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.