Just out of the box: Medicare’s 2015 Advantage Plans
This annual opener to the holiday season is much like Halloween or Christmas, depending on your health-care plan. After an overall 3 percent cut for 2015 plans, nothing appeared too bad and nothing appeared too good.
The good: We did not see a huge hemorrhage of doctors being cut from networks (although some plans showed a small bleed-off during the year). Plans showed benefit cuts but none were drastic considering there was less money to go around.
Medicare Advantage plans have a maximum allowable out-of-pocket of $6,700, which we are seeing pretty frequently — especially those plans with Part B premium give-backs. One plan achieved a five star rating, meaning it will have open enrollment beyond Dec. 7. This was not one of those tiny plans, either. That plan did focus on making its network very tight and monitored high performance, according to the way Centers for Medicare and Medicaid Services scores.
Even better, CMS got rid of the side by side presentation showing regular Medicare from the year before compared to the Advantage plan because Medicare benefits for the current year are not released until the later part of open enrollment. Now you will see only the plan benefits and won’t have to look at last year’s Medicare.
Also the dreaded enrollment verification call has turned into an enrollment verification letter you will receive after you have enrolled in a plan. Often members would not answer or would hang up the telephone thinking this was a solicitation. Everyone is glad this practice is dying. But there still will be calls to confirm if an enrollee has a chronic illness for the purpose of disease management programs.
The bad: Instead of premium give-backs some plans now are charging premiums; you will see this more in PPO plans. This will be a bit of a shock for Floridians. We just are not used to paying premiums — unlike in other states where paying a premium for your Advantage plan is pretty common. Primary doctors saw slight co-pay changes but office visits went up all over for specialists.
Dental and vision benefits are growing slim or just going away. Ancillary benefits and discounts now are barred from the being part of the Medicare presentation according to CMS which wants to see the focus of the presentation to be a healthcare decision process.
And yes, there is no Santa Claus. The benefits are a little less than last year in most cases, so if you feel the water slowly boiling you might want to jump out and go to a Medicare supplement and stand-alone drug plan. A Medicare supplement is a choice with a premium, but it is not as variable as the yearly benefit changes of an Advantage plan.
Betsy Vipond is CEO of The Senior Health Advisor and has been in insurance for more than 38 years. She is a former board member of Tampa Bay Health Underwriters part of the National Association of Health Underwriters and specializes in Medicare products. Call her at (800) 603-0901.
