Do you have a Medicare Advantage Plan?

Be prepared for changes in 2010

by Charles Chaput,
President Primary Care Insurance Services

Medicare Advantage insurance companies choose to do business in a federally controlled industry called Medicare. The rules are clearly defined by the government, but they may change rapidly and often do so. In fact, when we consider things on a broader scale, we begin to see a trend that seems to repeat itself about every two or three election cycles. The government either wants to incent the movement of the Medicare population into Medicare Advantage plans or Congress believes that too much spending is associated with funding the Medicare Advantage program and therefore cuts need to be made. The latter is now happening.

Medicare Advantage plans will be impacted by an approximate 4% reduction in the overall payment they receive from the federal government for 2010.  Additionally, during a recent speech to the American Medical Association, President Obama specifically made comment to $300 billion that could be saved by eliminating the excess payments under the Medicare Advantage program.  Finally the Centers for Medicare and Medicaid Services (CMS) have been encouraging Medicare Advantage companies to consolidate the number of different plans being sold when prudent.  Insurance companies are cautiously  monitoring the pulse of Congress and the White House, and we believe that 2010 may be a year of considerable change within the Medicare Advantage arena.

While it is possible that a few Medicare Advantage plans may choose to leave the market for 2010, what is more frequently to occur is that we will see premium and co-payment amounts going higher, and  some adjustments being made to benefit limits.  By federal law, Medicare Advantage plans need to inform members of any changes being made for calendar year 2010, by the beginning of November.

Here are a few helpful tips when evaluating your Medicare Advantage coverage for 2010:

1. Has your premium gone up?  If so, how much per YEAR?
2. Were any important benefits eliminated or reduced significantly?
3. Have there been any changes to the co-payment amounts?  Pay attention to the dollar amount, as well as the number of days you must pay before the plan picks up all additional costs.
4. Did any co-payments change from being a dollar amount to being a percentage of charges?  Pay close attention, as this can be significant for things such as lab services or outpatient tests and procedures.
5. Did any of the co-payments change for your prescription medications?
6. Did your prescription plan’s formulary (list of approved drugs) change and will any changes affect the specific medications you are using?
7. Did your own personal health care needs change in the past year?  Are there any benefits you need going forward that are not provided with your current plan?

The most important thing, is do not panic.  If your Medicare Advantage plan is changing substantially for 2010, there are likely other Medicare Advantage plans accepted by your Primary Care Physician and any Specialists that you may see.  The Medicare Annual Election Period officially starts on November 15, 2009 but Medicare Advantage plans generally publish their plan designs at the beginning of October.  This provides nearly three full months to carefully evaluate your options before the end of the Annual Election Period on December 31, 209.

Despite the changes expected for 2010, we believe Medicare Advantage will continue to provide an extremely valuable service to the Medicare community.  While Medicare Supplements can now easily surpass $200 per month in premium and most still do not include an annual physical, Medicare Advantage plans should remain attractively priced compared to Medicare Supplements and nearly all Medicare Advantage plans provide an annual physical with your family doctor.  Medicare Advantage plans may also include additional benefits associated with vision, hearing, dental or transportation.

Medicare Advantage plans and benefits vary by county, and most Primary Care Physicians only accept a limited number of plans, so be sure to only consider plans accepted by your physician and available where you live.