The latest Medicare star ratings are available for Medicare Advantage plans – and there are changes for plans in Tucson. One company’s plans that received 4 stars for 2012 are now rated 3.5.  Health Net plans are now rated 4 stars, the highest in town.  The ratings are based on data from 2011 for some plans and early-2012 for others.

Here is a list of plans available in Tucson, AZ and their star ratings (out of a possible 5 stars).

CareMore Value Plan:  3.5 stars
CareMore StartSmart: 3.5 stars (This is new to Tucson for 2013, so how is it even rated???)

Health Net Ruby 1 and 4: 4 stars
Health Net Jade:  4 stars
Health Net Ruby Select: 4 stars (This plan is not even in place until January 2013, so how is it rated?)

AARP Medicare Complete Plus:  3.5 stars
AARP Medicare Complete 1: 3.5 stars

Humana Readers Digest… HMO:  3.5 stars
Humana Regional PPO ($154/month): 3.5 stars
Humana Local PPO ($92/month): 3 stars

SCAN:  3 stars

Abrazo: 2.5 stars (This plan does not yet exist in Tucson, so the rating must be based on their plans in Phoenix.)

Universal Any Any Any PFFS: 2 stars
Universal Hassel-free PPO: too new to be measured

So how do they come up with these scores? Here is a list of some of the things that are considered:

-Screenings received by plan members for:  breast cancer, colon cancer, cholesterol, diabetes, glaucoma, osteoporosis
-Flu vaccines received by plan members
-Medication reviews received by plan members
-Customer Service
-Getting appointments and care quickly
-Complaints about the health plan
-Members choosing to leave the plan
-Plan makes  timely decisions about appeals

Complaints and people leaving the plan are the most important rating factors for me.  Getting appointments and care quickly seems to be beyond the control of most Advantage plans (in my opinion).  Most Advantage plan are insurance companies that contract with doctors.  So how can Advantage plans control doctors’ schedules when the doctors are not their employees?

As for all those screening tests:  If you wondered why your Medicare Advantage plan has been calling you about getting a flu shot or mammogram, now you know. Medicare is grading the plans on how many of their members get preventive screenings and tests.  So be a good team member and get that flu shot! Your plan needs your help!

Go to Medicare.gov and use the Plan Finder to compare plans.  The star rating data can be found on the CMS website.

Mitt Romney says 4 million seniors will lose their Medicare Advantage plan because of Obamacare.  Is this true?  It sure isn’t true in Tucson, Arizona!

The Tucson area currently has 17 Medicare Advantage (MA) plans – and this number is growing. Two new companies, Abrazo and SCAN** will be marketing their MA plans in Tucson for 2013. Health Net is introducing a new MA plan that will have a limited doctor and hospital network. CareMore is  introducing a new plan with a twist. (Sorry, I can’t write about the details here.)

According to CMS (Centers for Medicare and Medicaid Services), Medicare Advantage enrollment has grown by 28% since 2010 – when Obamacare was passed and MA payment reductions were announced. CMS projects Medicare Advantage enrollment will increase 11% over the next year.

Payment cuts to Medicare Advantage (MA) plans began in 2011 and will continue through 2019. This gradual reduction in payments is meant to allow MA companies to adapt to the changes rather than driving them out of business with one large cut. At the same time, more money will be paid to MA plans that provide high quality services to their members. Eventually, plans  receiving less than three stars on the MA rating system will be kicked out of the program (and that’s probably a good thing).

According to CMS, payment cuts have not resulted in people losing access to Medicare Advantage.  Some companies might have decided to discontinue operations in a particular county, but seniors have other MA plans they can enroll in.  CMS recently reported:

 Access to the Medicare Advantage program will remain strong, with 99.6 percent of beneficiaries having access to a plan. Additionally, the number of plan choices will increase by 7 percent in 2013. The average MA premium in 2013 is projected to increase by only $1.47 from last year, coming to $32.59. However, if beneficiaries choose lower cost plans at the same rate in 2013, as they did in 2012, the average premium is expected to increase by only 57 cents.

NOTE:  In Arizona most Medicare Advantage plans have $0 premium. One Tucson HMO MA plan has a premium, and all Arizona MA PPOs have premiums ranging from $79 to $149 per month.

