Today marks the approximate halfway point in the Medicare Annual Election Period for 2012 enrollments. We have just four more weeks left before the Dec. 7 closing date.
I am going to share with you some observations from the past three weeks of reviewing programs and drug list for folks on Medicare.
It is very easy for people to glance at the packet of information that arrived in their mailbox and assume, “Well, the plan worked OK this year, I am sure it will be OK for 2012 also.” Wrong. We all know what happens when we assume anything without checking it out.
So while this may sound tedious, I am strongly recommending you take the time to ensure all your medications will be listed and also at what tier level or co-pay amount.
In previous columns I have mentioned the changing formularies as well as what I call tier creep, where a Tier 1 medication with the lowest co-pay amount mysteriously turns up in Tier 2 with higher co-pays.
I had a perplexing situation recently with a gentleman from Port Angeles who visited our office. He was 74 years young and never had enrolled in Part D, as he took just one medication.
I advised him of the penalty he would incur for late enrollment and then reviewed the medication he took.
On www.Medicare.gov it showed the price of the drug at less than $10 per month. I advised that if he bought a plan, that $10 medication would cost him $50 per month. $15 for the premium, $25 for the penalty and then $10 for the drug, as the $15 plan had a large deductible.He told he was paying over $80 per month for that $10 drug. I was so skeptical that I called the pharmacy in question. I explained who I was and asked for the cash price for the medication and the
client was correct, it was in fact over $80, but the pharmacy tech told me that if he had the FREE store discount card, the price was only $19.99. Yes, that is right, if he’d had a FREE store discount card, it would have saved him $60 per month for who knows how many years.
That one situation leaves me speechless.
This is generally a quiet year for the peninsula without major changes either positive or negative with any of the plans available here.
However, elsewhere up and down the I-5 corridor, things are hopping. Two very large clinics with multiple locations, the Everett Clinic and the Vancouver Clinic, are two examples. They are telling their patients they no longer will be accepting traditional Medicare and supplements (Medigap) but only will be accepting Medicare Advantage plans.
This has truly amazed me until some things were explained to me.
By law, the Medicare Advantage plans have to reimburse providers at least the same amount they would receive if a person were on traditional Medicare. However, a plan can choose to pay providers an amount larger than the Medicare approved amounts if they choose to do so. So, these clinics have negotiated higher reimbursement rates from the Medicare Advantage plans than they would receive from Medicare.
In addition the vast majority of these plans have changed from PFFS or PPO plans, Private Fee For Service or Preferred Provider Organizations, to a more restrictive HMO, Health Maintenance Organization, plan.
Under an HMO format, a person must choose a primary care provider whom they have to see before seeking any specialist services. This simple step acts as a speed bump and attempts to reduce the amount of services and testing that are potentially unnecessary.
Whereas under a PFFS or PPO plan, a person could seek multiple services and duplicate testing from various specialists without any restrictions.
You may wonder why I am so interested in what is happening along the I-5 corridor. The main reason is I always am attempting to look into the future to spot trends before they hit. With the recently announced agreement between Olympic Medical Center and Swedish Medical Center, I wanted to see if Swedish was part of this trend.
I am glad to report that they are not. They basically will accept all plans, both Medicare Supplement as well Medicare Advantage.
If you or anyone you know requires any assistance in reviewing their options for 2012, free help is available from your local insurance agent or those great folks at SHIBA at 411 W. Washington St. They also hold free clinics at the Sequim Senior Activity Center, 921 E. Hammond St.
Phil Castell is an independent insurance agent in Sequim. Reach him at 683-9284 or PhilCastell@msn.com
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