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 .

Insurance agents who make a living enrolling seniors in Medicare Advantage plans are gearing up for the Medicare Annual Election Period which runs from November 15th to December 31st.  This is the period during which seniors and younger Medicare beneficiaries can change their Medicare Advantage plan or their Part D drug plan. People with only Medicare can join a Medicare Advantage plan or a Part D plan at this time.

In past years, insurance agents had five months to enroll people in Medicare Advantage plans, but this has changed – and agents must find a way to make a year’s worth of commission between November 15^th and December 31st.

Because of this new, compressed Medicare Advantage change/enrollment period, some agents are already prospecting for new business -  and some of them are breaking Medicare rules. I’ve heard stories of seniors receiving phone calls from insurance agents they don’t know and don’t really want to talk to.

An agent I know (let’s call her Mary) was just telling me that one of her clients called to say an insurance agent was coming to his house the next day to talk about Medicare Advantage.  The senior told Mary he had told the agent that he worked with Mary on all his insurance decisions.  But the pushy insurance agent had somehow gotten the senior to agree to an appointment.

Mary called the pushy insurance agent and told him she was working with this senior and that the senior had told her he was not interested in changing his Medicare Advantage plan.  Mary (politely) told the agent to back off.

What this pushy insurance agent did was not only unethical, it was against Medicare rules.  Medicare has told all Medicare Advantage plans that insurance agents contracted with them are not allowed to make calls to people who are not their clients.  This is “cold calling” and it is forbidden by Medicare rules.

Unfortunately, there are insurance agents out there who break the rules and give everyone in the business a bad name.  And unfortunately, many seniors are unable to push back against pushy salesmen (and women) and end up letting them into their homes.

Insurance agents can call their clients to talk about upcoming changes in their Medicare Advantage and Part D plans, but they can’t call people they don’t know.

Information on Medicare Advantage changes for 2011 is not yet available to agents. People enrolled in Medicare Advantage won’t receive information from their plan until mid-to-late October.

Changes to Medicare Advantage Enrollment Periods:

In past years, people enrolled in Medicare Advantage plans could change plans between November 15^th and December 31^st and then again from January 1^st to March 31^st.  In 2011, the January through March Open Enrollment period is gone and everyone will be “locked into” their Medicare coverage for the rest of the year (unless they meet certain conditions that give them a special enrollment period).

From January 1st to February 14^th, people will be able to disenroll from their Medicare Advantage plan and go back to Medicare (and sign up for a standalone Part D plan). If a senior is unhappy with his Medicare Advantage plan in January, this will be his only option for making a change.  Otherwise, he is stuck with his Medicare Advantage plan for the rest of the year.