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Judy Beaston decided last year that she had had enough of her Medicare Advantage plan.
She has not received the required annual notice of changes to her coverage and costs. She learned from research online that her monthly premium was increasing.
On top of that, she had grown increasingly pissed off by a confusing series of plan benefit claims that were outdated, redundant, or just plain bogus.
“They would be for the year before, or two years earlier, or three years earlier,” Beaston, 70, of Beaverton, wrote in an email. “Some of them were duplicates with no change from the original (I checked my files). Others would exchange amounts, then undo them and change them again. Very slimy! ”
So, she changed her plan when she enrolled in Medicare. This is the time – this year is Oct. 15 to Dec. 7 – when Medicare registrants can switch medical or drug plans without penalty.
So far, so good, Beaston says of the change. And his statements are no longer confusing.
Beaston’s former plan provider, Health Net, was acquired in 2016 by St. Louis-based Centene Corp., which last year purchased Wellcare, another health-care plan provider, based in St. Louis. Tampa. Centene renames Health Net plans to Wellcare plans for 2022.
When asked about Beaston’s experience, Wellcare released a statement saying that recent surveys of Health Net members found an ‘overall satisfaction rating’ of 91%, but that it is working to improve integration. members, call center agent training and member communications.
Every year during this time, consumer advocates and leading advocates say Medicare registrants should revisit their plan. Each year, experts find only about one in ten. Let’s face it; Life before Thanksgiving and Christmas is busy, and the details of Medicare plans are complicated and difficult to understand.
So, this year, we’ve decided to list the top nine reasons why Medicare beneficiaries should consider switching plans. If none of these reasons apply to you this year, maybe you can start decorating for Halloween instead. But if you recognize your own fate in the following, it’s probably a good idea to sit down with a knowledgeable person – a family member, experienced health insurance lawyer, or insurance broker – and reassess. your choices.
“The best thing to do is pay attention to the material you get from your plan if you are currently enrolled,” said Juliette Cubanski, deputy director of the Medicare policy program at the Kaiser Family Foundation, a non-profit research company. lucrative San Francisco-based company. “As painful as the comparison process can be, it’s always worth taking a look just to see if there are any major changes to your coverage that will affect access to the providers you want to see. or the medications you need to take. “
Each year, The Oregonian / OregonLive publishes comparison charts to help readers choose the right health insurance options for them.
1. Customer support is not favorable. If Judy Beaston’s experience sounds familiar to you, you might not be alone. The government assigns “star ratings” to Medicare Advantage plans, and increasingly, plans are judged more by customer service and coordination of care than by reported health outcomes. The ratings come from surveys of beneficiaries about how easy it was to get care, how quickly they were seen, and even how easy it was to fill out plan forms. Higher ratings mean higher government reimbursements for these insurance companies.
By 2023, thanks to changes to these federal government surveys, customer experience could determine more than half of a plan’s star rating, according to consulting firm McKinsey & Company.
“Did you have any issues with customer service? Asked Lisa Lettenmaier, a health insurance broker with HealthSource NW in Tigard. “Is this working for you?” If not, this is probably the number one reason to consider doing something different.
2. The plan removes your doctor from their network. You may have been diagnosed with a new disease that requires treatment by a specialist who is not part of your plan network. Off-grid tours usually cost significantly more. You’ll want to consider upgrading to a plan that covers your more expensive vendors – provided you can find one that does.
3. Your prescription drugs are getting more expensive. This can happen in a variety of ways that are not always obvious. You may need a new prescription that is not covered by your plan. Or, the plan changes its “formulary,” an official list of covered drugs, and takes the drug from a cheaper level to a more expensive level. Or he could drop the drug altogether. Open registration is a good time to review this.
“People can either request their plan’s full form or go to Medicare.gov’s (online) search engine to enter their specific medications and dosages,” said Sarah Murdoch, director of client services for Medicare. Rights Center, a New York-based consumer. advocacy group. Insurers also publish forms on their websites.
4. Your plan expenses are too high. The plans do not appear to be increasing premiums or other reimbursable expenses this year. In fact, many of these costs decline in 2022.
But suppose your health changes: you are diagnosed with cancer or chronic disease. You may then find that you have to pay 20% of the cost of chemotherapy. Or maybe you ended up in the hospital this year for a week on a high daily copayment.
A recent Kaiser Family Foundation study found that half of all Medicare Advantage enrollments would pay more for a five-day hospital stay as part of their plan’s co-payment requirements than if they were. remained on Basic Medicare.
“Even though Medicare Advantage plans may have relatively low copayments, if you need a lot of medical care, your costs can add up and exceed the amount you would pay if you were on traditional Medicare,” Cubanski said.
5. You have moved. Most plans only cover specific counties. The same provider may charge more or cover services differently in a different county down the road. Put a Medicare Plan Assessment next to a change of address form on your to-do list if you move.
6. Your plan disappears. Sometimes insurance companies pull out of counties or stop offering coverage altogether. In 2022, for example, Express Scripts will no longer offer stand-alone Part D drug plans. Current registrants will automatically transfer to a Cigna drug plan if they do not choose a new one. themselves (Cigna acquired Express Scripts in 2018).
But Cigna plans may cover prescriptions differently, so for current Express Scripts members, evaluating all plans would be a useful and cost-effective exercise.
Seniors in Clatsop County had to scramble late last year when Moda Health pulled out, leaving its 11,000 Medicare-eligible residents without a Medicare Advantage provider. Federal rules allowed former Moda members a special enrollment exception so they could enroll in a Medigap plan without undergoing a medical underwriting.
7. You lose your additional help status. Low-income Medicare beneficiaries are eligible for a “low-income grant” or “extra help,” receiving discounts on their drug premiums and co-payments. A change in income can result in disqualification, making the premium for an existing plan suddenly more expensive than others. Plans can also make changes that increase costs. Medicare is expected to send alerts on such changes in October and November.
8. You buy a second home or spend a lot of time outdoors. Seniors who divide their time between homes in different counties or states may want reliable medical care in both locations.
“They want to go somewhere for the winter and have their mammograms while they’re there,” said Hedy Towan, a volunteer with the Oregon Senior Health Insurance Benefits program.
Not all plans offer national coverage. Thus, many “snowbirds” are considering switching to basic health insurance supplemented by a Medigap plan. Or they can look for a Medicare Advantage plan that offers a nationwide network of providers sufficient for their needs and budget.
9. You are eligible for prescription drug coverage through the Veterans Administration. Such coverage is robust and inexpensive, and a veteran may opt for it in place of the coverage offered by the stand-alone Part D plans and most Medicare Advantage plans. This is why insurers offer Medicare Advantage plans without drug coverage. There are 11 such plans in the Portland area, some with names such as “Patriot”, “Eagle” or “Honor”.
Brent Hunsberger is a representative investment advisor in Portland. For important information and disclosures about Brent, visit bit.ly/2dwmN7w. Reach it at [email protected] or leave a message at 503-683-3098.
Read more: The Basics of Open Medicare Enrollment
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