It's that time of the year again, as the Medicare annual enrollment period is upon us. This is the time at the end of each year that Whatcom seniors get a chance to choose a Medicare Advantage Plan, or stay with traditional Medicare. While this process occurs each year, each go-around there are always changes, as often there are new private Medicare plans to choose from, and some existing plans leaving the market. However this year is shaping up to have even more changes in the market than usual.
The Whatcom Alliance for Healthcare Access, where I work, administers the local Statewide Health Insurance Benefits Advisors program, a non-profit, unbiased source of information about Medicare sponsored by the state's insurance commissioner. Senior volunteers and staff answer literally hundreds of questions each year. Services are available by phone, by walk in, and by appointment. Volunteers and staff are trained to understand and communicate the nuances and oddities of these Medicare options. American health care is confusing in the best of circumstances, and the Medicare program is no exception. Every Medicare open enrollment brings lots of mail in the mailbox, claims and counter claims, and usually a great deal of change for some seniors. The SHIBA program is one safe place to go to sort this all out.
For additional information about the SHIBA program at Whatcom Alliance for Healthcare Access please call the local SHIBA HelpLine at 360-788-6533, or visit whatcomalliance.org.
For additional information on the Washington SHIBA program, please call the Insurance Consumer Hotline at 800-562-6900 for free help. Or visit insurance.wa.gov/shiba.
SHIBA "clients" typically have questions about many dimensions of the Medicare Advantage (as the private or Part C plans are called) Program. What does each plan cost? Are my drugs covered? What is the reputation of the plan? Is my doctor in their network? What benefits are offered? Are there extra benefits? How does it work? These are typical questions we field every year.
This year three private health plans are leaving the Whatcom market. Sterling, which mainly started here in Bellingham, has been a so-called Medicare fee-for-service plan - a plan type that the government is eliminating. Two relatively new plans, Essence and United Healthcare, are also exiting Whatcom. Two years ago Essence made a splash with lots of advertising and a zero-premium offering. United Healthcare, which is aligned with AARP, last year rolled out a new zero-premium offering and signed up more than 2,000 locals. Both are leaving, presumably because they could not sustain those price levels. It is important to note that United and Sterling offer Medicare Supplement Plans and that those will still be available locally. This leaves five Part C private plans available, down from eight plans last year.
What's the big picture here? There are about 28,000 Medicare beneficiaries in our county and around 35 percent of those are on Medicare Advantage (Part C) plans, a percentage much higher than national averages. The remaining 18,000 beneficiaries have stayed with traditional Medicare, most also buying a supplement plan. Physicians tend to like Medicare Advantage service, as in many cases they get paid more than they do with original Medicare. Due to this, finding any doctor as a beneficiary using only original Medicare can be a challenge here. With Medicare Advantage that's often somewhat easier.
The Medicare Advantage program has been around for about 15 years now. Originally it was designed to "privatize" Medicare by permitting health insurers to offer Medicare coverage. To induce seniors to switch to private plans, extra benefits were permitted (health clubs, dental, etc.) and the private plans were given hefty government subsidies. As late as 2008 these subsidies made the private plans 12 percent more expensive than traditional Medicare on average. Under health reform these subsidies are being gradually phased out - likely part of the reason for plans exiting our local market. Because they were paid more, the private plans could also pay doctors more, making them attractive to physicians. These Part C plans have given us choice and have proven attractive to consumers. Some are likely to have staying power. On the other hand, with choice has come confusion and higher cost. SHIBA is here to help you get through the often confusing language of Medicare, and find the plan that offers you the coverage you need.
Larry Thompson is the director of the Whatcom Alliance for Healthcare Access.
The status of Sterling's Medicare Supplement Plan was updated Nov. 9, 2012.