What’s going on with Tufts Health Plans’ strategy to serve seniors on Medicare in Massachusetts? It appears Tufts' politics is showing through the veneer of its supposedly unbiased status. It looks like Tufts, a non-profit insurer, is in the beginnings of an exit strategy from serving senior citizens on Medicare, perhaps preferring to concentrate on its new business serving non-seniors on Medicaid. That would certainly be consistent with the non-profit’s ideology – Tufts Health Plan executives are an extension of the national and state Democratic party. When it comes to how it can help or hurt seniors, Tufts, not surprisingly, appears to be fully embracing the Patient Protection and Affordable Care Act (PPACA), better known as Obamacare, which becomes fully implemented in 2014 and which guts major parts of Medicare and diverts Medicare funding (and nominal Medicare funds1) to Medicaid and other subsidies for non seniors.
To try to figure out what’s going on, you have to follow the bouncing ball.
On October 1, Tufts kicked 5,000 Worcester County, Massachusetts seniors off its Part C Medicare (also called Medicare Advantage) health plan. The apparent reason for the move – based on a letter Tufts executive James Roosevelt (yes, of those Roosevelts) sent the 5,000 seniors -- is to push senior citizens on to Tufts much more expensive totally private supplemental Medicare insurance (also called Medigap). The typical cost increase for an affected senior is from $48 to about $180 a month (2013 prices not available) in premiums, almost a 300% increase.
OK, that’s marketing. All’s fair in healthcare insurance marketing. There is no reason Massachusetts seniors have to stay with Tufts and pay its increased premiums. However many of the effected seniors may have to choose a more expensive plan IF they want to stay with their doctor. And many other seniors who want to keep a low priced premium – typically the poorer seniors that use Medicare Part C health plans disproportionately – will have to change doctors.
But the apparent Tufts marketing push to get seniors on to its expensive Medigap plans takes a strange twist. Seniors kicked off a Part C Medicare Advantage plan have an almost complete right to buy a Medigap plan for up to 62 days after their plan is terminated, no questions asked. But in the same Roosevelt letter that kicks the 5000 Worcester County seniors off Part C Medicare, Tufts highlights the following:
“Massachusetts also has an Annual Open Enrollment Period for Medigap that runs from February 1, 2013 through March 31, 2013. If you elect to buy a Medigap policy during this time, your coverage will be effective on June 1, 2013.”
So, seniors ask, am I going to lose coverage for months. Not necessarily, maybe there is another reason for the Democrat Roosevelt’s letter. I can hypothesize two possiblities:
- It looks as if, given Tufts’ strange wording, that some seniors might go without important supplemental health care insurance for up to five months. But they also can come back to Tufts -- outbound Tufts phone marketing people and robocalls are telling seniors -- and choose a different, “new” Tufts Medicare Part C health plan that costs 50% more than their current plan. “New” is in quotation marks because the “new’ Tufts Part C Medicare health plan in Worcester County strangely has the same name and approximately the same benefits as the plan that kicked off 5,000 seniors on October 1.
- Or, as mentioned above and to be clear, these seniors are under no obligation to deal with Tufts. They can move to another company. That actually might really be what Tufts wants; perhaps the Worcester Country cohort cost Tufts too much to service and wanted to get rid of these particular seniors. This could be considered a new high (or low, depending on your ideology) in Medicare markting, "reverse cherry picking."
Don’t know. The letter from Roosevelt says call the Department of Insurance (DOI) to explain the confusing Medigap open enrollment wording. It has been two weeks and I cannot get a satisfactory answer from DOI. All DOI will effectively say is “the letter is a bit confusing.” Ya think?
-- Dennis Byron
1 PPACA has new taxes associated with it that have the word “Medicare” in them but the money raised by these taxes never reaches the Medicare trustees but goes instead to be used for non-senior healthcare insurance.