Make up your mind
by MARK ST.J. COUHIG
More than 1,300 Medicare Advantage Plan subscribers in Clallam County must change their plan before Jan. 1 or lose their coverage.
All of these subscribers had private fee-for-service plans, one of three options available under Medicare Advantage. In Clallam County the private fee-for-service companies all are closing up shop, including Sterling Health Insurance, SecureHorizons, Cigna, UniCare Health Insurance and the Humana all-in-one program (Humana will continue to sell prescription coverage.)
Phil Castell, owner of Castell Insurance in Sequim, says this year the "open season" - the annual opportunity for subscribers to change their plan - has been extended through Jan. 1, 2011. That may lead some to believe their own coverage also will be extended. That's not the case, Castell said, noting all private fee-for-service plans will expire Dec. 31.
Castell, who specializes in Medicare plans, says across the U.S., "many millions enrolled in these plans because they could get the same or superior services at little or no cost to them."
Terry Cumpton, special assistant at the Centers for Medicare and Medicaid Services in Seattle, said, "We can't say why (these companies) didn't submit a bid. But for 2011, the big change for Medicare private fee-for-service plans is the requirement to have an agreement with providers."
Calls to the insurance companies by the Gazette failed to produce answers at time of printing.
A little history
Castell provided the background, saying under the 2008 Medicare Improvement and Providers Act Medicare Advantage programs must provide a list of health care providers by 2011. Those who had private fee-for-service plans could see any doctor, at any time, but the law said that circumstance was confusing. In theory, Congress reasoned, doctors could determine on a day-to-day basis who they would see.
Castell says the companies are leaving Clallam County and other rural areas of the U.S. because "they don't want to build a network. It's a question of time and money."
Marjorie Stewart, coordinator with Statewide Health Insurance Benefits Advisors, says she isn't sure why the companies chose to leave this area, but noted "it's just a business decision."
bearing the brunt
Castell said under Medicare Advantage plans Medicare benefits are administered by private companies, with three different plans offered. In addition to the private fee-for-service plans, subscribers also can sign up with a Preferred Provider Organization. PPO companies give subscribers a list of "preferred providers." Clients who choose the preferred caregiver pay a lower co-pay; those who go outside the list pay a higher co-pay, Castell said.
The third option is a health maintenance organization, HMO, which has its own caregivers on staff.
For 2011, Clallam County residents who choose a Medicare Advantage plan will have to choose a PPO or an HMO. Two firms are offering PPO plans: Regence Blue Shield will provide coverage throughout Clallam, while Group Health Options will serve only those living in the two Port Angeles zip codes, and the Carlsborg and
Sequim zip codes.
There will be one operating HMO in Clallam County: Community Health, based in Clallam Bay.
Those covered by Medicare have a third choice: signing up directly with Medicare. Castell says those who choose "standard Medicare" can utilize an AARP or Mutual of Omaha supplemental plan to help cover the payment gap.
The rates go up
Castell says many local Medicare subscribers are unhappy about the change.
"A company like Sterling used to provide the coverage for $39 a month and threw in a gym membership and a limited dental plan," he said.
Jack Caldicott, of Sequim, was notified by mail that Sterling would be discontinuing his coverage and since has signed up with Group Health Advantage. The coverage is "pretty much the same," but the payments are "significantly more," he said.
Inge Erbenich was a
SecureHorizons client until she received a notice that
SecureHorizons was leaving the area. She also joined Group Health Advantage. The services are "almost the same," but she'll pay $41 a month more for the coverage.
Both Caldicott and Erbenich said they were provided with no explanation for the cancellation.
Stewart has expanded the hours she is available to advise Medicare clients in Sequim. She's now setting up shop at the Sequim Senior Activity Center on Mondays beginning at 9 a.m. and will work "until we're finished." She also will be available at the center most Tuesdays beginning at 9 a.m.
Those seeking additional information also can call 800-medicare for advice on the programs available in Clallam County. Clallam-specific information also is available at medicare.gov. The website provides a detailed analysis of the best plan for an individual, based in part on his or her medication needs. Castell cautions against too quickly grabbing the lowest monthly payments, saying those plans often have hefty deductibles.
Reach Mark Couhig at email@example.com.