Open Enrollment for Medicare Advantage plans has ended, and most people are locked into their plan for the rest of the year.  But there are exceptions for people with certain chronic illnesses or low income subsidies.

CareMore has Medicare Advantage plans for people with diabetes or breathing illnesses, and because these are “special needs plans”, people can enroll in them all year long.  In order to qualify for these plans, a doctor must sign a form confirming that the Medicare beneficiary has the chronic illness.

Evercare has Medicare Advantage plans for people with certain chronic illnesses such as heart disease, respiratory disease (such as asthma), high blood pressure, diabetes or dementia.

Low Income Subsidies: Medicare beneficiaries who are getting help with their Part B premium or Part D drug costs can change Medicare Advantage plans throughout the year.

People who have monthly income of  less than $1,354 (for a single person) or $1,821 (for a couple) can get help with their Part D premium and their prescription costs.  This help is received through an application to Social Security.

AHCCCS (Arizona Medicaid) will pay the Medicare Part B premium for a single person living on less than $1,218 per month, or a couple with monthly income of less than $1,639.  An application for this help is made to AHCCCS and usually requires a copy of the annual letter from Social Security that shows how much a person receives and what is deducted from that amount. The qualifying amount is the gross Social Security payment – before $96.40 (or $110.50) is taken out for the Medicare Part B premium.

If AHCCCS approves the application for “Medicare Cost Sharing”, they will notify Social Security that the individual or couple also qualifies for help with their Part D premium and drug costs.

FYI:  AHCCCS stands for Arizona Health Care Cost Containment System and is pronounced “access”.

So, while the vast majority of Medicare Advantage enrollees are “locked into” their plans, about 30% of seniors qualify for the low income subsidy, and many have chronic illnesses that would allow them to join a special needs plan.

FOR MORE INFORMATION ON MEDICARE CHOICES IN ARIZONA, check out my website.

And the winners are…..CareMore and Humana.  Thousands of Medicare beneficiaries in Pima County changed their Medicare Advantage plans in January and they still have February and March to make a switch.  CMS (Center for Medicare and Medicaid Services) reports each month on enrollment numbers, so we can see which plans are growing and which are losing members.

CareMore, a new Medicare Advantage plan in Tucson, enrolled 1,969 people as of the end of January according to CMS numbers.  CareMore is still advertising seminars and mailing brochures to seniors (for the third or fourth time), so they will likely gain more members before the end of March when the Open Enrollment Period ends.

Humana has been in Tucson for several years and has spent that time building its network of contracted healthcare providers for its HMO Medicare Advantage plan. As of December 1, 2009 they had 1,102 people enrolled in their HMO.  By February 1, they had nearly doubled their numbers to 2,079. This is an icrease of 89%. 

Humana’s PPO Medicare Advantage plan was also a big winner, growing from 195 enrollees to 465.

The big loser in enrollment numbers is Health Net’s Medicare Advantage HMO which had 19,670 members on December 1 and 17,182 on February 1st.  This amounts to a loss of 13% in its business.  Health Net is the first HMO Medicare Advantage plan in Tucson to have a premium ($36/month) and about 2,500 people chose to change plans rather than pay.  Losing only 13% of their members doesn’t seem like a bad result, given the competition in the Tucson Medicare Advantage market.

Another loser is the Evercare chronic illness plan (Evercare MP).  The plan lost 39% of its members, dropping from 4,029 to 2,476. This plan had very low co-payments three years ago, but is now fairly similar to other Advantage plans.  They also lost their contract with a large doctor group which forced enrollees to change their primary care doctor or change plans.

The big Kahuna in town is still Secure Horizons, with nearly 25,000 enrollees in their AARP Medicare Complete Plan 1. This plan has been around for a long time (though co-pays have changed over the years) and it does not have an annual cap on out-of-pocket expenses.  Over 2,000 seniors moved out of this plan and they may have enrolled in the AARP Medicare Complete Plan 3, which does have a cap.  Plan 3 gained 3,704 new enrollees as of February 1 for an 85% increase.

Medicare beneficiaries can make one change in their coverage between January 1 and March 31, so it will be interesting to see the final numbers for April 1.  The CMS web page with Medicare Advantage enrollments numbers can be found through this link:

http://www.cms.hhs.gov/MCRAdvPartDEnrolData/MMAESCC/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=2&sortOrder=descending&itemID=CMS1231978&intNumPerPage=10

Medicare Advantage plans are agressively marketed by insurance companies such as Humana, Health Net and Secure Horizons, and nearly 40% of seniors in Tucson are enrolled in these plans. Medicare Supplements seem to be left out of the picture for many  people as they consider their Medicare choices.

I was talking to a couple last week who are both 67 years old.  They have been enrolled in a Medicare Advantage plan since they got their Medicare.  As I explained their Medicare choices, they looked at me in amazement (or perhaps confusion) as I talked about Medicare supplements.  Medicare supplements seemed to be a new and unknown concept to them.

Now, it is very possible that they learned about Medicare supplements when they first looked at options for their Medicare coverage.  Two years have passed since then and it’s easy to forget the many details and options involved in Medicare.

These folks told me they were concerned about having to stay in a local network of providers with their Medicare Advantage plan. And they told me they were concerned about rising co-payments in their current plan. So I explained how Medicare supplements work with Medicare and can be used anywhere in the country with any provider who accepts Medicare.

As I went back and forth explaining the difference between Medicare Advantage and Medicare supplements, I felt bad about the confusion I seemed to be creating for these educated, smart, and capable people.  I drew diagrams, listed companies, and explained Part D. (That only added to the confusing picture in their minds). But eventually they got the picture and I told them they should take some time to think about all the information I had given them. We agreed to meet again a week later.

So I met again with these folks this week.   As we talked about the cost of Medicare supplement plans and Part D plans, the wife would recoil a bit.  And then she would say the benefits would outweigh the cost.  And then she’d say she is really quite healthy, so perhaps she would save money with a zero premium Advantage plan.  And then she’d say she doesn’t want to deal with a network……… So we spent another hour talking and…… they made their Medicare choice:  Medicare plus a Medicare Supplement plus a Part D plan.

Now I can tell you the story of another couple with whom I had a similar conversation (and two meetings). This second couple were very similar to the couple whose story I have told here.  We also went round and round and they eventually asked me what coverage I would choose: Medicare Supplement or Medicare Advantage?  I told them I would choose to get a Medicare supplement and they paused and looked at each other and……. told me their choice……….Medicare Advantage!

Meeting new people.  Hearing their stories and concerns.  Sharing my five years-worth of Medicare knowledge….. and seeing how people react so differently to the same information………….  makes my work very interesting.

For more information check out:  http://medicarechoicesofarizona.com