Maybe I am just over hyping this annual ritual just a wee bit. While things may be quiet on the surface, we are like a duck, paddling furiously below the water line or in our case behind the scenes.
We have invested untold hours taking a whole slew of online certifications to ensure we are fully compliant with all the Medicare rules and regulations, as well as the different insurance carriers and their specific programs for 2013.
Let’s start with the Medicare Advantage Plans available in Clallam County.
These Medicare Advantage Plans are where Medicare pays a private insurance company to provide your Medicare benefits to you. They can either include your Part D, prescription drug benefit, or not.
Regence Blue Shield will still have three different plans two with Rx coverage and one without. The premiums for their plans have done everything. One has increased, one has decreased and one has even stayed the same. However, the most popular plan is Regence MedAdvantage + Rx Classic has lowered it’s premium from $119 per month to $99 per month.
Group Health offered two plans in 2012 and has reduced that to a single plan in 2013. They dropped the Elite plan. This was the plan that included the Part D with a $0 deductible. The remaining plan is the Prestige Plan, it has a $325 deductible for the Part D portion with very slightly higher co-pays than what the Elite plan had. The biggest change with this plan it the monthly premium. It has jumped from $67 to $103.
Now consumers have a little more to compare between the Regence and Group Health as they are both very close in pricing structure.
The strangest Medicare Advantage Plans available in Sequim and Port Angeles (in my opinion) are the plans offered by Community Health First. They offer three plans, two include the Part D coverage and one is just medical.
All three plans are Health Maintenance Organization plans (HMO). That means you have a Primary Care Provider (PCP) who you would need to see to get referrals to see a specialist or out of network provider.
According to their web-site they have a total of 10 Primary Care Providers in Clallam County with 9 of those 10 located in either Forks or Clallam Bay. When I contacted the other PCP listed for the area, I was informed that the web-site was in error and they would not be contracting with Community Health First for the Medicare Advantage plan.
I cannot understand the rational of Medicare in approving a program where the PCP’s are located in excess of 70 miles away.
OK, let’s turn our attention to the Medicare Part D plans available for 2013.
First by the numbers, we have the exact same number of plans available in 2013 as we did in 2012, with that number being 30 plans. Of these 30 plans 13 offer a $0 deductible, 14 have a $325 deductible and the remaining 3 have a deductible in between the $0 and $325 amounts. This is very similar to last year also.
We do have a new contender for the lowest priced plan, it is a new AARP branded plan offered by United health Care and it has a $15 per month premium, whereas the Humana-Walmart Plan has a monthly premium of $18.50.
The lowest plan without a deductible is the First Health Value Plus plan with a monthly premium of $28.80 closely followed by the Silverscript Choice plan at $29.10.
Community CCRx has merged with Silverscript and all enrollee’s will be automatically moved to the Silverscript plan that most closely resembles the plan they are currently enrolled in.
One company has left the marketplace, Health Net Orange but according to the Medicare web-site they only had a total of 91 members in Clallam County.
Two new companies enter the field and one in particular surprises me, if only for the name it is being marketed under. That is Readers Digest Value Rx plan issued by Health Markets Medicare. Readers Digest selling Medicare Part D insurance why that sounds as unlikely as Gerber, the baby food people selling Long Term Care Insurance. But wait, way back in the 1980’s THEY DID sell LTC Insurance.
The other new company is going by the name Smart D Rx and I have been unable to find out too much about at this point, but will you know what I find out as time progresses.
I will be having another column next week and that will be discussing the ways in which with a little diligent work you can probably save yourself hundreds of dollars in your drug expenditures in the 2013. Wow, I am so excited I can hardly contain myself.
In closing please remember the earlier dates for both the opening and closing of the Annual Enrollment Period.
If you require any assistance in helping determine which plan may work best for you, help is close at hand. The wonderful folks of SHIBA can be contacted here in Sequim at 411 W. Washington 360-452-3221 and they hold help sessions twice weekly at the Sequim Senior Center. The Medicare.gov web-site is a very useful tool that we rely upon daily and if you prefer to call Medicare they can be reached 24/7 by calling 1-800-MEDICARE, or 1-800-633-4227. In addition call your friendly local insurance agent as they should be able to help you navigate this situation.
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Affordable Care Act updates
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An update on insurance exchange
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Looking at long-term care
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Wed, Mar 6, 2013
Are we there yet?
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Wed, Oct 24, 2012
Medicare Plans for 2013
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Medicaid expansion, explained
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The Medicare voucher system
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