This is an archived article that was published on sltrib.com in 2010, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.
The Medicare open enrollment period begins Monday, lasts for six weeks and normally would be fairly routine.
Not this year.
Across the nation and in Utah, numerous Medicare Advantage plans — the private health insurance alternative to original Medicare — are pulling out of the market.
About 8,000 Utahns will lose their Medicare Advantage plans in 2011, the National Association of Insurance Commissioners says. Rural areas are seeing the biggest losses: Carbon County residents now have no Medicare Advantage plans; in San Juan County, there's just one.
Urban Utah is getting hit, too. Of the 38 Medicare Advantage plans offered in Salt Lake County this past year, only 14 will survive in 2011.
Insurers are alerting customers about these and other changes. But Peter Hebertson, outreach director and health care counselor for Salt Lake County Aging Services, worries the letters could get tossed instead of read.
That could prove disastrous, Hebertson says.
While seniors will automatically be enrolled in original Medicare for hospitalization and out-patient coverage, they wouldn't have prescription coverage or Medigap supplemental insurance that picks up what Medicare doesn't pay for.
"You'd be uncovered for a year," Hebertson says, and placed at risk of medical costs that could reach into the hundreds of thousands of dollars in a year.
—
Change is tough • "If you've been happy with the plan you're on and you don't realize your plan is being dropped," warns Vicki Nelson, a Salt Lake County Aging Services volunteer Medicare counselor, "you could easily ignore the whole issue until you go to your doctor in January."
Even when Medicare Advantage plans have survived, people need to make sure the coverage is still adequate for their changing health needs, Nelson says.
At the Harman Senior Center in West Valley City, Nelson is trying to walk Taylorsville resident Teddy Garrick through the federal interactive website, medicare.gov, which isn't loading.
Garrick has her Medicare Advantage insurer's letter that says her plan won't change in 2011, but she still wants to look at other options.
"I haven't been happy with [my plan] for years," says Garrick, who turns 89 in a few months. "But I've been scared."
After enduring terrible pains in her side that propelled her into her basement to scream where no one could hear, Garrick received a prescription for narcotic pain-relievers from her doctor. The problem went on for months, until a friend suggested Garrick get an ultrasound — which revealed gallstones.
Since her surgery, she's been fine, but she's unsatisfied with her doctor.
"I'm looking for [a plan] where I can go to any doctor or any hospital," she says. "I feel like I've been through the mill."
At the Eddie Mayne Kearns Senior Center, Edythe Eis, 68, of Salt Lake City, says she was dismayed by how impatiently insurers treated her when Medicare prescription plans first offered coverage, for 2006.
It seemed their representatives felt "you're all idiots, you're all senile, so just pick something and leave me alone," Eis says.
"I'm not savvy enough to understand all these plans," she says. "That's why I don't do anything else" but stick with original Medicare.
—
Please call • So far this year, Salt Lake County has gotten about 100 calls for help, even though Hebertson estimates more than 100,000 residents should be re-evaluating their plans for themselves or for family members.
Darren Hotton, who manages the Utah State Health Insurance Counseling and Assistance Programs [SHIP], says not just Medicare Advantage plans are folding their tents. Of the nearly 60 prescription plans available two years ago, only 35 remain. Medigap plans also are closing.
SHIP counselors, available statewide, generally help people narrow their choices for prescription and gap coverage to the three least-expensive plans. There is no charge.
Hotton and Kasie Kveset, the SHIP coordinator for Carbon, Emery and Grand counties, are setting up enrollment events. In Carbon County, 544 residents have to make new decisions by Dec. 31.
"I've had a lot of people contact me," Kveset says.
People also can contact Medicare directly, Hotton says, or use its website, where "they feel empowered once they get over their initial fears."
His bottom line: "People need to be actively involved in their plans."
Hotton says his grandmother didn't want to switch insurers because the ones she had were nice. Her litmus test? They only hung up on her once.
"I said, 'Grandma, just because they were nice doesn't mean you're indebted to that company for the rest of your life,' " he says.
Hotton says he found a plan that saved his grandmother $400 per year.
—
Private help • A private insurer can help clients examine plans more closely, says Mark Snihurowych, president of The Center for Senior Benefits in Salt Lake City, a for-profit brokerage for Medicare Advantage and supplemental plans.
"Cheap is not objective," he says. Sometimes low premiums — the amount a subscriber pays up front — come with higher back-end costs such as co-payments and deductibles.
Plans change remarkably every year even if their names stay the same, he says.
"It's important the senior understands the good, the bad and the ugly of every plan," Snihurowych says. "We have people who are 65 who have just retired from executive positions and they're confused."
New regulations curb profits for agents, a concern raised when Medicare Advantage plans were new, he says.
Cautioning about fraud, he notes that agents aren't allowed to make first contact with a potential customer. Medicare never calls people directly, so anyone claiming to be from Medicare isn't.
Some legitimate but "captive agents" might not disclose they sell a single plan, he adds.
There are hundreds of high-quality agents who will "do the right thing," he says. "But as my mother used to tell me, 5 percent of the people cause 80 percent of the trouble."
Read the letters, ask for help
I By now, Medicare Advantage, prescription drug plans and Medigap insurers should have sent letters to customers explaining 2011 changes — or even that the plans will no longer exist.
State and local Medicare counselors say beneficiaries and their families need to read the letters, then take action to make sure they or their relatives will be covered adequately next year.
To find help:
Call 1-800-541-7735 from anywhere in the state to find a local Medicare counselor
For direct interactive online counseling or research plans, visit http://www.medicare.gov. —
Dropping coverage in Utah
Some Medicare Advantage policies offered by seven insurance companies are exiting the Utah market, affecting 8,003 beneficiaries statewide. The number of residents who are affected:
UnitedHealthCare's Secure Horizons • 2,567
Humana • 1,578
Universal American Corp. • 521
Wellpoint Inc. • 1,043
Munich American Holding Corp. • 380
Coventry Health Care Inc. • 1,905
Universal Health Care Inc. • 9
Source: National Associations of Insurance Commissioners