I’ve been busy talking with seniors about their Medicare coverage and their options for 2010.  There are a number of options and some people just can’t make up their mind! 

I’ve moved a number of people from their Medicare Advantage plan back to Medicare and a Supplement (and a stand-alone Part D plan). These folks were concerned with changes that might be coming to Medicare Advantage next year, and they felt more comfortable with a Plan F Medicare Supplement.

Then there are those who just can’t make up their mind about switching to another Medicare Advantage plan.  They study the doctor co-pays, the hospital co-pays, the maximum out-of-pocket. And sometimes the gym network is the deciding factor in choosing a plan.

Many people stay with their Advantage plan because not all their doctors are in the other plans’ networks. Many people are curious about the CareMore Advantage plan because of the many mailings they’ve received from that company.  The CareMore co-pays are much lower than the other Advantage plans, but the doctor network is very limited.  I’ve met some people who are diabetic and would benefit from the special needs plan CareMore has for diabetics – but if their doctors are not in the CareMore network, the person is reluctant to make the change.

For people who just can’t decide, I tell them they still have January, February and March to make a change.  While there is a big rush to change by the end of December, people can still change their Medicare Advantage plan during the first three months of 2010.  As long as they have an Advantage plan with a drug plan – or if they have Medicare and a stand-alone Part D plan – they can make changes up until the end of March.

Clarification on Part D:  If a person has Medicare and a stand-alone Part D plan, they can only switch to another stand-alone Part D plan from November 15-December 31st. Their deadline for changing plans is December 31st. If a person with Medicare and Part D decides in January, February, or March to enroll in Medicare Advantage, they can make this change – because they have a Part D plan.

I have heard that in 2011, the January – March open enrollment period will not be offered by Medicare.  So next year at this time, December 31st really will be the deadline.  That should be interesting.

This time of year (November -December) is the only time when people who need a Part D drug plan can get one. If they wait until January, they will be refused enrollment.  If they want to get into a Medicare Advantage plan in January, February, or March, they can only enroll in an Advantage plan that does not have a Part D.  And they must wait until next year at this time to have another chance to get into Part D.  So these folks must make a choice by the end of December.

I often say that you don’t know how good (or bad) your insurance is until you get sick. As I’ve been talking to seniors about their Medicare Advantage plans recently, I have seen first-hand how true this is.

A lady told me she paid out $7,000 in co-pays for her cancer treatments two years ago because her Medicare Advantage plan only covered 80% of the cost of radiation and chemo therapy.  I told her that every Medicare Advantage plan covers cancer treatments the same way – leaving seniors with the possibility of large bills if they are diagnosed with cancer.

I also heard the story of a man who paid out $10,000 for chemo and radiation treatment for his prostate cancer earlier this year.  The person telling me this story was worried that he had the same plan as his friend with prostate cancer. But I told him his plan has a MOOP, or maximum-out-of-pocket limit, because he is enrolled in Secure Horizons Medicare Complete Plan 3.  I assumed his friend is enrolled in Secure Horizons Plan 1, because that plan has no MOOP.

A few years ago, most Medicare Advantage plans had no annual MOOP, and the people involved in the above stories, obviously were in such plans.  For 2010, most Advantage plans will have a MOOP.  Health Net has a $3,400 annual MOOP.  Secure Horizon Medicare Complete Plan 3 has a $3,550 MOOP. Humana’s Gold Plus HMO has a $5,000 MOOP. 

Having a MOOP means that if a person gets sick with cancer, or is in and out of the hospital multiple times, their co-pays are capped by the MOOP.  So if a person is diagnosed with cancer and enrolled in a Health Net plan, they will stop paying co-pays for the rest of the year once they hit $3,400.  This is a good safety net.

But many people are enrolled in plans with no MOOP and they won’t know it until they get sick and are hit with huge medical bills- unless they look at the materials they recently received from their Medicare Advantage plan.  Unfortunately, most people I’ve met with had not opened the package from their Medicare Advantage plan.  This is the time of year for everyone to review their plan and determine if it is as good as it used to be – or if they should shop for a better plan.

Health Net has upset many of the members in their Medicare Advantage plans by announcing a $36 per month premium for their Ruby 1 plan in 2010.  Seniors in Arizona are accustomed to paying nothing for their Medicare Advantage plans, plans which include drug coverage, gym membership, and even  dental benefits (in some plans) – all for $0 per month premiums.

Those days are gone, or will be gone a year from now.  Humana,  with its $0 premium plan, will be working hard to take lots of business from Health Net.  Secure Horizons will be trying to get back the thousands of seniors it lost to Health Net over the last three years. Seniors are being inundated with mailers from all these companies, as well as CareMore, a new HMO Advantage plan in town.

But back to the cost of Medicare Advantage plans.  Tucson is one of the few places in the country where Medicare Advantage plans have no monthly premium -except for Florida, where there are no premiums and no co-pays for hospitalization and doctor visits.  Up in Phoenix, Humana and Secure Horizons are charging $30 per month for their HMO’s.  Here in Tucson, the same plans have $0 premium – for 2010.

Two weeks ago I was helping a couple who moved to Tucson from Michigan. They needed to change from their Michigan Medicare Advantage plan, which cost them $75 per month, to a local plan.  For them, $36 per month sounded like a good deal. But for many seniors here in Tucson, the idea of paying for their Medicare Advantage plan is just too much to take.

I have been warning everyone that they can change plans for 2010, but they can’t avoid what’s coming down the road in 2011. That’s when the real cuts to Medicare Advantage will begin, and every plan will have to charge a premium or go out of business. 

How can there be a $0 premium for a Medicare Advantage plan?

In Arizona, when a senior signs up with Humana, for example, Medicare pays Humana  around $800 per month to act as that senior’s Medicare coverage.  Humana will pay the medical bills for that senior, and the senior will pay co-pays associated with each service.  In Florida, Medicare pays around $1,100 per month for each person enrolled in a Medicare Advantage plan.  This is why the Humana plans in Florida have such “rich benefits”, such as no co-payment for hospitalization or doctor visits.

When Medicare starts to cut payments to Medicare Advantage plans, the plans are going to pass on costs to people enrolled in the plans.  So seniors in Tucson are going to have to get used to paying monthly premiums in 2011.  Health Net is just ahead of the game by making the change for 2010.  It will be interesting to see how many seniors jump ship to another Medicare Advantage plan in the meantime.  A year from now, things will get really interesting.