Many new options in Medicare enrollment this year
Medicare enrollees have a flood of options to choose in Medicare open enrollment and this year the privatized plans will come with three months to “test drive” the option.
Nearly 2.3 million people in Ohio — including around 160,000 in the Dayton metro area — are eligible for the federal health insurance program and will need to decide by Dec. 7 whether to enroll in traditional Medicare or one of the many privatized options, known as Medicare Advantage plans.
This season, Medicare enrollees who choose a Medicare Advantage plan will also have from Jan.
1 to March 31 to change their mind and switch to another plan.
Overwhelmed? The state gives free one-onone help through the Ohio Senior Health Insurance Program, which can help you review coverage options. The plan that worked last year might not be the best option this year. The plan that works for one spouse might not be the best option for the other.
“Medicare open enrollment is the time that everyone on Medicare should review their health care and prescription drug plan to see if they need to make a change,” said Chris Reeg, program director for Ohio Senior Health Insurance Program.
Reeg said people should review what the cost of a plan is, whether it provides the medical and prescription coverage they need and how convenient the plan is to use.
Seniors should keep an eye out for a letter from their insurance plan which will detail any changes coming next year to their current Medicare plan, Reeg said.
About 66 percent of Ohioans get traditional Medicare, typically also with supplemental coverage. The other 34 percent have Medicare Advantage, which is a Medicare plan privately managed by a commercial insurance company.
Original Medicare is accepted almost everywhere and enrollees don’t have to worry about a network. Medicare Advantage plans have limited networks and those networks can change during the year after enrollment is closed.
On the other hand, Medicare Advantage plans tend to be less expensive and can come with additional benefits like dental and vision. Next year will be the first year that private Medicare plans can opt to pay for non-clinical benefits like adult day care and caregiver support services. The privatized Medicare plans also cap outof-pocket expenses once enrollees have paid out to a certain limit set by the plan.
Don Mackos, president of Miamisburg-based Retired MediQ, which brokers Medicare plans, said in past years, open enrollment has been marked by disruptions like plans dropping physicians from their networks, but this year he’s mostly seen improvements in Medicare Advantage plans.
There’s more competition entering the area and prices are holding steady. Nearly 83 percent of Medicare Advantage enrollees remaining in their current plan will have the same or lower premium in 2019, according to U.S. Centers for Medicare & Medicaid Services.
“Most of the changes we see with Medicare Advantage this year are improvements,” Mackos said.
He said the option
Medicare Advantage enrollees to make a change the first three months of this year will benefit customers and pressure insurance companies to provide good service and a good product or lose business.
“If, for whatever reason, you are on a Medicare Advantage plan and you want to make a change, you could just one time or go back to original Medicare,” Mackos said.
Another upcoming change is the early closing of part of the Part D coverage gap, sometimes called the “doughnut hole.” It’s a coverage hole where enrollees pay more for prescriptions after they reach a certain threshold until they pay enough to reach a second threshold, after which costs go substantially back down. The doughnut hold for brand name drugs closes in March and for generic drugs in 2020.
Medicare enrollment season also tends to draw out scammers, so people should be aware of phone scams and other kinds of fraud. Any concerns about fraud can be reported directly to Medicare at 1-800-633-4227.
While enrollees might get advertisements in the mail, no one should be calling or knocking on doors and saying they are with Medicare or asking for any kind of payment. No one should be asking by phone for Medicare card information or social security numbers.
The only contact seniors should get will be from someone calling them back or contacting them about a scheduled appointment. Medicare open enrollment season traditionally draws out scammers and predatory sales tactics. Here’s what you should know about what insurance agents can do and what sales tactics the Ohio Department of Insurance says are not allowed. Insurance agents can:
• Distribute information and forms in a retail setting, at health fairs and promotional events.
• Travel to meet Medicare beneficiaries in their home IF they have been invited.
• Provide consumers information about public assistance programs and help individuals apply for government subsidies. Insurance agents cannot:
• Send unsolicited emails or solicit door-to-door.
• Collect names, addresses and enrollment applications or conduct sales presentations at a health fair or promotional event.
• Sell products which are not health-related during a Medicare Advantage or prescription drug plan sales or marketing presentation.
• Provide meals at promotional and sales events.
• Sell products in health care settings (doctors offices, pharmacies, etc.). Do not be persuaded by an insurance agent who tries to scare you into believing your Medicare rates are going to increase if you do not switch plans immediately.
If you believe you have been the victim of a deceptive sales practice, contact the Ohio Department of Insurance at 1-800-686-1527. By Kaitlin Schroeder
Ohio paid insurance companies millions of dollars to manage benefits for Medicaid enrollees who had died, according to a federal watchdog who says the state should recover the money from those companies.
However, the state is appealing the finding, and questions the accuracy of the total.
An inspector general with the U.S. Department for Health and Human Services says the state should claw back $51.3 million. The payments covered deceased people who were still listed as enrolled in the low-income health insurance program, according to the IG.
But Ohio officials dispute that math. They say it will take considerable time to determine exactly what Ohio Medicaid — which gets state and federal funding — should have paid out during those years, and that the result is likely similar to the payments that were actually made.
In other words, they say any overpayments were minimal.
Ohio Medicaid officials also say it has updated its systems to better notify the state when someone enrolled in the program dies.
“No provider has billed for services for a deceased person, and nearly a year ago, as part of ongoing work to modernize the system, safeguards went online that prevent it from happening,” said Ohio Medicaid.
Most Ohio Medicaid benefits are managed by private insurance companies that get paid a flat fee per member per month. The insurance companies use that money to cover the cost of health care for their members, and the companies keep what doesn’t get spent on care.
Ohio Medicaid paid six private insurance companies $90.5 million between 2014 and 2016 to manage the health insurance benefits for people who had died but were not removed from Medicaid’s books, according to the federal inspector general.
Of that amount, the inspector general asserts Ohio still needs to recover $51.3 million, which breaks down to $38 million for the federal government and $13.3 million for Ohio.
The largest of these six privatized Medicaid plans is CareSource, based in Dayton. Steve Ringel, CareSource Ohio Market president, said the money paid to Medicaid plans to provide care are appropriate and adjusted regularly by the state.
“CareSource is committed to the health and wellbeing of the members we are privileged to serve and we pride ourselves on being a good steward of taxpayer dollars,” he said.
The state is appealing the federal government’s claims. The state and federal government are likely not actually owed millions back in tax dollars, according to Ohio Medicaid officials.
Ohio Medicaid officials say if they redid the math on how much should have been paid to the insurance companies and this time didn’t include the dead enrollees, Ohio Medicaid would have to pay insurance companies more each month for each Medicaid member during those years.
That’s because the amount of money Ohio Medicaid pays private insurance companies considers how much the companies need to spend on health care for each member. Since the insurance companies were not paying for health services for the dead enrollees, it watered down the average amount spent on health services for each Medicaid member.
To resolve the issue of the $51 million, Ohio Medicaid wants the inspector general to consider that if it had immediately stopped making payments when enrollees died, then the state would have made monthly payments for fewer people on Medicaid but paid more money in monthly payments for each person on Medicaid.