appearing at peoples’ doors and calling them on the phone – things that are totally against Medicare rules.  The reason for this aggressive behavior is a shortened selling season for Medicare Advantage.  Changes can only be made between November 15th and December 31st this year.  In the past, Medicare beneficiaries also had January through March to choose or change a Medicare Advantage plan.

I know an insurance agent who follows the Medicare rules, and she called Health Net to complain about an agent who did break Medicare rules with her client. Health Net said there is nothing they can do.  The senior called Medicare to complain about the rule-breaking agent and was told there is nothing Medicare can do.  Very odd to have rules that nobody seems to enforce.

Six months ago I was predicting big changes for Arizona Medicare Advantage plans in 2011.  I was wrong.  There will be very few changes to most of the Arizona Medicare Advantage plans in 2011. Most HMO plans still have $0 premium.  Co-pays for doctor visits and hospital stays have not changed much. Plans are still offering free gym memberships.  Some Advantage plans are being canceled and this will require about 2000 people in southern Arizona to find a new plan.  Plan cancellations are more about the “business model” of the canceled plans than changes brought about by health care reform.

POSITIVE CHANGES

Every Medicare Advantage plan must cap enrollees’ out-of-pocket expenses. This means all the co-pays for doctor visits, hospital stays, chemo and radiation treatment, and other services (when added up during the year) are capped at a certain limit for that year.  The highest allowable maximum-out-of-pocket (MOOP) is $6,700, but most plans have set their MOOP at $5,000 or less. $3,400 is the lowest MOOP being offered by two companies.

Relief in the Part D Donut Hole: In 2011, if a person reaches the donut hole, he will get a 50% discount on the price of his brand drugs and a 7% discount on generics.  A person reaches the donut hole when what the enrollee and the Part D plan have spent (added together) totals $2,840.  If a person has total monthly drug costs of $400 (even if his co-pays are just $100), he would hit the donut hole after 7 months ($400 x 7 = $2,800). Starting in August he would be responsible for 100% of his drug costs ($400), but he will get a 50% discount if these are brand drugs.  Thus he would pay only $200 for his brand name prescriptions each month from August to December.

A new Medicare Advantage plan in Pima County: SCAN (Senior Care Action Network) is a California-based not-for-profit which began operating in Maricopa County two years ago. They say they will have a good doctor network in Pima County, though that could take some time to accomplish.  Their Part D drug plan could make it worthwhile to look into SCAN as it will cover generics through the gap. I’ve met some people with expensive generics that put them in the donut hole.

NEGATIVE CHANGES

The Annual Election Period (November 15 – December 31) will be the only time to change your Medicare Advantage plan or Part D plan.  In previous years seniors had another chance to switch Advantage plans during the Open Enroll Period from January 1 – March 31. The Open Enrollment Period has been eliminated.  If a person decides in January that she doesn’t like her Advantage plan….too bad.  She cannot change to another Advantage plan – but she can dis-enroll from her plan and go back to Original Medicare (between January 1 and February 14).  She would probably want to purchase a stand-alone Part D plan as well as a Medicare Supplement, both of which have monthly premiums. As of February 15th she is “locked into” her advantage plan unless she qualifies for a special enrollment period due to certain chronic illnesses, limited income subsidy, or moving out of her plan’s service area.

A number of plans are being canceled for 2011 and people enrolled in them will have to shop for a new Advantage plan – or go back to Original Medicare, get a stand-alone Part D plan and a Medicare Supplement.  See my recent post about “guaranteed issue” for Medicare Supplements if your Advantage plan is canceled: http://tucsoncitizen.com/medicare/2010/09/27/medicare-advantage-cancellation-your-options/

Health Net’s Amber plan is changing to a “Dual Eligible” Advantage plan.  The Amber plan has always been a plan for people who get their co-pays covered by AHCCCS (Arizona Health Care Cost Containment System, aka Medicaid).  But the Amber plan has also covered people who had incomes less than $1,240 (single) or $1,660 (couple) if they applied for Medicare Cost Sharing help.  These seniors on limited incomes (but not low enough to qualify for Medicaid) have been helped by the low co-pays that came with the Amber plan.  As of January 1, 2011, the Amber plan will have 20% co-pays (which will be paid by AHCCCS for “full duals”). That means that people who do not get their co-pays paid by AHCCCS will need to shop for another Medicare Advantage plan. Unfortunately,  most Advantage plans have co-pays that are double the Amber co-pays.  Seniors who have to move off the Amber plan will face sticker shock as their co-pays double for doctor visits and hospital stays. They will still get help with their prescription costs. There is one plan in Tucson with co-pays similar to the Amber plan, but it has a limited doctor network.  People leaving the Amber plan will have to choose between plans with a bigger network of doctors and hospitals or a plan with low co-pays and a limited network.

FOR MORE INFORMATION GO TO MEDICARE CHOICES OF ARIZONA .