Massachusetts Health Stats

Public Part C Medicare Advantage Plan Monthly Costs Jump 20%-30%, up to 100% on Cape Cod, Massachusetts

(For more on the national implications of health care reform on United States Medicare, and information on other Medicare issues, see theabcsofmedicare blog here.)

Once we saw the large size of the Obama administration cuts in public Part C Medicare health plan capitation fees back in September, there was no question where we were headed. I knew personally that my own Worcester-County-Massachusetts plan from the Democratic Party's Tufts Health Insurance organization was going up about 10% in price. As of the October 1, 2015 release of the Medicare Plan Finder and organization of the data by research organizations such as q1medicare.com, I now begin to see the bigger picture: compared to my friends on Cape Cod, my 10% monthly increase wasn't that bad.

(This Cape Cod group is not ready for Medicare yet but I like to show off their photos and brag about them all.)

Whereas Obama administration propaganda says things such as:

 "...the average Medicare Advantage premium will go up for 2015 by about $1.30 (a month)... CMS says most plan members will not see any increases."

...it is more accurate to go by what has actually happened in the real world. In Barnstable County MA, which basically means Cape Cod as we all think of it (over the bridges but not the Islands) plus the area off Cape up to Manomet, the monthly cost of the three most popular Medicare Advantage plans (accounting for about 60% of Cape Medicare Advantage beneficiaries) has gone up as follows:

1. Tufts Medicare Preferred HMO Basic Rx -- Held the monthly premium the same at around $36 but raised drug deductible from zero to $150 for an effective 33% monthly increase
   
2. AARP Medicare CompleteChoice PPO -- premium up 33% from $30 to $40  a month, a lot more than $1.30, with the drug deductible up from zero to $255 adding another possible $20 to the base monthly expense for a nice round 100% increase
   
3. Medicare PPO Blue PlusRx -- The annual drug deductible went up to $200 from $0 and the monthly premium went up 24%, from $124 to $153. Combining those two factors alone -- before we know what Blue Cross of Massachusetts did to co-pays -- the typical increase is $50 more a month -- not $1.30

The good news for the rich people on Cape Cod: two very expensive Tufts Part C plans with premiums between $150 and $200 a month only went up a few dollars a month each. But the poor and middle-class seniors that disproportionately use Medicare Advantage on the Cape and in other rural areas are not buying those very expensive plans.  (And I would guess those rich are overpaying, which I would think would drive them crazy.)

This game with averages played by Obama's minions is one way the government gets to claim everything is fine while the lower middle class seniors dependent on these Part C plans pay more for their health coverage so people not yet on Medicare -- some making over $60,000 a year -- can get large income tax breaks from the Federal government.

NOTE: No-drug-coverage and Medicare/Medicaid Medicare Advantage plans in Barnstable County were not compared year over year in detail but a quick scan indicates similar effective double-digit increases.

Massachusetts AARP President Wrong about Medicare in Massachusetts

(For more on the national implications of health care reform on United States Medicare, and information on other Medicare issues, see theabcsofmedicare blog here.)

There is a misleading article appearning in Massachusetts media written by the President of the AARP of Massachusetts. Here is an example. There are some errors in the article (or at least misleading statements):

1. AARP says

“This is the one chance the nearly 1 million Medicare beneficiaries in Massachusetts have to review and make changes to their coverage for the year ahead.”

That is not correct. Only about 300,000-400,000 of us on Medicare in Massachusetts need to make a decision in the Oct-Dec timeframe. The rest of us have

• Retiree insurance and our open enrollment is whenever our former employer or our union says it is (which may be now but not exactly the same dates as those of us who buy supplemental Medicare insurance individually or it may have already passed)
• Social Security Extra Help (we can change any time)
• Prescription Advantage (we can change one other time during the year)
• Medicaid as well as Medicare (we have a whole separate set of rules).

So more than 600,000 of us can or must review and make changes at other times, not the upcoming time frame (because over 50% of us are eligible for Prescription Advantage).

2.        AARP says during “open enrollment” a person can drop their

“Medicare Advantage plan and return to Original Medicare.”

This is not correct. A person in Massachusetts on public Part C Medicare Advantage never leaves Original Medicare. In fact, you cannot get Medicare Advantage unless you first have Original Medicare. Medicare Advantage is never about leaving (or returning to) Original Medicare; it is about supplementing Original Medicare with a managed care plan such as Medicare Advantage or supplementing Original Medicare in some other way, typically private retiree indemnity insurance or a private Medigap fee for service policy.

3.        AARP say:

“In some cases, if you drop your coverage, you may not be able to get it back.”

