This article is full of misleading statements and out right lies. Before my husband passed away at 73, his Medicare Advantage through MVP was almost $90 a month. So the “average” they claim is so far from the truth, it isn’t funny. Tell the truth for a change! You wonder why people are so angry at the “media” and the “government, here is a prime example!
“We’re hearing, ‘What does the Affordable Care Act mean to me.’ It’s very minimal and nothing they have to be overly concerned about right now.” HEATHER SMITH, Excellus BlueCross BlueShield
AFFORDABLE CARE ACT CHECKUP: SENIORS
WHAT’S BEHIND MEDICARE ADVANTAGE
Obamacare not necessarily to blame, insurers say
Larry Feldman likes that his Medicare Advantage plan covers a gym membership for him and his wife, Sharon.
At the same time, the Irondequoit resident isn’t wild about the monthly premiums nearly doubling for 2014.
If he were to shop for a cheaper premium and then had to pay separately to join a health club, the math might come out the same. “Now I have to look at it again,” he said, after getting information for next year’s plan.
Retirees, like lots of others, have their work cut out for them in what could be the busiest, most confusing open enrollment season in a long time.
Medicare sign-up begins Tuesday and runs through Dec. 7. It overlaps with the launch of the new health insurance exchanges under the Affordable Care Act. The controversial legislation known as Obamacare is being credited or blamed — rightly or wrongly — with just about every change in health care.
People receiving Medicare won’t use the exchange to shop for coverage. Still, some Medicare beneficiaries say the far-reaching law is behind increasing monthly premiums and co-payments for services in their Medicare
Advantage plans. These plans are offered by private insurance companies which receive a stipend from the federal government to take care of the people who enroll.
Obamacare, which has added benefits for seniors, is a piece of the puzzle. As with everything about health care since the law was upheld by the Supreme Court last year, the reasons behind higher Medicare Advantage prices are complex.
“For people in 2013 and 2014, I have not seen any direct relationship in increase in their costs from Obamacare,” said Rick Grossmann, registered insurance consultant at ROC Insurance Services in Brighton.
“That may change down the road,” he said. “I don’t think it’s fair to say in 2013-2014 that Obamacare increased my costs. It potentially could become that way over time. No one knows how we’ll pay for the Affordable Care Act, what the impact will be on other federal services.”
The Affordable Care Act called for a gradual reduction in payments to Medicare Advantage insurers to bring them more in line with the payments to original Medicare, according to the Kaiser Family Foundation, which tracks many aspects of health and health care in the nation.
Heather Smith, director of Medicare sales for Excellus BlueCross BlueShield, said rising medical costs and increasing demand for services drive prices. “It’s the health plan’s ability to really take their reimbursement and what they have and be able to offer the most robust plan at the lowest cost. Every health plan, like every business, will do that a little bit differently.”
2 types of Medicare
Medicare comes in two forms: Original and Medicare Advantage.
Original, or traditional, Medicare covers hospitalization (Part A) and medical services (Part B). Supplemental policies cover gaps, such as prescription drugs. Medicare Advantage plans have hospitalization and medical, and they tend to include prescription drug coverage (called Part D). Advantage plans provide extras, such as gym memberships and wellness perks, and some even provide rides to medical appointments. These plans have to follow Medicare’s rules, but they can set policies on referrals and networks, and they can charge different out-of-pocket costs.
Enrollment nationally in Medicare Advantage plans has grown from 11.1 million in 2010 to 14.4 million in 2013, according to reports from the Kaiser Family Foundation. In New York, about one-third of the more than 3 million Medicare beneficiaries are enrolled in Medicare Advantage in 2013. In Monroe County, nearly two-thirds of the 136,669 Medicare beneficiaries are in these plans, giving it the highest enrollment percentage in the state.
Medicare is dense enough. Add the implications of the Affordable Care Act, and it’s like hacking through the jungle with a butter knife.
The law did add benefits — shrinking the prescription- drug coverage gap known as the doughnut hole and providing more preventive services at no cost to recipients. Other changes are less visible. Medicare Advantage plans can’t ask their subscribers to pay more than people with original Medicare for certain services. Starting in 2014, Medicare Advantage plans have to spend at least 85 percent of every dollar on services, which limits the amount that can go to administrative expenses.
A number of Medicare Advantage subscribers, though, are seeing an increase in premiums or copayments and linking it to the Affordable Care Act.
“You want to point the finger, you want to pin the blame on anything that happens under Obamacare,” said Ed Leo of Irondequoit, who created his own spreadsheet to compare plans and track costs. He said his costs would go up if he keeps the same WellCare plan. At the same time, he said, “I see a lot of benefits. Like many, I say, ‘How will we pay for that?’ ” The average Medicare Advantage monthly premium for 2014 is projected to increase by only $1.64 from last year, coming to $32.60, according to the federal Department of Health and Human Services, which oversees Medicare. Paul Luft of Lima, Livingston County, has a plan from Excellus that doesn’t charge a monthly premium. While co-payments next year for some services will go up by $5, he said others will rise $45 or $75. “Why would it go up so high one year to the next?” he asked. Luft, who just turned 66, said he’s a frequent consumer of health care. “That’s why I have a plan with zero premium. It’s a crapshoot. I’m not paying anything a month. If you’re in the hospital once, it’s $550. It’s probably cheaper than a monthly premium.”
Monroe County residents have about a halfdozen options in Medicare Advantage. Last year, MVP Health Care was the most popular with nearly 42,000 enrollees, and Excellus had nearly 34,000, according to the state’s Office for the Aging. Patrick Glavey, executive vice president of Medicare programs for MVP, acknowledged that some members with the GoldAnywhere plan were upset that their monthly premiums went from $33.80 to $64 for next year. “I do realize some people are on a fixed income,” Glavey said. “It’s still good value in terms of what you get.” Glavey said MVP was not able to absorb cuts in government reimbursements on its Medicare Advantage plans. Insurers must get approval each year from the Centers for Medicare & Medicaid Services to offer Medicare Advantage plans. As part of that process, CMS must sign off on changes in the plans’ benefits and premiums.
Other MVP Medicare Advantage plans have gone up $16 to $19 a month, Glavey said. “When you’re able to explain things and show them that we do have other options, if they’d like to buy down to a lower premium, they can do that.” Excellus raised the monthly rate on one of its plans by $19 but still has an option with no premium.
“We’re hearing, ‘What does the Affordable Care Act mean to me,’ ” Smith said. “It’s very minimal and nothing they have to be overly concerned about right now.” Smith said many people expected higher increases. “They walk away saying, ‘You’re still keeping my zero plan zero?’ ‘Yes, we are.’ They walk away very happy.” Ron Brandwein provides information about Medicare in his job as health insurance specialist at Lifespan. He urged seniors to consider how much health care they need and to look at all their options. “They think because their plan went up, they’re stuck with that,” Brandwein said. “They’re not stuck with that. They have the right to evaluate whether or not they’re getting an adequate return on what they’re paying for.”
Some may find that original Medicare and a supplemental drug plan are suitable. Brandwein said they won’t know until they do the comparisons.
“They have a multitude of choices that they don’t tend to examine and seek out the best solution.”