Private firms pitch Medicare options

Jerry Disotell can’t wait to sign up for a Medicare Part D plan.

Not that he’s excited; he really cannot wait. Since one medication he takes costs $1,400 a month, the 70-year-old multiple sclerosis patient simply can’t afford to be without prescription drug coverage.

“And he takes more than that,” his wife, Jackie, said.

So the Disotells attended their second meeting on Medicare’s new prescription drug benefit this week and plan to go to a third Wednesday.

“I’m happy that (Part) D is coming, but I’m confused about how to do it,” said Jackie Disotell, a nurse.

Adding to the confusion for some is that private insurance companies are offering Medicare prescription drug insurance alongside the federal government’s basic plan. Those companies are selling insurance packages to Medicare-eligible people that include the drug benefit, plus hospital, doctor and other health coverage. As independent agencies such as the Statewide Health Insurance Benefits Advisors, or SHIBA, have been holding information sessions about Part D around the region in recent weeks, insurance companies are hosting their own meetings to attract new policyholders.

The Medicare Advantage offerings are getting mixed reviews from seniors – the Disotells have opted against using one – and from health-coverage advocates.

Ralph DeCristoforo, coordinator of Health for All, a Spokane agency that helps people obtain health insurance, said some seniors have gone to Medicare Advantage meetings thinking they’re going to hear only about the government program.

“The majority of what they’re going to get is a sales pitch,” he said.

That concerns DeCristoforo.

“We don’t have enough advocates to monitor what they’re doing.”

But the companies’ plans could be a welcome option for seniors who want more comprehensive insurance than Medicare offers.

About 13 people attended a meeting last week hosted by Spokane Community Care, a division of Bothell, Wash.-based Arcadian Health Plan Inc. The company is one of four in Spokane County and five in North Idaho contracting with Medicare to include the government’s prescription drug benefit in its plans.

Sales representative Deana Bell told attendees there’s no charge for preventative screenings such as colonoscopies and pap smears under any of Spokane Community Care’s plans. She said they’d pay less for visits to skilled-nursing facilities than they would under traditional Medicare.

Bell also told them they’d have to select doctors from the company’s approved list and could only undergo outpatient surgery at Deaconess Medical Center, Valley Hospital or Rockwood Clinic. Such restrictions are common among Medicare Advantage plans.

While Bell’s presentation was part pep rally – “Book those cruises now. You’ve got health-care coverage!” she cheered, after informing attendees her plan included out-of-country coverage – a SHIBA presentation Tuesday sounded more like a battle cry.

“It’s time to get really assertive about your health care,” said Chris Ellis, SHIBA’s Regional Coordinator for the eastern part of Eastern Washington. “It’s time to get tough.”

Ellis spoke to about 25 people – some were seniors trying to make their best choice, some were professionals who work with the Medicare-eligible population. She broke consumers into four groups: people who already have prescription drug coverage that’s as good or better than Medicare Part D; people who either don’t have coverage or have less coverage than Part D; people eligible for both Medicare and Medicaid who will be automatically enrolled in Part D; and people who will choose a Medicare Advantage plan.

Ellis referred to the Medicare Advantage plans as “one-stop shopping” and said they might be a good option for people who are generally healthy and like the list of participating doctors.

Ellis advised people without drug coverage who are healthy now to at least enroll in the government’s cheapest Part D plan, which costs $7 a month, because uninsured people who don’t enroll in any plan by May 15 will see their monthly premium grow by 1 percent for every month they don’t register.

“Choose the $7 plan,” she said. “It gets you in the game.”

DeCristoforo liked that advice.

“There are still seniors out there that think they do not have to make a choice,” he said. “The penalty is going to be too large.”

Both DeCristoforo and Ellis and many seniors complained about Part D’s complicated choices. Throwing Medicare Advantage plans into the mix only further confuses people, DeCristoforo said. The federal government’s Part D and the Part D packages offered by insurance companies are so different, counselors can’t give seniors an apples-to-apples comparison of them, he said.

“I don’t even use the apples and oranges (analogy) because they’re not all fruit,” DeCristoforo said.

He suggested seniors bring an advocate with them to Medicare Advantage information sessions and to not sign up for a plan on the spot.

Medicare replacement plans aren’t a new concept. Spokane-area consumers had six so-called Medicare + Choice insurance companies to choose from in the 1990s. But it became less profitable for those companies to provide Medicare plans so they faded away.

“Medicare’s increase in payment (to insurance companies) did not keep up with medical inflation,” said Lloyd Guthrie, a district administrator for Group Health Cooperative in Eastern Washington.

Group Health was one of the companies that held out the longest, but it was the only Medicare + Choice insurer that offered a prescription-drug benefit. That meant the sickest – and most expensive – patients chose Group Health.

The federal government has taken steps to level the playing field, Guthrie said. Interest in Group Health’s new Medicare Advantage plan has been so high recently, the company expects to complete 60 information sessions by January. That’s twice as many as it had planned to hold.

In addition to Spokane Community Care and Group Health, Asuris Northwest Health and Sterling Life Insurance Co. are signing consumers up for Medicare Advantage plans in Spokane County.

In North Idaho, Regents Blue Shield, Blue Cross of Idaho, Humana Inc., UnitedHealth Group Inc. and Sterling are offering plans.

Penny Wilhelm, the SHIBA regional coordinator in North Idaho, sees Medicare Advantage plans as a positive way to bring more competition to the market. For a long time, seniors wanting a Medicare-related insurance plan had to choose Sterling, the only option in North Idaho.

“Now, in every area, they have at least two to five choices,” she said. “It’s really opened up.”

Plus, the Medicare Advantage companies’ advertisements clearly state their purpose, she said.

Spokane resident Ron Clark attended a meeting hosted by Sterling in Spokane Valley Wednesday and walked away with a good feeling – but not a health-care policy. The retired utility company employee pays $100 a month for his former employer’s health insurance plan, which covers him and his wife, Cynthia.

Because Cynthia Clark is only 57 and not Medicare eligible, Sterling advised Ron Clark to stick with his current plan instead of signing up for its service, which would have cost him more.

“They didn’t push me into something that wasn’t right for me,” he said.

While Wilhelm doesn’t worry about Medicare Advantage plans, she is concerned about insurance brokers and financial planners not under contract with Medicare who also are hosting information session under the Part D banner now.

“I’m hearing that there are some high-pressure sales tactics to buy other products besides Medicare Part D,” she said.

At those meetings, seniors are filling out inquiry cards with their addresses and phone numbers and companies are putting that information into their databases, she said.

The glut of information and options surrounding Part D is causing heads to spin and, in one case, blood to boil.

A woman attending Ellis’ SHIBA presentation at Deaconess this week raised her hand within five minutes of the meeting’s start. In a voice teetering between anger and frustration, the attendee criticized SHIBA for not telling her which plan to select during a telephone inquiry. The woman, who rode an electric scooter and used an oxygen tank, said she doesn’t have access to a computer, which is the only way to register for the government’s Part D plan.

Ellis said the presentation would address the woman’s concerns, but within a few minutes she backed up her scooter and exited the room.

“I wish she had stayed,” Ellis said later, gesturing to the space the woman had vacated.