It is unclear what AARP means by this but I suspect the person from AARP is using a national form letter.

-- If he or she means drop your coverage and “never get it back,” that is not true in Massachusetts. It is true that if you are talking about Part C plan – not all are called Medicare Advantage by the way – and you are part of the minority of us not on Socal Security Extra Help or eligible for Prescription Advantage, you will have to wait until 2016 to get it back. But you can get it back then.

--  And if -- as I suspect -- AARP is talking about a Medigap plan, Massachusetts has continuous open enrollment. You can get it anytime.

Is Every Phone Call about Medicare in Massachusetts a Scam?

(For more on the national implications of health care reform on United States Medicare, and information on other Medicare issues, see theabcsofmedicare blog here.)

There is a story circulating, particularly in Western Massachusetts, about a Medicare phone scam. The link is to a local TV station but I have seen similar information on Facebook and on the web site of the Springfield Republican newspaper.

This may not be a scam. I have no idea what the TV reporter means when he or she writes

"Police explain that Medicare has confirmed these calls are not coming from them and will not call subscribers."

 

Did the reporter not understand what the police are saying or are the police wrong or is there really a scam? This little article appearing in multiple places will cause harm to the senior community if someone in the media doesn't do the right thing and get more information.

Here are some possibilities:

1. It is true that Medicare "will not call subscribers" if by Medicare the reporter and/or the police means the Centers for Medicare and Medicaid Services (CMS). That's because claims from people with fee for service (FFS) Medicare in Massachusetts -- typically with a supplement such as Blue Cross Medex Bronze -- are handled by the Wellpoint Insurance Company of Indiana, which subcontracts some of its Massachusetts work to the National Heritage Insurance Company of Dallas with its local office in Hingham. It is virtually certain that none of these three private insurance companies (Wellpoint, National Heritage, or Blue Cross) would call a senior about a Medicare FFS claim. They deal with the providers and then each other and just send Medicare beneficiaries through the mail those mounds of paper they get after they go to the doctor's or hospital. But the fact that it is these insurance companies that handle FFS Medicare claims -- not CMS -- that means "Medicare" will not call subscribers. And Blue Cross or whomever sells a senior his or her supplemental so-called Medigap insurance might call him or her for some marketing purpose.
2. But people on Medicare with CMS-approved capitated Part C Medicare health plans are called by their insurers all the time. That applies to about 20% of the people on Medicare in Massachusetts. Examples include Health New England, Tufts and others. And some of the insurance companies -- like Blue Cross -- that sell supplemental policies to FFS Medicare beneficiaries also sell Part C Medicare health plans.
3. Some of these CMS-approved capitated Part C Medicare health plans do make house calls as part of their efforts to control health care costs. Typically it would be a nurse or PA and not a doctor who would come to the house. But it is possible that this is the source of the phone calls, not scammers.

I agree seniors should be leery about any phone calls but I don't see the scam here; nothing in the story says they asked for a Medicare number or credit card number. There is not much money in door-to-door scamming. But my overall point is simply that the media ought to get the story straight before printing something like this short uninformative article that will do nothing but possibly unnecessarily scare seniors.

Huge Increases -- Up to 100% -- in Boston, Massachusetts Medicare Advantage Monthly Costs for 2015

(For more on the national implications of health care reform on United States Medicare, and information on other Medicare issues, see theabcsofmedicare blog here.)

Once we saw the large size of the Obama administration cuts in public Part C Medicare health plan capitation fees back in September -- and saw that Boston took the biggest hit -- there was no question where we were headed. I knew personally that my own Worcester-County-Massachusetts plan from the Democratic Party's Tufts Health Insurance organization was going up about 10% in price. As of the October 1, 2015 release of the Medicare Plan Finder and organization of the data by research organizations such as q1medicare.com, now we begin to see the bigger picture. It ain't pretty, especially in Boston.

Whereas Obama administration propaganda says things such as:

 "...the average Medicare Advantage premium will go up for 2015 by about $1.30 (a month)... CMS says most plan members will not see any increases."

