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Thursday, Mar 21, 2019
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Medicare Advantage users face enrollment pitfalls

TAMPA — Going with the status quo may no longer do for seniors enrolled in Medicare Advantage plans.

With just two weeks before the annual Medicare enrollment period ends, some seniors are finding hundreds of Tampa area doctors and H. Lee Moffitt Cancer Center may no longer be covered under their privately-run Medicare Advantage insurance plans.

As a result, Moffitt, physician groups and others are warning seniors to make sure the plan they choose includes the benefits and providers they want. Chris Pittman, president of the Hillsborough County Medical Association, estimates 200 local doctors have been dropped from various commercial Medicare policies for 2014.

“If they want to keep their doctor, they better check,” he said.

Every year, commercial insurance companies tweak their Medicare Advantage products, sometimes renegotiating contracts with, or opting to drop, providers. But most seniors enrolled in Medicare don’t look closely at the changes or consider switching to a new policy during the two-month open enrollment window that closes Dec. 7.

This year is the first in a long time that Eileen Britz, 87, is double-checking. The John Knox Village resident said she got concerned after she received a postcard from Moffitt explaining that as of Jan. 1, it no longer will be “in-network” for UnitedHealthcare Advantage policyholders.

She said her current Medicare Advantage policy is with another company, Humana, and she never has had cancer. But she still wanted to be sure she has the option of receiving treatment at Moffitt, a National Cancer Institute comprehensive cancer center.

“I would like the access. They are top of the line, and they are convenient,” said Britz, who also plans to verify that her primary care doctor is still in her network.

Many seniors don’t realize that insurance companies are looking to cut costs because the government reimbursement rates for Advantage plans are decreasing, said Janene Culumber, Moffitt’s chief financial officer. It means networks of providers are shrinking, and patients who want out-of-network providers and facilities will pay a larger portion of the final bill.

About 2,500 of Moffitt’s 60,000 patients are UnitedHealthcare Medicare Advantage policyholders. Before this year, their claims for in-network care were approved though an informal short-term agreement between Moffitt and the insurer.

Now many of those policyholders, including those in the midst of cancer treatment, are looking for new plans, Culumber said. A letter has been sent to all of those patients about the change, and the hospital has set up a Web page linking patients to plans that include Moffitt in their network.

“We’re definitely hearing from them,” she said. “They’re frustrated.”

Pittman said the Hillsborough Medical Association is urging its doctors to contact their patients if they have been dropped from any Medicare Advantage plans. He said patients need to know it’s the insurance company cutting ties, not the physician.

“Just re-enroll in a plan where your doctor is included,” Pittman said.

The Florida Medical Association is so concerned about the number of people dropped from UnitedHealthcare plans this year that it wants the Centers for Medicaid and Medicare Services to investigate. The group sent a letter recently to Florida’s congressional delegation alleging the changes limit patients’ access to a “network of appropriate providers.”

Nearly 1.2 million of the 3.5 million Medicare beneficiaries in Florida in 2012 had Advantage policies, Kaiser Family Foundation research said. The remaining 2.3 million opt for what is referred to as “original” Medicare, which may cost less but often includes fewer medical benefits and options.

In the past, government reimbursements for Advantage plans were higher than those for original Medicare, as a way to entice private insurance companies to insure seniors. But shrinking reimbursements, coupled with higher health care costs, are forcing insurance companies to adjust, UnitedHealthcare spokeswoman Jessica Pappas said.

The changes to these Tampa-area Medicare Advantage plans, however, don’t deny patients access to quality care, she said.

“We feel that our members in need of cancer treatment can receive appropriate care at the hospitals that participate in our network,” Pappas said in an email. “For especially unique cases and for members in need of transitional care, we will continue to process claims at the in-network rate when members access care at Moffitt.”

The local Medicare enrollment hotline is hearing from a lot of the UnitedHealthcare customers, said Lee Champagne, a volunteer counselor with the Area Agency on Aging program known as SHINE. Though the changes this year are limited to just a few Advantage plans, seniors are worried.

“For a lot of them, there’s a fear factor,” he said of the changes. “They are worried about the future.”

It’s also intimidating to review all the different plan options under Medicare and Medicare Advantage, Champagne said.

In 2014, the 71 plans available in Tampa include 13 Humana Advantage plans, four Advantage plans from Florida Blue and eight from UnitedHealthcare, including several that are part of the popular AARP MedicareComplete product.

That’s why Champagne suggests seniors ask volunteer SHINE counselors for help sorting it out. In Florida, the free service can be reached by calling (800) 96-ELDER [(800) 963-5337].

“Some people just don’t want to do anything that rocks the boat,” Champagne said.

“But it’s astronomical how much they can save if they just shop around.”

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(813) 259-7365

Twitter: @MaryShedden

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