More than 9,200 Iowans, many of them in rural areas of the state, will need to select another Medicare Advantage plan beginning Oct. 15 or risk losing coverage on Jan. 1, 2014.
Each year Medicare Advantage plans decide whether to sign a new contract with Medicare. Kris Gross, director of the Senior Health Insurance Information Program (SHIIP) in the Iowa Insurance Division, said some plans make business decisions to leave Medicare altogether or stop offering plans in certain areas.
“Sometimes the provider network has changed,” Gross said. “The Medicare Advantage plan is required to have a minimum number of health care providers so people can get their care within a certain radius of where they live.
“Sometimes the plan doesn’t feel it can provide the services for the reimbursement it is receiving from Medicare.”
Gross said Linn and surrounding counties have either no one or less than 10 people affected by the discontinued Medicare Advantage plan coverage. She said more than 500 people in Clinton County will be affected, with a varying impact in other areas of the state.
Gross said the Medicare Advantage plans were to notify members by Wednesday, Oct. 2, if they will not be renewing their contract with Medicare. She said letters notifying members of non-renewal should include a list of Medicare Advantage plans available in their area in 2014.
“They have two choices — join a new Medicare Advantage plan or return to original Medicare,” Gross said. “They can choose another Medicare Advantage plan or change to original Medicare between Oct. 15, 2013, and Feb. 28, 2014.
“Making a decision by Dec. 31 assures they will have coverage that best meets their needs on Jan. 1.”
No matter what a member chooses, Gross said they will remain in the Medicare program.
When checking out potential Medicare Advantage plans, Gross said it is important to determine if existing doctors and other medical providers accept the plans.
“They need to be sure they have prescription drug coverage that meets their needs, whatever option they choose,” Gross said. “If they decide to return to original Medicare, they need to consider joining a Medicare prescription drug plan. They have until Feb. 28, 2014, to enroll in a new Medicare drug plan.
“If they enroll after Dec. 31, 2013, their new coverage will not start by Jan. 1, 2014, when their Medicare Advantage coverage ends.”
Gross said anyone choosing to return to original Medicare has a guaranteed right to buy a Medicare supplement policy to help pay health care costs that Medicare does not cover. That means the insurance company must sell them a policy, must cover pre-existing conditions and cannot charge more because of past or present health problems.
“If they leave their Medicare Advantage plan, they have 63 days from the day their coverage ends to apply for a policy,” Gross said. “That deadline is March 4, 2014.
Gross said annual open enrollment for Medicare Part D drug plans begins Oct. 15 and runs through Dec. 7.
In 2014, Iowa will have 29 drug plans, three fewer than in 2013. Gross said some of the plans may have changed premium, deductibles and co-payments, so comparing plans is critical.
“Five new plans were added and six plans changed names,” Gross said. “Seven plans show reduced premiums and 16 plans have increases.
“The lowest premium will be $12.60 per month.”
Gross said the Medicare Part D deductible for 2014 will be $310, down from $325 in 2013. The amount of out-of-pocket expanse to get out of the so-called doughnut hole is going down $200, to $4,550.
On Oct. 8, Medicare will announce the plans that receive the program’s highest rating of five stars. The program also will identify low performing plans.