...it is more accurate to go by what has actually happened in the real world. In Suffolk County MA, which basically means Boston, the monthly cost of four of the five most popular Medicare Advantage plans (accounting for about 80,000 of the 124,000 Medicare Advantage beneficiaries in the county) has gone up as follows:

1. United Healthcare Senior Care Options SNP -- Premiums up from $13.50 to $22.90, a lot more than $1.30
2. United Healthcare (AARP) Medicare CompleteChoice PPO -- premium up 33% from $30 to $40  a month, a lot more than $1.30, with the drug deductible up from zero to $255 adding another possible $20 to the base monthly expense for a nice round 100% increase
   
3. Tufts Medicare Preferred HMO Basic Rx -- Held the monthly premium the same at around $56 but raised drug deductible from zero to $150 for an effective 20% increase
4. Medicare PPO Blue PlusRx -- The annual drug deductible went up to $200 from $0 and the monthly premium went up 24%, from $124 to $153. Combining those two factors alone -- before we know what Blue Cross of Massachusetts did to co-pays -- the typical increase is $50 more a month -- not $1.30
5. Medicare HMO Blue PlusRx -- The annual drug deductible went up to $200 from $120 and the monthly premium went up 16%, from $167 to $193. Combining those two factors alone -- before we know what Blue Cross of Massachusetts did to co-pays -- the typical increase is $35 more a month -- not $1.30

No plans appear to have gone down in monthly cost effectively or even absolutely but two very expensive Tufts Part C plan premiums were held at about the same rates up near $200 a month. The poor middle-class seniors that disproportionately use Medicare Advantage are not buying those plans; it must be the rich people in Beacon Hill and in West Roxbury. 

This game with averages played by Obama's minions is one way the government gets to claim everything is fine while the lower middle class seniors dependent on these plans pay more for their health coverage so people not yet on Medicare -- some making over $60,000 a year -- can get large income tax breaks from the Federal government.

NOTE: No-drug-coverage and Medicare/Medicaid Medicare Advantage plans in Suffolk County were not compared year over year in detail but a quick scan indicates similar effective double-digit increases.

Public Part C Medicare Advantage 2015 Monthly Costs Through the Roof in Worcester County, Massachusetts

(For more on the national implications of health care reform on United States Medicare, see theabcsofmedicare blog here.)

Beginning a few weeks ago, we began to see the effects of the cuts to Part C Medicare health plans in Massachusetts mandated by the Patient Protection and Affordable Care Act of 2010 as amended. We saw Part C Medicare Advantage plans being dropped in Northern New England and I knew personally that my own Worcester-County-Massachusetts plan from the Democratic Party's Tufts Health Insurance organization was going up about 10% in price. As of the October 1, 2015 release of the Medicare Plan Finder and organization of the data by research organizations such as q1medicare.com, now we begin to see the bigger picture. It ain't pretty.

Whereas Obama administration propaganda says things such as:

 "...the average Medicare Advantage premium will go up for 2015 by about $1.30 (a month)... CMS says most plan members will not see any increases."

...it is more accurate to go by what has actually happened in the real world away from the Goebbels' disciples who work for President Obama. In Worcester County MA, my legal residence, the monthly cost of the three most popular Medicare Advantage plans (accounting for about 50% of the Medicare Advantage membership in the county) has gone up as follows:

1. United Healthcare (AARP) Medicare CompleteChoice -- premium up 33% from $30 to $40  a month, a lot more than $1.30
2. Medicare PPO Blue PlusRx -- The annual drug deductible went up to $200 from $0 and the montly premium went up 24%, from $124 to $153. Combining those two factors alone -- before we know what Blue Cross of Massachusetts did to co-pays -- the typical increase is $50 more a month -- not $1.30
3. Medicare HMO Blue PlusRx¹ -- The annual drug deductible went up to $200 from $120 and the monthly premium went up 16%, from $167 to $193. Combining those two factors alone -- before we know what Blue Cross of Massachusetts did to co-pays -- the typical increase is $35 more a month -- not $1.30

No plans appear to have gone down in monthly cost effectively or even absolutely (not counting the fifty cent monthly decrease I wrote about on September 21) but a few Part C plan premiums were held at the same rate. But raising the annual drug deductible by $100 or more a month, makes the same premium actually 10% to 20% higher in the typical case.  

In Worcester County, Massachusetts, Medicare Advantage is used disproportionately by the urban and rural lower middle class and minorities. This game with averages played by Obama's minions is one way the government gets to claim everything is fine while the lower middle class seniors dependent on these plans pay more for their health coverage so people not yet on Medicare -- some making over $60,000 a year -- can get large income tax breaks from the Federal government.

NOTE: No-drug-coverage and Medicare/Medicaid Medicare Advantage plans in Worcester County were compared year over year in detail but a quick scan indicates similar effective double-digit increases.

