By Tom Murphy
Millions of Medicare Advantage customers are fast approaching a deadline for a task they’d rather avoid: Researching and then settling on coverage plans for 2015.
The annual enrollment window for the privately run versions of the government’s Medicare program for the elderly and disabled people closes on Sunday. This is the main opportunity most customers have each year to adjust their health coverage, and it may be worth paying extra attention to the details.
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Insurers frequently tweak their coverage plans from year to year, but brokers and other industry insiders say they’re seeing more changes over the past few years as companies weed out lower-quality coverage and adjust to government funding cuts.
About 4 percent of Medicare Advantage enrollees, or roughly 480,000 people, will have to find new coverage for 2015 because their current plan won’t exist, according the nonprofit Kaiser Family Foundation, which studies health care issues. Last year, more than 500,000 people faced that choice.
Customers who lose their old plans may be eligible to pick coverage in a special election period that runs through the end of February.
Other customers with discontinued plans are being automatically enrolled in another option offered by the same insurer. Companies generally try to limit the coverage changes in these cases, but the plans may not be identical, especially when comparing premiums.
“It really pays to shop around,” said Dwane McFerrin, a vice president with Senior Market Sales Inc., which helps agents sell Medicare Advantage coverage.
However, sitting down to figure out coverage changes or whether there’s a better option can trigger headaches. Customers need to make sure their new plan covers all their doctors and prescriptions and leaves them with manageable bills if a major health problem hits.
Plus, they have to make sure the price or premium is right.
The whole process left Roy Cheeseman bewildered after his insurer, Group Health Cooperative, notified him earlier this fall that he won’t be enrolled in his plan for 2015. The 70-year-old resident of Sedro-Woolley, Washington, sees a couple of doctors and takes nine prescriptions. Cheeseman lives mainly off Social Security and needed to find something that covered all of that and fit into his budget.
“There’s more health care policies out there than you can shake a stick at,” he said. “They’re all yelling in your ear, but they’re not going to tell you until after you sign up that they’re not going to pay more than they have to.”
Almost 16 million people are covered by Medicare Advantage plans, nearly twice the total covered just seven years ago, according to Kaiser. The foundation’s researchers have found that people have, on average, 18 plans to choose from, but they generally prefer to stick with what they have and find it daunting to review all those options.
Insurers say those choices are changing more than in the past because years of funding cuts have forced them to trim the number of plans they offer or adjust their benefits. Deductibles, premiums and other costs can vary with these plans, and many also come with extra benefits like dental and vision coverage or gym memberships that might be pared.
The government has paid insurers who run Medicare Advantage plans more per enrollee than the cost of care for people with traditional Medicare coverage. But that is being scaled back in part to help fund the health care overhaul, the massive federal law that aims to cover millions of uninsured people.
Blue Cross and Blue Shield of North Carolina informed about 50,000 customers earlier this fall that it decided to stop offering a couple of plans for 2015, and will provide alternatives. Spokesman Lew Borman said there have been significant changes to how Medicare reimburses insurers. As a result, his company has had to review the cost of its plans “to ensure the sustainability of our products over the long term.”
While Kaiser found that 378 plans are leaving the market for 2015, a total of 309 are either starting up or expanding to new markets.
Overall, the Medicare Advantage program is “stronger than ever,” said Aaron Albright, a spokesman for the federal Centers for Medicare and Medicaid Services. He noted that enrollment has climbed since the overhaul was enacted in 2010, and customers still have access to an array of “high value” options for next year.
The government started a quality rating system a couple of years ago that provides extra funding for plans with higher ratings. Next year, only plans with four or five stars will be eligible for the bonus payments.
Most of the plans leaving the market after this year have lower quality ratings, according to Kaiser.
That means, in some cases, plans with weaker coverage are being be eliminated, which can make it easier for customers to sort through options, said Ross Blair, a senior vice president for eHealthMedicare.com, a division of the insurance broker eHealth Inc.
That would be a welcome change for Cheeseman, the GroupHealth customer who lost his coverage. He wound up in another GroupHealth plan with a lower premium, but he said he found it only because an eHealth operator helped him.
Cheeseman doesn’t relish going through that search again anytime soon.
“You damn near have to be an attorney to go through this stuff and figure out what they do pay and what they don’t pay,” he said. — AP
