Behind the scenes, Medicare changes are evolving

This is usually the quiet time of year as far as anything related to Medicare goes.

Did you notice I said the word "usually." This year, there are tons of changes that will take place and the ripples are sure to be felt by Medicare recipients all over the country.

Medicare Advantage plans that have enjoyed massive popularity by offering physician, hospital and prescription drug coverage all in one low-cost program will have a lower per capita rate from Medicare. This lower rate will force companies either to cut back on the popular benefits or increase the premiums they charge the recipients.

Already two companies have announced that they will withdraw their current products from the marketplace. I will not name them now because I do not intend to cause a stampede by affected policyholders.

One company has said it will withdraw its Private Fee For Service plan, that allows patients to see any Medicare provider as long as that provider chooses to accept the plan's reimbursement, and instead will offer a Preferred Provider Option where patients will have a whole list of providers from whom they may receive care.

At first glance, that seems pretty innocuous and, for most people, it may be that way. However, in talking to company officials, they will have the provider network in place in the metropolitan areas but not likely in rural areas like as Clallam County.

I believe June 1 was the date insurance companies must have submitted their plans to Medicare for approval for the upcoming year. Over the next few months, I will receive information from most companies regarding their plans for 2010 and will make it public as appropriate.

So while the TV ads are silent, the insurance companies are burning the midnight oil in the back rooms deciding which plans to offer in the future and at what price.

The good news is that if you belong to a plan that is affected, you will have a guaranteed period in which you can choose a different plan regardless of your age or any pre-existing health conditions.

On a different subject, last month I said that I had sent a letter to numerous public officials regarding my opinions and experiences of the Medicare programs. As of today, I have yet to receive a single response from more than 20 letters. Once again, I will keep you informed as far as responses I finally do receive.

Traditional Medicare Supplement plans will have more options available in 12 months' time, when the 12 standardized Medicare Supplement plans (Plans A through L) will be revamped and joined by an additional two plans called Plan M and Plan N.

These new plans will offer traditional supplement benefits but will have small co-pays such as $20 per primary care visit. In talking to leading companies, they expect the premiums for these plans to be approximately 30 percent lower than the current premiums.

Their rationale is that if people have zero co-pays, they don't think twice about running to the doctor's office at any time, whereas if they had to make a token co-payment, it would cut down on the number of visits to the physicians.

I see two distinct effects to this option:

_ Doctors may see fewer patients. This may be good for the patients as they may be able to see a doctor in a more timely manner.

_ However, some people may not see a doctor when they really should and may leave it to where they require a more expensive visit to the hospital or emergency room.

So whatever plan you currently are in, relax and enjoy the fine weather that finally has arrived as there is nothing to do at this time.

I will keep you apprised of the changes as information becomes available and, as always, I am happy to answer any and all questions that you have.

Phil Castell is an independent insurance agent in Sequim. He can be reached at 683-9284 or

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