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Consumers are growing frustrated as they find their current doctors aren’t included in new Covered California individual and family plan (IFP) health insurance networks. There is also widespread uncertainty about the rules of in-network providers with the new Exclusive Provider Organizations (EPOs) and California’s new 19 pricing regions. When California consumers are craving information the doctors have been silent and the insurance companies along with Covered California are providing scant information.
Health Net and several other administrators of Medicare Advantage plans were issued fines from the Center for Medicare and Medicaid Services (CMS) for errors in their updates to people enrolled in the MA-PD plans. The penalties, issued in October 2013, were for incorrectly stating plan information in annual notices to Medicare beneficiaries enrolled in the Advantage plans and ranged from $23,410 up to $86,530.
If a Medicare Advantage plan has been awarded a 5 Star rating from Medicare you’ll see that trumpeted in TV commercials and print advertising. The star rating that either the Medicare Advantage or Part D Prescription Drug plan must display is a composite of 35 different measurements. Perhaps the most important rating for most beneficiaries is the level of customer service if there is a problem.
Medicare beneficiaries who suffer from chronic and debilitating illnesses such as cancer, dementia, HIV/AIDS or have suffered a stroke may be eligible for a Medicare Advantage Special Needs Plan (SNP). These SNPs may offer transportation to and from doctor appointments, hearing aids and special language interpreters for doctor appointments.
California Medicare beneficiaries will have over thirty Part D Prescription Drug Plans (PDP) to choose from in 2014. But a recent Kaiser Family Foundation study found that upwards of 80% of individuals never switch their PDP even if new plans offer better coverage and a lower premium.
Thousands of Medicare Advantage plan members in California are receiving letters that their health plans are closing from carriers such as Anthem Blue Cross and Health Net. Some of the health insurance companies will be leaving some counties completely while others will be offering new Medicare Advantage (MA) plans to their members. Regardless of the reasons, the plan closure triggers a Special Enrollment Period for Medicare beneficiaries to select a new plan offered in their county.
Numerous Medicare Advantage (MA) plans will be offered in 2014 throughout California. All MA are county specific and may have additional reduced availability by zip code within the designated county. Most of the MA plans also include the Part D Prescription Drug plan (MA-PD), but not all.
Not too long ago the talk in conservative circles was how the cuts to Medicare Advantage plans under the Affordable Care Act would hurt seniors. The Centers for Medicare and Medicaid Services (CMS) has announced that more seniors now have access to higher quality Medicare Advantage plans as there has been a 28% increase in plans receiving four or more quality star ratings for the 2014 open enrollment period beginning on October 15th.
The Affordable Care Act set in motion a series of reforms to slowly close the coverage gap or “donut hole” that Part D members faced after they met their initial coverage dollar amount. Pharmaceutical manufacturers that wanted their Brand name drugs covered in the gap had to sign an agreement with Medicare to cover 50% of the cost of the drug. Medicare has had to assess civil monetary penalties on many companies that failed to cover the discount.
Anthem Blue Cross announced that it will issue rebates to members enrolled in their Medicare Supplement plans in five different states. The rebates are a result of the Medicare supplement or Medigap plans failing to meet the medical loss ratios (MLR). Rebate checks being sent out in September will range from $3.51 to $487.08 per member.