Category Archives: Phone Insurance

The smart prescription drug plan choice a year ago may not be the smart choice for 2012, but local Medicare health insurance counselors are worried that too many people are failing to take a second look that could save hundreds or thousands of dollars.

”I expected more phone calls than we’re getting,” said Martha Johnson, program manager for the Health Insurance Counseling and Advocacy Program of Area 1 Agency on Aging. “Medicare is bumping up its TV ads starting Nov. 25, trying to get people to wake up and do something.”

The prescription drug plan enrollment began last month and runs through Dec. 7. The Oct. 15 start was a month sooner than previous years, and the Dec. 7 cutoff is three weeks earlier than in the past.

”Half the people who enrolled last year did so three weeks before the deadline,” Johnson said. “That’s a lot of people — and those that are thinking the enrollment period is the same as before could miss the boat.”

Inertia is part of the problem. Studies have shown that once seniors choose a drug plan, most stay in it even if there are cheaper alternatives as years go by. last month, researchers released a study of the plans used by about 270 California seniors and discovered three-quarters of them would have saved an average of $450 if they changed plans in 2011.

”I am reviewing all of our client intakes so far and have found savings that range from hundreds of dollars to several thousand,” Johnson said. “each year the plans change, the premiums change and the deductibles change. The drugs covered change and the co-pays change. For up to a third of the people we see, the current plan will work best for the next year, but for many, there are better choices.”

If the current plan is the best choice, Johnson said members “don’t need to do anything to have it continue for 2012.”

The deadline for changing into a Medicare Advantage plan or initially enrolling in one that may or may not include a prescription drug plan is also Dec. 7.

Medicare Advantage is managed care provided by private insurance companies approved by Medicare. Advantage plans generally require members go to doctors and other providers in the company’s network.

”They offer at least what Medicare parts a and B offer, and they may offer some additional coverage such as limited dental and vision,” Johnson said. “In urban areas, some plans even offer gym memberships, some transportation to medical appointments and all kinds of enticement benefits we don’t have up here.”

Last year, Medicare Advantage plans enrolled 376 people in Humboldt County and 126 in Del Norte. Johnson said most were enrolled in the Anthem Blue Cross Advantage preferred provider plan. That plan did not renew for 2012, leaving the region to be served by either United HealthCare or Universal American. Two of the latter’s plans have received low ratings from Medicare three years in a row.

United HealthCare is a continuance of the plan offered in 2011 as Secure Horizons, but has been renamed with increases in premiums and out-of-pocket costs, Johnson said.

”The people in a non-renewing Advantage plan, such as the Anthem Blue Cross Freedom Blue, have until Feb. 29 to change, but if they want to avoid a gap in coverage that have to do it by Dec. 31,” Johnson said.

Johnson said the people most likely to benefit from an Advantage plan are those who feel they cannot afford a Medicare supplement plan or those who would rather not pay the monthly premium and can pay out-of-pocket costs.

”Some Medi-Cal recipients with a share-of-cost may sign up for an Advantage plan in order to have access to more providers,” she said. “as we all know, there are a limited number of Medi-Cal providers.”

HICAP’s in-person appointments through Dec. 7 have been full since Oct. 18, but the office is still doing prescription drug plan worksheets for those who call 444-3000. Leave a name and mailing address and HICAP will mail a two-page worksheet asking for medication information.

Once the worksheet is returned, HICAP will match the drug list against the coverage, costs and restrictions for each of the 33 drug plans available in California. Then, HICAP will return via mail a printout of best options based on the worksheet.

”Then you can make an informed decision,” Johnson said. “Changing from one drug plan to another is a very simple process.”

So simple that it requires only a phone call to 1-800-MEDICAR. Medicare tells the old plan to scratch your name off the list and the new plan to enroll you. Johnson said a packet of information with new identification cards will arrive two to four weeks after making the change.

During the 2010 part D enrollment period, Johnson said her trained staff of mostly retired professionals conducted 1,488 counseling appointments, handled 2,251 phone calls, and saved clients and taxpayers $1.3 million.

Johnson said she expects those numbers to increase this year as the 15-person staff, eight of which are unpaid volunteers, is processing more worksheets.

”It’s all hands on deck,” she said. “our volunteers and staff give a lot of extra time in order to help more people.”

Individuals or their family members can do their own background work by going to Medicare.gov and entering medication needs and pharmacy preferences. Click on the “enroll” button to change to another plan.

”It’s a mistake to think that you can look for the premium only, or the premium and deductible, to pick the best plan,” she cautioned. “it really depends on which prescriptions each person uses.”

Once medication needs are entered, the Medicare website produces a chart that outlines limitations and prior authorization requirements. it also provides a chart showing the full cost of the drug, what you will pay during the deductible period, what you will pay every month at the pharmacy in the initial coverage period and what you will pay once you enter the gap after reaching $2,930 in costs.

”next year in the gap, you pay 50 percent of the cost for name brand drugs and will get a slight discount on generic drugs,” Johnson said.

Area 1 Agency on Aging commissions freelance writer Carol Harrison to produce Gray Matters every two weeks.

GRAY MATTERS: Medicare enrollment period at halfway point