Friday, October 21, 2011

Not For Wussies

This getting older has some downsides, as I've discovered. Still, it shouldn't be as difficult as it has just gotten for me and a whole raft of other elders when it comes to our Medicare coverage. Part A, the part which provides the coverage we've paid into and which deals with the most basic of healthcare access is easy. You turn 65, you get it. The tough part is Part B, which covers doctor's visits and diagnostic testing. It is a little harder to nail down and requires an additional premium which gets deducted from Social Security benefits. Elders have to research the available programs (offered by private insurers) and select the one that fits them best, given any special healthcare needs and income constraints.

I did the work: I checked out dozens of plans and finally settled on a Medicare Advantage HMO plan offered by Anthem Blue Cross. I signed onto it within the time frame allotted after my 65th birthday. I know, I know: after all of my posts on all the scams run here in California by Anthem, I should never have even considered this company, but the plan had reasonable co-pays, included a Part D prescription plan with a large formulary of medications covered, and its list of participating doctors and pharmacies gave me plenty of options in the area in which I live.

Now, six weeks later, I received notice that the plan is changing, and changing rather dramatically. I wasn't pleased at the thought that I now had to go through the process all over again. It turns out that I wasn't the only policy holder who was upset.

David Lazarus's latest column details another policy holder's shock at receiving two letters from Anthem. The first was sent right around the new enrollment period opened and stated essentially, "Relax. We've got you covered." The second, which arrived a week later, announced that there would be changes and those changes amount to less coverage for more money.

Kristin Binns, an Anthem spokeswoman, said the two letters were basically an example of one hand at the insurance company not knowing what the other was doing.

Anthem, she said, "sent an initial letter to our members to make them aware of possible changes coming with this year's annual election period." That was the happy, smiling letter talking about how Anthem "has you covered."

Right around the same time, though, the company mailed out its more in-your-face letter alerting people to changes in the Medicare Advantage program. ...

Here's what's going on: Anthem has been losing money on its Medicare Advantage plans in Northern California because of higher medical costs there.

But the company can't just fiddle with those policies, because it offers uniform rates and benefits throughout the state. It can't change terms for some people without changing them for everyone.

So Anthem is terminating its existing California Medicare Advantage plan, replacing it with 13 regional variations that allow it to set premiums and benefits according to local conditions.

In Los Angeles County, for example, the company's new Medicare Advantage PPO plan will have the same premium but "somewhat different benefits," Binns said.

Please note that the article deals with a PPO plan, which is a bit less restrictive than my HMO plan, but the changes are essentially the same. More premium dollars, more copays, less coverage.

I'm lucky. I can do the research on-line to see if I'd be better off with Kaiser or Aetna or United Healthcare, or whatever. Those elders who don't have that kind of access have to put up with insurance agents and bulky mailings which are difficult to decipher if only because the print is so damned small. And we only have until mid-November to get the coverage in place for January, 2012.


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Blogger Charles said...

Diane, I suggest contacting the state insurance commission and suggesting to them that this is a breach of contract. Medicare enrollment is annual, so there is some level of implied contract. Doing a bait-and-switch like this may amount to a breach of contract.

I wouldn't be surprised if the insurance commission would like to take on Blue Cross.

11:26 AM  

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