Seniors are likely to see Medicare insurance costs rise, benefits fall

Review options during enrollment, experts advise By Getahn Ward • THE TENNESSEAN • November 18, 2009 For next year, 67-year-old Anna Nickerson plans to stick with a HealthSpring private Medicare plan for medical and prescription drug coverage, preferring to ignore a heated marketing battle as rival health plans jockey to sign new members over the next six weeks of enrollment here. "I'm very pleased with everything I have," said the Nashville resident, who sat through pitches from two other plans last year and had a choice among 46 Medicare prescription drug plans available statewide when annual enrollment kicked off Sunday. Health insurance experts, however, say most seniors would do well to at least review their options. Careful study could be even more critical this year as consumers probably will see higher premiums and reduced benefits, including from many of the Medicare Advantage plans on the market. "This is probably going to be the wildest open enrollment period for Medicare since the launch of the drug benefit in 2006," said John Gorman, chief executive of Medicare consulting firm Gorman Health Group. Reimbursements fall Gorman estimates that Medicare Advantage plans, on average, had to reduce benefits or increase members' out-of-pocket costs by $40 to $80 a month to make up for a 4.5 percent reduction in federal reimbursements. The health plans are paid a set monthly fee by Medicare for each enrollee. HealthSpring didn't make any major changes for next year to its HealthyAdvantage plan in which Nickerson is enrolled, a spokeswoman said. But beneficiaries in the Franklin-based managed-care company's plans overall should see the value of added benefits drop about $60 a month or see their share of costs increase by that much, said Chief Executive Herb Fritch. "If they give us less, we can't provide the same level of benefits," Fritch said, adding that HealthSpring still offers some zero-premium options. Services that could face cuts include free transportation to doctors' offices, he said. Meanwhile, HealthSpring no longer offers separate "special needs" plans for people with high cholesterol levels and hypertension, after a mandate from Medicare's overseer seeking an overall reduction in the number of such plans. Beneficiaries in some plans from BlueCross BlueShield of Tennessee, meanwhile, should see premiums rise and expect to pay more when they're hospitalized or undergo CAT scans and MRI tests. Rob Slattery, vice president and general manager for the insurer's senior care division, estimates a 10 percent to 15 percent adjustment on average through a combination of changes in benefits and pricing. He attributes the changes to the federal reimbursement cuts and patterns of usage by patients in the affected plans. On the other hand, BlueCross has expanded its lower-cost plan offerings, including rolling out a zero-premium plan in northeast Tennessee. And next year 45 more counties statewide — including several in Middle Tennessee — would have access to the insurer's Medicare Advantage PPO network. Slattery said that move would give beneficiaries a lower-premium option in anticipation of the end to such so-called private-fee-for-service products in 2011 for any county with two or more HMOs or PPOs. Extra benefits available During open enrollment through year-end, Medicare beneficiaries can switch to one of the private alternatives to traditional Medicare and/or enroll in a Medicare prescription drug benefit plan. Nationwide, 11 million people are in Medicare Advantage plans. Many seniors are drawn to the extra benefits offered by many such plans. But as with other HMOs, prior approval is needed for some services, and members are limited to certain doctors and hospitals for others. HealthSpring, for instance, added dental benefits to the HealthyAdvantage HMO plan in which Nickerson is enrolled. But there are restrictions on which dentists can be used. Helen Lee of Nashville is among seniors who have decided to stay on traditional Medicare, under which the federal insurance program for the elderly and disabled reimburses providers a fee for services. "It's like everything: It sounds good, but if you get down to the bottom of it, it doesn't," Lee said, expressing her suspicion of extra-benefit plans. Lee has a supplemental policy that costs about $330 a month to pick up expenses Medicare doesn't cover. For seniors, the variety of choices can create confusion. One mistake many make is thinking only about premiums, paying too little attention to such important topics as making sure their drugs are covered and that their key providers accept the plan, said Paul Precht, a spokesman for the Medicare Rights Center in Washington, D.C. Seniors can call 1-800-Medicare to get help searching among various plans for those that may best meet their needs and budgets.