BY PALLAVI AGARWAL
SEBRING - Hugh Catlett is expecting to pay at least $500 more next year for the four medications he takes, as his Medicare Advantage plan has announced a copay for all drugs ordered through the company's mail order pharmacy for 2014.
Linda Bell and Karen Cayo have found out that their Medicare Advantage plans have dropped the health and wellness program, Silver Sneakers, as a free add-on benefit for next year.
Cayo "loves" her health coverage, she said, but her four-times-a-week exercise routines at the Highlands County YMCA are too important to her, and she's switching plans so she can still attend her Silver Sneakers classes without having to pay out of her own pocket.
Bell feels the same way.
"I am 66 years old and feel it is important to stay active to stay healthy," she said in an email. "I will be shopping for another plan with Silver Sneakers."
Medicare open enrollment for next year ends Dec. 7 and industry experts are asking Medicare recipients to carefully review their plan options to ensure they have no surprises come 2014.
"...Seniors shouldn't simply renew their policies and assume the current coverage will stay the same. There's a likely payoff for those who pay close attention to the details," advises the Kaiser Family Foundation's Kaiser Health News.
Like any other health insurance, Medicare sees changes every year, although insurance companies might be doing more belt-tightening next year as Medicare cuts reimbursement rates across-the-board, especially affecting Medicare Advantage plans, some say.
That might mean changes in the drugs covered, the members' share of costs, the number of in-network providers for PPO plans and the cutting of add-on benefits such as Silver Sneakers.
According to an analysis by Washington-based Avalere Health, Medicare Advantage HMO offerings will grow while PPO offerings will drop. The analysis also shows a "significant variation" in premiums of prescription drug plans in 2014, Avalere adds.
"Five out of top 10 prescription drug plans have a double digit increase," the company stated in a report.
Matt Eyles, executive vice president of Avalere Health, said payment changes for Medicare Advantage plans under the Affordable Care Act "are taking root and starting to broadly impact the number and types of plans available in the market."
A new health insurer fee, among other factors, is also driving the changes, Avalere adds.
If coverage is changing, an insurance company has to provide a notice of changes.
"Look at the notice of changes and make sure there are no surprises come Jan. 20," said SHINE volunteer and Highlands County volunteer coordinator Jim Tolbert.
The Serving Health Insurance Needs of the Elderly program is an arm of the Department of Elder Affairs and provides health insurance advice to seniors. Highlands County is serviced by the West Central Florida Area Agency for Aging's SHINE office.
Tolbert said those who have original Medicare and a supplemental plan, which covers what original Medicare doesn't, should probably stick with the supplemental plan since there is no guarantee they will be able to get into one later, when they are older and maybe sicker.
The premium for a supplemental plan is also based on the age when a subscriber first purchased the plan, he added.
While they may want to retain their supplemental plan, Tolbert said subscribers should review their drug coverage every year, make sure their medications are being covered and any pricing changes that may take place.
"You might change your prescription plan from year to year," he said.
A good place to start the review process is at medicare.gov, which provides a plan finder for people and allows them to compare different plans offered in their zip code, giving them a choice to include the medications they take.
Enter the drug list and choose a plan that would be most cost-effective, Tolbert said, taking into account all the out-of-pocket costs.
While people can shop and compare plans on the Medicare site on their own, SHINE volunteers also help people who want help, either in person or over the phone.
Tolbert is available for counseling from 9:30 a.m. to noon on the second and fourth Fridays at the Avon Park Public Library and the first and third Fridays mornings at the Lake Placid Memorial Library.
While he will service walk-ins, he strongly advises people to set up an appointment if they don't want to wait during enrollment season.
He and other SHINE volunteers also will help enroll people at two sessions each in November at the Lake Placid and Avon Park libraries. Appointments are required for these two meetings, set from 10 a.m. to 2 p.m. Nov. 1 (Lake Placid) and Nov. 22 (Avon Park).
Call 1-800-963-5337 or 1-800-96ELDER to make an appointment.
While Medicare supplemental plans have a monthly premium, some Medicare Advantage plans have no premiums but subscribers pay a co-pay and co-insurance when they get service.
According to Kaiser Health News, roughly one in four Medicare beneficiaries has coverage in Medicare Advantage plans, which are run by private companies that get a stipend from Medicare.
Lately, at least one company has cut the number of network providers in its regional zero-premium Medicare Advantage PPO in Highlands County and other parts in Florida.
Independent insurance agent Matthew Richardson said that alone should not be the only reason to switch plans and that subscribers should compare the totality of services offered - from free over-the-counter drug benefits to co-pay amounts to see specialists - before making changes.
"Look at all your plan highlights," he advised. "Do the math."
The first question he asks his clients to see is if their primary care physician is in-network and whether they are happy with their doctor.
Also, a physician may not be in-network but subscribers may still be able to see them if they are willing to pay a little bit more in out-of-network charges, he pointed out.
However, "It's still up to that provider whether they will take that insurance," he said.
He also advised people to seek out an independent agent who can help compare plans and give them an unbiased opinion.
For local Medicare recipients, what may be frustrating are the relatively fewer plan choices offered in Highlands County compared to say, coastal counties in Florida or more metropolitan areas in other parts of the country.
"That's been like that for many years," Tolbert said.
That means there is competition among insurance companies, Catlett said, forcing residents here to make do with what they have, unlike friends of his in Melbourne who have a better choice of offerings because they live in a bigger place.
Either way, not having the required medical insurance coverage is not an option for him, Catlett said.
Lately, he spent several hours comparing two Medicare Advantage plans and the annual notice of changes he got from his insurance company was 14 pages long with a "lot of little tables."
Even though he is looking at paying at least $500 more a year on the medicines he is taking, along with his other health-care related costs, Catlett has to have the insurance he needs, he said.
"I'm stuck between a rock and a hard place," he said.