Medicare is in trouble, and the only way to save it is to reform the program and cut costs. But how to do this? It turns out the Affordable Care Act (aka “Obamacare”) provides some answers to this vexing question. The Affordable Care Act will cut or save billions of dollars for Medicare through new tools and resources to help crack down on fraud, waste, and abuse in the Medicare system, as well as reforming payment systems to reward high quality care.  These efforts are aimed at creating better health, better care, and lower costs for patients, providers, and taxpayers, according to the Centers for Medicare and Medicaid (CMS).

Here is how Medicare will save $120 billion over the next four years:

This last area of savings ($50 billion) is the amount of money Medicare expects to cut from Medicare Advantage plans.  I wonder if this number has been adjusted for recent changes that have been made to lessen the impact of payment cuts on the 11 million people enrolled in these private Medicare plans?  In Arizona over 45% of seniors in Maricopa, Pima, and Pinal counties are enrolled in Medicare Advantage plans.

Originally, Medicare was only going to reward top performing Advantage plans that earned 4 and 5 stars in the Medicare rating system. The reward is more money. Earlier this year, Medicare said it would also reward 3 star-rated Advantage plans. This is good news for Arizona as most of our Advantage plans get just 3 stars, meaning they are good but not excellent. I wrote about the Medicare Advantage star rating system late last year.

So, while Medicare will be taking away money from Medicare Advantage plans with one  hand, with the other hand Medicare will  give money to plans for providing high quality service to their members. The end result could be lower savings for Medicare, but happier seniors, who will not experience drastic changes in their Medicare coverage.

The full report on Medicare savings can be found at: http://www.cms.gov/apps/files/medicare-savings-report.pdf

The Medicare.gov website finally has its Part D plan and Advantage plan ratings available.  If you can work your way through the Plan Finder to the point where you get a list of Part D and Medicare Advantage plans available in your county, you can see how the plans are rated for various services.  The major players in Pima County all get 3 stars (out of 5 possible stars). This means these plans are good but not great.

Health Net, Humana, and AARP Medicare Complete Plus (Secure Horizons Plan 3) get three stars for their overall rating.  For some reason Secure Horizon’s biggest plan, AARP Medicare Complete Plan 1, is not showing up on the list.  Health Net’s Ruby 1 is also not appearing on the list.

SCAN and CareMore are newcomers to Tucson, yet SCAN gets a 3.5 star overall rating while CareMore is “too new to be measured”.  SCAN begins its Medicare Advantage plan on January 1, so the ratings must be based on SCAN’s two years of operation in the Phoenix area. CareMore is finishing up its first year of operation in Tucson.

The Medicare Advantage plan ratings are based on many areas of customer service for both drug coverage and medical services.  Some of the ratings would seem to be based on audits which Medicare does of each plan.  A category like “Staying Healthy: Screening, Tests, and Vaccines” is probably based on how many tests and screenings were administered for people enrolled in the plans.

Several rated services are not under the control of the plans, such as “Doctors Who Communicate Well”.  How is the insurance company responsible for doctors communicating?  Health Net, Secure Horizons, and Health Net essentially have the same, very large doctor network, and yet one plan gets only one star, another gets two stars, and another gets three stars for its doctor network.  Explain that to me, please.

“Getting Appointments and Care Quickly” is dependent upon the doctors and hospitals in each plan’s network – and yet the plans with the largest networks are not rated as highly as SCAN, which barely has a network in Tucson.

I don’t think the ratings are helpful to  people in Pima County because the three major players come out about the same, even though one plan might have better telephone customer service while another has more members who are checked for osteoporosis.   Complaints I have heard from people enrolled in certain Advantage plans concern prior authorization for certain drugs or tests like MRIs – and yet this is not addressed in any of the ratings.

MARICOPA COUNTY PLANS

Plan ratings might be more useful in the Phoenix area where there are 29 Medicare Advantage plans with drug coverage. One plan, Cigna, gets four stars.  SCAN gets 3.5 stars after just two years in operation there.  Once again, I see that plans – major plans – are missing from the list of Advantage plans on Medicare.gov.  AARP Medicare Complete Plan 1 (with the largest membership in Arizona) and Health Net Ruby 1 do not appear on the list of Maricopa County plans.  I don’t know the plans in Maricopa as well as I do in Pima County, so I don’t know if other plans are missing.

IN CONCLUSION

I don’t think the rating system helps consumers in Pima County.  The best way to get a feel for a Medicare Advantage plan is to ask your friends and neighbors what their experience is with their plan.  With 45% of seniors in Pima County and 44% in Maricopa County enrolled in Medicare Advantage, it should be very easy to get feedback on how these plans work – and if they work well for people enrolled in them.

Another major factor in choosing a Medicare Advantage plan will be “Are your doctors in the network?”.  And you will want to look at co-pays for your prescriptions.  A drug on one Advantage plan might be a tier 2 with a $42 co-pay. That same drug on another plan might be a tier 3, which would cost you $84 per month.  That will help you with your decision.

PART D

The Medicare.gov Plan Finder can be very useful in finding a stand-alone Part D plan, especially if you have a long list of drugs, or unusual, or expensive drugs.  You put your prescriptions into the Plan Finder and it will give you a list of stand-alone Part D plans that cover your drugs.  You can then enroll in the Part D plan on-line.

FOR MORE INFORMATION ON YOUR MEDICARE CHOICES CLICK HERE.