¹This plan is listed on q1medicare.com as the third most popular normal (non-Medicare/Medicaid) plan but is not listed on Medicare Plan Finder for either year as of October 1, 2014

UPDATE: Massachusetts Seniors: Double Digit Increase for Tufts Medicare Preferred Part C Plans

Updated on October 1, 2015. The original September 21 post was amended on October 1 to reflect my actual receipt from the Massachusetts Democratic Party's Tufts Insurance Company, where I get my personal Medicare coverage because that's what my doctor accepts, of my Annual Notice of Change and 2015 Evidence of Coverage (that is, government speak for my insurance policy). The annual drug deductible mentioned in the September 21 post applies to only Tier 3-5 drugs. That might lower my rate increase depending on my one-off drug needs in 2015. On the other hand, other co-pays were increased substantially. 

This is why we hate healthcare insurance companies.

As per a post on Friday September 19, and more Massachusetts Part D detail that became available on September 21, the news is not good for Massachusetts Medicare beneficiaries who use a standalone Part D drug plan¹. But it's too soon to tell a lot about all of the 20% of us Massachusetts Medicare beneficiaries on public Part C Medicare Advantage and other Part C health plans. In my opinion it does not look good for that group of us either looking quickly at my own plan.

And watch for the tricks your insurance company might play. Mine - Tufts -- has a doozy. Based on a public website called HealthPocket that has begun analyzing the Part C Medicare numbers nationwide, my personal health plan premium actually went down a half a buck a month... Wow that's good news you say. BUT wait! It also looks like Tufts added a $100 annual deductible in 2015 for my Tier 3-Tier 5 drug costs where there is no annual deductible this year. That's more than an $8 a month premium increase from $65.60 or a 12%-13% raise.

Can't entirely blame Tufts though. Because of the Patient Protection and Affordable Care Act of 2010 as amended -- better known as Obamacare -- Tufts is now building a large tax into my monthly premium to pay for healthcare for people that have not yet joined Medicare. 

¹Typically if you have a standalone drug plan you have an individually purchased Medigap plan (e.g., Blue Cross Medex Bronze) as a supplement or you receive retiree healthcare insurance from a former employer

Massachusetts Seniors: Double-Digit Monthly Price Increases as High as 37% for Five Most Popular Part D Drug Plans in Massachusetts

As per a post on Friday September 19, the news is not good for Massachusetts Medicare beneficiaries who use a standalone Part D drug plan. The monthly prices are up dramatically for the five most popular plans and benefits are decreased at least in terms of higher or new deductibles (details on co-pays and formularies are not available yet and those details might bring even worse news):

• AARP MedicareRx Saver Plus -- Up 27% to $27.40 a month; still has deductible before benefits begin; co-pays not yet known
• AARP MedicareRx Preferred -- Up 19% to $48.20 a month; no deductible; co-pays not yet known
• Blue MedicareRx Value Plus -- Up 21% to $40.30 a month; now has $320 annual deductible before benefits begin; co-pays not yet known
• Humana Preferred - Up 17% to $26.70 a month; deductible up to $320 befoe benefits begin; co-pays not yet known
• Wellcare Classic -- Up 37% to $30.70 a month; now has $320 annual deductible before benefits begin; co-pays not yet known

Source: q1medicare.com as of Friday afternoon September 19

Massachusetts residents in these plans are going to have to look hard at the detailed benefit structure and formulary on medicare.gov when available and make sure these are still the right plans for you.

Open enrollment in a different plan happens between October 15 and December 7 effective January 1, 2015 or at any time if on Social Security Extra Help effective the first of the following month. Anyone on Massachusetts' Prescription Advantage program can change once during a calendar year in addition to during open enrollment; many people making up to $55,000 a year in retirement are eligible for Prescription Advantage¹.

¹Prescritpion Advantage is a Massachusetts state program and always subject to modification.

Massachusetts Seniors: 2015 Part D Drug Plans in Massachusetts To Cost 17% More on Average, Choices and Benefits Being Slashed

The details of county-by-county Part D and Part C plans for Medicare beneficiaries are beginning to dribble out nationwide... and Massachusetts is along for the ride. There is no easy answer of what your circumstances will be because the comparisions are different for every person depending on their drug needs and preferred pharmacy -- if any -- and different for every county (because -- from among many reasons -- not all plans are necessarily available in all counties).

• The spin from the Obama administration is roughly "Things will not be too bad if you think about switching plans.¹" It's a bad sign that the government is saying things like that.
• The spin from the healthcare press is "Make sure you look at the weighted numbers, not the averages that the Obama administration highlights." But even the weighted numbers do not mean bad news for everyone.
• Massachusetts' politicians are not saying anything yet; they just came home to Massachusetts (except for Markey who doesn't live here) to ask for your vote but since no elected Federal official is facing any kind of real contest for re-election in Massachusetts, there's nothing you can do to them no matter how mad you get when you see your new 2015 Part D premium prices online early in October. 

