By Susan Jaffe OCTOBER 8,
2019
Millions
of older adults can start signing up next week for private policies offering
Medicare drug and medical coverage for 2020. But many risk wasting money and
even jeopardizing their health care due to changes in Medicare’s plan finder, its most popular website.
For
more than a decade, beneficiaries used the plan finder to compare dozens of
Medicare policies offered by competing insurance companies and get a list of
their options. Yet after a website redesign six weeks ago, the search results
are missing crucial details: How much will you pay out-of-pocket? And which
plan offers the best value?
That’s
because the plan finder can no longer add up and sort through the prescription
costs plus monthly premiums and any deductibles for all those plans. A mere
human can try, but it is a cumbersome process fraught with pitfalls. One plan
might have the lowest premium but not the lowest drug prices. Another could
exclude a plan’s preferred pharmacy that offers lower prescription prices.
“We
can’t guarantee you that you’re going to be in the best plan or the cheapest
plan anymore,” said Howard Houghton, the former Fairfax County coordinator for
the Virginia Insurance Counseling and Assistance Program who still helps with
enrollment as a volunteer.
Using
the old plan finder produced big savings. Counselors at Passages, the Senior
Health Insurance Information Program (SHIP) serving five counties in Northern
California, said in August they used it to save one woman $8,400 for this year
and more than $5,000 when helping another client.
Medicare
officials say the total cost calculator will be fixed in time for the annual
enrollment season, which starts nationwide Oct. 15 and runs through Dec. 7. But
they have yet to address multiple other issues raised by the Medicare Rights Center and industry groups.
“The
new tool will provide more enhanced price and quality information” to assure
informed health care decisions, Seema Verma, administrator at the Centers for
Medicare & Medicaid Services, said when she unveiled the redesign in
August.
During
open enrollment, beneficiaries can sign up for Medicare Advantage plans, the
alternative to traditional Medicare that offer drug coverage and often more
benefits than the government program does. About a third of the 64 million
people in Medicare choose this option. Next year, the average Medicare Advantage
monthly premium is expected to drop 14% compared
with 2019 to an estimated $23, according to CMS.
This is
also the only time most people in traditional Medicare can sign up for a drug
plan, also known as Part D, to help cover their prescription costs. It’s a good
idea to review plans every year since costs and covered drugs can change from
year to year. Estimated average monthly premiums for these policies will be $30
next year, about 8% less than in 2019, CMS has reported.
Medicare
Advantage plans next year are allowed to offer new additional benefits for
people with certain chronic diseases, such as dementia, diabetes or heart
disease. That’s on top of the non-medical benefits that are not tied to a
person’s health problems they were allowed to add this year,
such as home-delivered meals after a hospitalization, transportation to medical
appointments and minor home improvements, such as grab bars to prevent falls in
the bathroom.
Next
year, the additional services some Advantage plans will offer hardly sound like
insurance benefits: pest control, dog food for service animals, home-delivered
meals and discounted groceries.
“It’s
really shifting from reactive care to preventative care,” said Martin Esquivel,
vice president for Medicare product management at Anthem, which will offer
those and other new perks to some of its more than a million Medicare Advantage
members.
Smaller
Medicare Advantage plans have also expanded benefits. The 60,000 Alignment
Healthcare members in some California, Florida and North Carolina plans will
have access to free transportation to doctor appointments from Uber or Lyft.
To
address social isolation, some California members who also have certain chronic
diseases can receive visits from “Grandkids On-Demand,” college students who
can help with light housekeeping and provide companionship for up to two hours
a day. Humana and Aetna will also offer the service in some plans.
But
most insurers are not embracing the opportunity to add extra benefits.
“Of
those Medicare Advantage plans affected by the new rules, 10% (or about 500)
offered new supplemental benefits in 2020 for people with serious chronic
illnesses, such as in-home services, palliative care, respite support for
people’s caregivers or adult day care,” said Robert Saunders, research director
for payment and delivery reform at Duke University’s Margolis Center for Health
Policy. He is still analyzing the other categories of extra benefits.
UnitedHealthcare,
which controls 26% of the Medicare Advantage market, is focused“on providing
the core medical benefits, which is why people purchase health insurance in the
first place,” said Steve Warner, vice president of the UHC Medicare Advantage
product team.”Most consumers don’t want to buy a plan that’s been loaded up
with ancillary benefits that they don’t think they’re going to use.”
Instead,
the insurer is offering more plans that do not restrict members to a network of
health care providers and introducing specialized plans for people with
diabetes or dementia, among other changes.
Because
new extra benefits will not be accessible in every county, seniors may need to
do some detective work to find out what’s available. Using the plan finder,
it’s possible to narrow down the Medicare Advantage choices only to those plans
that offer hearing, vision, dental, fitness and transportation coverage.
Bonnie
Burns, a consultant to California Health Advocates, recommends that customers
call insurers to confirm details before signing up.
Among
the improvements in the new plan finder is the ability to compare estimated
costs of Medicare Advantage plans against coverage under traditional Medicare
with a separate drug plan and one of 11 kinds of Medigap supplement plans, which
cover all or some of the out-of-pocket costs Medicare doesn’t pay for.
But the
monthly premiums listed for Medigap policies ― at least in some areas ― are
wildly off course. According to the plan finder, a senior in San Francisco can
buy a Medigap plan for as little as $20.83 a month. Yet such a plan is not
included in the rate chart published by the California Department of Insurance,
which lists the cheapest bare-bones policy for a 65-year-old at four times
more.
With a
more complicated, slower enrollment process, it’s likely that older adults will
need more help. And help may be scarce.
“It
means fewer people that we get to see because we’re giving each one more time,”
said Alicia Jones, administrator of the state SHIP program at Nebraska’s
Department of Insurance.
To find
your local SHIP program, call 1-877-839-2675 or visit www.shiptacenter.org/.
Susan
Jaffe: Jaffe.KHN@gmail.com, @SusanJaffe
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