I’ve written previously about Aetna, UnitedHealthcare, Cigna, and Wellpoint (the biggest insurance companies in the country) buying up companies that offer Medicare Advantage plans.  These insurance companies have spent billions of dollars to expand their Medicare Advantage business. They seem to know Medicare Advantage is here to stay.

Throughout September, Medicare Advantage plans are holding training meetings for insurance brokers, and introducing plan details for 2013.  In almost every meeting a broker has asked how Obamacare is going to affect the Medicare Advantage business, and what they should tell their clients who have heard Mitt Romney’s dire predictions.  I think I will prepare a handout to reassure brokers and their clients.  The handout will say:

Medicare Advantage enrollment has grown 28% since 2010.

Medicare Advantage enrollment is expected to grow 11% from 2012 to 2013.

Obamacare payment cuts have had no negative effect on Medicare Advantage premiums and co-pays.

Medicare Advantage is here to stay.

* *Explanation of SCAN:  SCAN is not technically a “new” plan in Tucson because they first arrived here in 2011.  However, they suspended their network building efforts in 2011 and restarted contracting doctors and hospital in 2012. They say they will aggressively market their Medicare Advantage plan this fall, so I consider them a new plan in the Tucson market.

Medicare has released  its grades for Medicare Advantage and Part D plans, and I was shocked.  Tucson finally has four-star Medicare Advantage plans.

The ratings go from one star to five stars and are based on more than 30 criteria such as: member complaints; members leaving the plan; surveys of members and their satisfaction with the plan; telephone customer service; managing chronic illnesses of members; how many members get screening tests and flu shots.

As an insurance agent, I can’t name names, lest someone think I’m promoting specific Medicare Advantage plans. But I will say that the newly-crowned 4-star plans in Tucson are relatively new to town – and they are all under one company. I have heard both positives and negatives about this company and its plans. This company has a very interesting model of care, especially for people with chronic illnesses.  Some doctor groups contracted with this company dropped out of the network in mid-year, leaving patients unable to see their doctor, who was then out-of-network. Many seniors enrolled with this company seem very happy with their plan and the attention they get from it. Some people have dropped, or will dis-enroll from these plans because they are unhappy with the network or the plan’s referral process. Please note that I am reporting what I have heard about these 4-star rated plans – both good and bad.

As with all Medicare Advantage plans, there are good things about them and  bad things. Choosing an Advantage plan based on the star rating system alone will not work for most people.

The rest of the Medicare Advantage plans in town, at least those that have been around for some time, have improved their ratings from 3 stars to 3.5 stars. The higher scores are due to concerted efforts by the plans to please Medicare. For example, plans have been calling and writing their members to encourage them to get annual preventive screening tests that are provided at no cost. Medicare wants Advantage plans to spend money on their members to try to keep them healthy – and this is a good thing.

Phoenix has three Medicare Advantage plans that get 4.5 stars.

MORE STARS MEAN MORE MONEY

In 2012, the star ratings will be very important because Medicare will pay bonuses to Advantage plans that get three or more stars. Five-star plans will be able to enroll new members all year long.  Unfortunately, Arizona doesn’t have any 5-star plans.

Fortunately for Arizona, 3-star and 3.5-star plans will get bonuses, because Medicare looked around and saw that most Advantage plans fall into this “average” range. The bonus rules were changed in order to keep the vast majority of Medicare Advantage plans in business. All Advantage plans are working hard to make improvements, with a goal of obtaining a 5-star rating  (and higher bonus payments from Medicare). This is a good thing for people enrolled in Advantage plans.

The summary rating gives an overall score on the health plan’s quality and performance in 5 categories:

• Staying healthy: screenings, tests, and vaccines. Includes how often members got various screening tests, vaccines, and other check-ups that help them stay healthy.
• Managing chronic (long-term) conditions. Includes how often members with different conditions got certain tests and treatments that help them manage their condition.
• Ratings of health plan responsiveness and care. Includes ratings of member satisfaction with the plan.
• Health plan member complaints, appeals, and choosing to leave the health plan. Includes how often members have made complaints against the plan and how often members choose to leave the plan.
• Health plan telephone customer service. Includes how well the plan handles calls from members.

To see how Arizona Medicare Advantage plans are rated, use this link:  Medicare.gov