Medicare Updates for 2011

On October 1st the Medicare.gov web-site was to have been updated with all the plan information for 2011. As of October 3rd, as I write this column those updates are not yet on that web-site.  Never fear though, this intrepid columnist has scoured other less known government web-sites to find out the scoop.
The biggest change for 2011 will be the demise of the Private Fee For Service (PFFS) plans in Clallam County. The rules have changed to where any Medicare Advantage plan must have a list of providers who will accept the plan. The PFFS model allowed you to see any provider, who would accept the plan.

This means that PFFS plans offered by Sterling, Secure Horizons, Humana, Unicare and Cigna will not be available for 2011.  Those members affected should have received notification of this fact from their insurance company already.  There are over 1,300 residents of Clallam County affected by this change.

If any doctors or medical practitioners are reading this,  I urge you to communicate to your clients who are on one of the affected plans, that they will need to do something before the end of the year.  Otherwise they will find themselves on Medicare only with no secondary coverage.  They are eligible for a Special Election Period (SEP) which started on October 1st and runs through January 31st, 2011. So, people who have been notified of their SEP are unable to find out their options until the Medicare.gov web-site is updated.

I can tell you that the only Medicare Advantage plans available in Clallam County in 2011 will be the offerings from Regence Blue Shield and Group Health Options, Inc. Both of these companies offer Preferred Provider plans with a list of accepting providers.  The Regence plans are available throughout the County whereas the Group Health Options plans are only available in the Sequim and Port Angeles zip codes in the County.

Premiums for Regence have dropped slightly and the co-pays have increased slightly. For Group Health Options the benefits have remained pretty much the same as 2010 but the premiums are somewhat higher. The Regence plan includes some limited dental coverage, where it is an extra cost item with Group Health Options.

Now let’s go over some big changes for 2011 and Medicare Part D.  The best news is for those people who reach the coverage gap.  In 2011, they will receive a 50% discount on brand name drugs while they are in the gap.  They will also receive a small discount on generic drugs in the gap.

Medicare thought that insurance companies were offering too many different Part D plans with similar benefits, and has required plans to be significantly different from each other to be approved. This has caused a reduction in the number of standalone PDP plans from 44 in 2010 to 32 in 2011.

United Healthcare’s AARP Rx Saver plan will not be available in 2011 and all those members will be automatically moved to the AARP Preferred Plan with a 2011 premium level of $ 35.10.  This plan is the lowest priced plan without a deductible.

One of the most popular plans for the past couple of years was the First Health Part D, Secure plan which had a monthly premium of $8.80 in 2010. This plan likewise will not be available in 2011.  At this time I am unsure if members will be automatically moved to another First Health Part D plan or just advised to look for coverage elsewhere.

The $8.80 plan was a direct to consumer plan and was not available through insurance agents.  I wonder if not having a local agent people could call and visit, played any role in their decision to pull the plug.

Talking about First Health Part D.  This is a plan owned by Coventry Healthcare which in previous years has issued plans under the AdvantraRx brand name.  The AdvantraRx name is no longer being used for 2011 and they will just market their products under the First Health Part D name.

What article on Medicare Part D would be complete without mentioning Humana.  There I have just mentioned it. Just kidding, Humana has good news also.   The Humana Value plan which was priced at $18.60 in 2010 has been rebranded and repriced for 2011.  It is now the Humana Walmart Preferred Rx Plan with a reduced price of $14.80. I guess the little yellow price slasher at Walmart has been at work once again. The plan ID numbers are the same, so technically it is the same plan but the benefits are totally different from 2010. For example, it has a $310 deductible for all drug tiers, but then many generics are priced at only $2 for a 30 day supply at Walmart or $10 at any other local pharmacy. When I first saw that I thought “What, that is a huge advantage for Walmart.” Then I read the fine print. The $2 co-pay is only for the generics on the Walmart $4 drug list, and other stores either have their own $4 list like QFC, or will match prices. But I still applaud Humana and Walmart for innovative thinking.

Talking about local pharmacies I would like to thank Fricks for all the wonderful services they have offered throughout the years to the community. It is tremendously hard for independent pharmacies to compete in today’s economy and I wish Cy, Jim, Beth and Patty all the best on the other side of Washington Street.

Posted on: October 5th, 2010 at 1:43pm by aveadmin12. Filed under: Medicare
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