As an example of how it works, compare the lowest cost Part D plans in the state. According to the first web site that has run the numbers released by the Medicare bureaucracy on September 18, 2014, the cheapest plan in Massachusetts -- Humana Walmart -- will cost $15 and change a month in 2015 whereas the cheapest plan in 2014 cost under $13 a month, a 24% increase.  But the price for the most expensive plan went down.  But those prices aren't for the same plan. The most expensive at $126 a month this year is Silverscript Plus. In 2015, the most expensive is a Cigna plan at a $123 a month. (And maybe Silverscript's price went down. Or maybe it went out of the market.)

As for that weighted average: up 17% in Massachusetts. And there are only 27 plans available in 2015 versus 33 in 2014 (they think you are stupid so they reduced the choices you have to make). More standalone Part D drug plans in Massachusetts will have an initial spending deductible in force in 2015 than this year (meaning most people pay a monthly premium and also pay the full cost of the drugs for most of the year, getting no benefit for paying the monthly premium).

It is very hard to connect the dots but these higher prices and decreasing benefits for 95% of us are pretty much the result of closing the donut hole for 5% of us. Is that fair? That's a different, almost moral question.

¹The Obama administration is saying roughly the same thing about public Part C Medicare health plans except the President recommends switching doctors or accepting higher out of pocket annual spending limits. More to come in future posts.

Is Pioneer Institute Right That Deval Patrick and the Massachusetts Healthcare Connector Authority Wasted $1 Billion?

Josh Ambichault of the Pioneer Institute says "the cost (of trying to get Obamacare insurance up and running in Massachusetts) was a billion dollars." The state says "it is only a few hundred million but Obama is paying for it so what's the issue?" The Patrick administration could refute the Pioneer Institute very easily without the vicious name calling from the governor (phoning it it from his his latest junket in Europe) and his lackeys.

The Pioneer Institute report has a list of 59 specific line items that add up to over a billion dollars. If Pioneer's numbers are not correct, what are the correct numbers, Governor? Pretty simple.

I have a different take. I believe that if we wasted just $1, it was still a waste. This Globe story on the quite revealing attack on Ambichault began:

"When the website that thousands of people in Massachusetts use to shop for health insurance failed disastrously, the recovery was bound to cost a lot of money."

This whole debacle -- going back to the other (RomneyCare) exchange  and (Romneycare) reform laws that Josh supported (even worked on, I think) -- only helped a few "thousands" of people out of the 6,500,000 people who live here. In 2007, between 1% and 2% of the population were given free or subsidized Medicaid lite at great expense and now most of that group has been moved to regular Medicaid. Another couple of percent who had not previously qualified for Medicaid were given Medicaid outright beginning in 2007. MassHealth could have handled all that without all the other changes to the law and roiling of the market and higher premiums and higher wait times at doctors and on and on that the goo goos foisted the other 96% of us in Massachusetts.

Massachusetts' Medicare Advantage Payments Cut Drastically for 2015; Expect Large Premium Increases or Fewer Benefits; Boston Hit Hardest

It looks like Massachusetts got hit hard by the Obama administration 2015 cuts to public Part C health care plans as mandated by the Patient Protection and Affordable Care Act of 2010 (Obamacare) as amended.

 

On an apples to apples basis -- comparing plans that would have received no bonus this year and would receive none next year -- it looks like the cuts are as high as 7% in Boston (and Chelsea) with no cut in the Berkshires. But all leading Massachusetts insurers participating in Part C are good enough to receives a bonus so I tried to compare a 2014 4-star plan to a 2015 mid-level quality plan (but note that Health New England is one of the top 20 plans in the country). No matter how you cut it, there will be cuts because the worst capitation rate in 2014 is still better than the best in 2015.

It's hard to compare 2015 with 2014 because as usual the Federal government changed formats in how it presented the final county by country capitation fee amounts¹. And capitation-fee cuts do not automatically mean the affected insurers -- primarily Blue Cross, Fallon, Health New England and Tufts (and to a much lesser degree Harvard) -- will raise premiums proportionately. They may also reduce benefits, raise co-pays or raise the annual out of pocket (OOP) spending limit, or do a combination of all of the above.

It is hard to see how they could not do at least some of the above because they are all non-profit organizations and are already running a tight ship (ha ha).

¹The Obama administration formatting -- perhaps intentionally -- is so confusing that perhaps I have it bass ackwards. But I don't think so. Also, as I have posted often, I beleive the differences between per-person Part C captiation fees and traditional fee for service per-person average payments should be equal. But these cuts -- if they translate proportionally -- will probably but Part C enrollees back at the disadvantage they suffered prior to 2005.