Health Advocates Insurance Services In The Media
BY PAUL SISSON psisson@nctimes.com North County Times | Call staff writer Paul Sisson at (760) 901-4087.
Shou-Mei Li, right, cares for her husband Hsien-Wen Li, who has Alzheimer’s, at their home in San Francisco, in this photo taken Sept. 1, 2011. Dementia is poised to become a defining disease of a rapidly aging population _ and a budget-busting one for Medicare, Medicaid and families. Anthem Blue Cross and UnitedHealth Group Inc. have both sent letters notifying their customers statewide that they will no longer offer their Medicare Advantage plans. (AP Photo/Ben Margot)
** This story has been modified from its original version.
About 8,600 Medicare beneficiaries in San Diego County and at least 5,200 in Riverside County must choose a new health plan because two large insurers have decided to end their Medicare Advantage plans in California next year. Anthem Blue Cross and UnitedHealth Group Inc. have both sent letters notifying their customers statewide that they will no longer offer their Medicare plans. Anthem has introduced a replacement program with similar benefits. UnitedHealth has eliminated a “special needs” program but has maintained its regular Advantage program, which serves 60,000 customers in San Diego County.
First approved by Congress in 1997, Advantage plans allow private insurance companies to offer Medicare benefits that use existing doctor networks similar to the ones provided through private insurance. Advantage plans generally put great emphasis on using “in-network” doctors and facilities. According to the state Department of Health and Human Services, 7,285 San Diego County residents and 5,200 Riverside County residents are enrolled in Anthem’s “Freedom Blue” plans, which will be eliminated in 2012.
UnitedHealth Group has notified the state that it will no longer offer an insurance plan that falls under the same Medicare Advantage category. The company’s plan serves 1,313 San Diego County residents. Darrel Ng, a spokesman for Anthem Blue Cross, said in an email that cost was the main reason why the company decided to quit offering Freedom Blue. He said continuing the plan as it was would have “resulted in a plan design and premium very different from what the members who enrolled had originally purchased, which may have caused concern and confusion among our members.”
The new Blue Cross plan offered in California will be available only in 13 of the state’s larger, more populous counties, including San Diego and Riverside. Local insurance brokers and other Medicare advisers said Friday that they are seeing a spike in calls and visits, especially from Freedom Blue beneficiaries.
San Marcos broker Daniel Anaya, owner of Health Advocates Insurance Services, said the warning letter sent to Freedom Blue patients states that the existing plan is going away, but doesn’t explain that Anthem is creating a new program very similar to the one that is being eliminated. Patients who want to continue with Anthem must enroll in the new plan —- their coverage will not automatically roll over.
Although there are few differences in the two programs, it’s important for each person to examine his or her specific situation, Anaya said. Depending on which drugs a patient takes or how often the patient is sick, it might be necessary to move to a different Medicare plan or return to the “basic Medicare” service available to all seniors.
David Weil, program manager for the Health Insurance Counseling and Advocacy Program, said he, too, has received quite a few calls from local seniors who received letters that their health plan would cease to exist at the end of the year.
He said most of those he has worked with — about 90 percent — have decided to enroll in the newly created Blue Cross program. Weil said it is important for people who are affected by the change to make a decision. Although all have until March to do so, Weil noted that Freedom Blue participants could temporarily lose coverage if they let the decision slide into 2012.
“I would definitely make sure they do something by Dec. 31, which is when their coverage ends, so that they don’t end up having a gap in coverage,” Weil said.
Correction: UnitedHealthcare did not eliminate all of its Medicare Advantage plans as previously stated.
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