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.

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.

If your Medicare Advantage plan is cancelled, you have two options:  Change to another Advantage plan or return to Medicare and get a Medicare Supplement – with no questions asked. This is called “guaranteed issue”, and it is an option that should be seriously considered.

Guaranteed issue means a person who is 70 years old (or 90) with health problems can get a Medicare Supplement plan with no questions asked.  A person in this situation will pay the premium rate for his age, but will have no penalty because of his health condition.  This is a great opportunity to get the full coverage offered by a Plan C or F Medicare Supplement - and people in this situation are encouraged to look seriously at this option.

A copy of the cancellation letter from the Medicare Advantage plan must be submitted with the  Medicare Supplement application.  The Medicare Advantage cancellation letter will say clearly that  the person has “guaranteed issue”  for a Medicare Supplement with any company.  There are also boxes on the Medicare Supplement application to indicate that the applicant has guaranteed issue.

A number of Medicare Advantage plans will be cancelled for 2011 and letters have been sent to more than 2,000 people in southern Arizona informing them that they will have to change their Medicare plan by the end of December.  Details of 2011 Medicare Advantage plans are not publicly available until October 3rd, so plan options cannot be discussed until that time.

For more information go to the Medicare Choices of Arizona.