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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• When you first become eligible for Medicare (3 months before you turn age 65 to 3 months after the month you turn age 65)
• If you get Medicare due to a disability, you can join during the 3 months before to 3 months after your 25th month of disability.
• Between November 15–December 7 2011 (your coverage will begin on January 1 of the following year)

However, you can’t enroll in or switch to a plan with prescription drug coverage during this time
unless you already have Medicare prescription drug coverage (Part D). You also can’t cancel a plan with prescription drug coverage or join, switch, or drop a Medicare Medical Savings Account Plan during this period.

In most cases, you must stay enrolled in your current Advantage plan for that calendar year starting the date your coverage begins.

However, in certain situations, you may be able to join, switch, or drop a Medicare Advantage Plan at other times. Some of these situations include the following:

• If you move out of your plan’s service area
• If you have both Medicare and Medicaid
• If you qualify for “extra help”
• If you live in an institution

To switch to a new Medicare Advantage Plan, simply join the new plan during the period listed above. You will be disenrolled automatically from your old plan when your new plan’s coverage begins.
If you are planning to switch your plan and need more information, please feel free to contact us.

1. Determine Your Eligibility

The first step you need to take for Medicare enrollment is to find out if you are eligible. You should meet the eligibility requirements if you can answer yes to one of the following questions:

• Are you age 65 or older?
• Are you under 65 with certain disabilities?
• Do you have End-Stage Renal Disease (kidney failure that requires transplant or dialysis)?

If you already receive Social Security Benefits, you will automatically be enrolled in Medicare Part A and B the month you turn 65. Three months prior to your birth date you should be receiving your Medicare card in the mail.

If you want to opt out of Part B coverage, you will need to follow the instructions with your Medicare card.

If you not receive Social Security Benefits, you will not be automatically enrolled. You need to apply at the beginning of your seven-month initial enrollment period (90 days prior to your 65th birthday) to make sure your coverage start date will not be delayed. At this time you have also the option to apply for Social Security Benefits.

2. Get Information

Once you have determined that you are eligible for Medicare, you should gather all of your personal documentation and information on your current health care and/or prescription drug coverage in order to find out if your current coverage will work with Medicare.
Make a list of the drugs you currently use, your desired coverage, the maximum premium you can afford so you can compare and select the coverage that will best meet your future needs.

3. Select A Medicare Plan

Learn how Medicare works, and familiarize yourself with each Medicare Plan (Part A, Part B, Part C, and Part D). Carefully consider each plan with your current and possible future personal needs in mind. Enroll in the Medicare program that best suits your needs.

4. Determine If You Qualify for Additional Programs

Unfortunately, Medicare does not cover all medical costs such as co-insurance, co-payments, deductibles, or services not covered by a Medicare plan. The good news is that there are several other programs like Medicaid, Medigap, etc. which provide additional coverage. Research, and find out whether you are eligible. If you are, apply to them in order to maximize your coverage and reduce your health care worries.

Medicare Part A
(Hospital Insurance)
Medicare Part A includes care in hospitals as inpatient, critical access hospitals (these are small facilities that give limited outpatient and inpatient services to people in rural areas), skilled nursing facilities, hospice care and some home health care. If you are entitled to Part A, there is no monthly or annual insurance premium charge. There may be a charge for most health care services.

Medicare Part B
(Medical Insurance)
Medicare Part B pays for doctor’s services, outpatient hospital care and some other medical services that Part A doesn’t cover, such as the services of physical and occupational therapists as well as some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. If you are enrolled in Part B, you must pay a monthly premium, which is typically deducted directly from your Social Security check.

Medicare Part C
(Medicare Advantage Plans)
Under Medicare Part C, the federal government contracts with private insurance companies to administer Medicare benefits through Medicare Advantage plans. Participation in a Medicare Advantage plan is optional and available to Medicare beneficiaries who have Medicare Part A and B. With Medicare Part C, you generally pay lower co-payments and get additional benefits such as coverage for extra days in the hospital, though this will vary depending upon the plan.

Medicare Part D
(Prescription Drug Coverage)
In addition to hospital and doctor insurance, you also have the option to purchase Prescription Drug Coverage (Part D), which helps you cover your prescription costs. This prescription drug benefit is voluntary, but if you don’t enroll when you first become eligible, you may have to pay a late enrollment penalty if you choose to sign up at a later date. You can get Part D coverage by itself or as part of a Medicare Advantage Plan.

You can find out more about eligibility and enrollment at the Government’s website.