After March 31st, seniors enrolled in a Medicare Advantage plan will be “locked into” their plan for the rest of the year.  Enrollees can still change their Advantage plan until March 31st. They can also go back to using their Medicare card and enroll in a stand-alone Part D plan.  These changes must be done by March 31st.

I have heard stories of seniors switching to a new plan starting in January only to find the new plan requires more prior authorization paperwork, or refused an MRI that was requested by a doctor. One caller told me he only realized in March that his Advantage plan had dropped coverage for one of his prescription drugs. Fortunately, he was able to change to a plan that does cover his drug. If this had happened in April, he would have been stuck in a plan that did not work for him.

Here are plan changes that are allowed through March 31st:

If a person is in an MAPD (Medicare Advantage plan with a drug plan) they can: 
1) change to another MAPD plan
2) change to Original Medicare and get a stand-alone Part D plan
3) change to a private-fee-for-service MA-only plan and get a stand-alone drug plan

If a person is enrolled in an MA-only (a Medicare Advantage plan without a drug plan) they can:
1) change to another MA-only plan, or
2) go back to Original Medicare (but they can’t get a Part D plan at this time of year).

If a person has Original Medicare and a stand-alone Part D plan they can:  enroll in an MAPD plan (HMO, PPO or PFFS)

If a person has only Medicare (and no Part D plan) they can: enroll in an MA-only plan (with no drug plan)

The key constraint during this period relates to the Part D plan. If a person is enrolled in a stand-alone Part D plan they can’t change to a new stand-alone part D plan.  BUT, if they are enrolled in a stand-alone Part D plan, they can enroll in a Medicare Advantage plan that includes a Part D plan (thus changing their Part D plan).  Confused?  Don’t worry, you’re not alone. 

After April 1st no changes can be made to your Medicare coverage, whatever it is – unless you move out of the coverage area for your plan (Part D or Medicare Advantage). And if you move, you have only 63 days to sign up for a new plan or find yourself in limbo – where you are disenrolled from your old plan and you can’t enroll in a new one (until the end of the year).

Note:  Medicare Supplements can be changed at any time.  And people covered by AHCCCS and Medicare, or the people receiving a Low Income Subsidy for their drug plan can change their Medicare Advantage plan throughout the year.

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

Sorry I haven’t written all week, but I’ve been very busy talking to seniors about their Medicare Advantage plans and their Medicare options.  With big changes to certain plans, people are confused and unsure about what they should do.  Should they stay put?  Should they change plans? Should they go back to Medicare and get a Medicare Supplement?

Here are some examples of people I’ve met with this week.

I met with several veterans who use the VA for their medications and even some of their health care, but they are also enrolled in Medicare Advantage plans.  All of them had forgotten how to use their Medicare Advantage plan, and in some cases they would have saved money if they had used their Advantage plan rather than the VA.  The VA has deductibles and co-pays for services which, in some cases, are higher than what they would have paid using their Medicare Advantage plan.

Several seniors had run into problems with their Advantage plans because they went out of network for lab services, or showed their Medicare card when they went to the emergency room.  They ran into lots of hassles trying to get their plan to pay the bills because of their mistakes.

One plan’s application form says, “I will read the Evidence of Coverage from ____ when I get it to know which rules I must follow in order to get coverage with this Medicare Advantage Plan”.  The Evidence of Coverage is over 100 pages of details about what is covered and rules that must be followed in order to get medical bills paid.  This book arrives after a person has enrolled in a Medicare Advantage plan.  I ask people, “Do you promise to read the Evidence of Coverage?”

I met a woman who had just quit her job to take care of her elderly parents, and she seemed very, very stressed.  I don’t know if she can afford to go without a paycheck, but both her parents are frail and need a lot of attention.  This woman asked me if Medicare pays for respite care for a caregiver like herself.  I had to tell her that I have never heard of that as a Medicare-covered service.  This woman, in her fifties, seemed overwhelmed by the responsibility of taking care of her parents and figuring out their medical bills, their prescriptions, and what might lay ahead in the coming months. 

So I’ve been very, very busy this week, and I’ve met lots of interesting people.  There are many more people to see over the next five weeks.

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.