In Calaveras and eight other rural counties throughout California, seniors and those on disability will soon see a change to their Medicare coverage.
United Healthcare is withdrawing two Medicare Advantage Plans from Calaveras County, which will change the Medicare coverage of a total of 871 individuals. This includes the prescription drug coverage for 800 residents and no coverage for 71 others.
Jack Cheevers, communications director for Region 9 of the U.S. Centers for Medicare and Medicaid Services, emphasized that if an individual is enrolled in either of the Medicare Advantage Plans through United Healthcare, they will not be losing their Medicare coverage; they will be transitioned back to original Medicare. They will, however, still need to enroll in a separate plan for prescription drug coverage. This separate stand-alone prescription drug coverage is known as Medicare Part D.
United Healthcare will not renew its two Advantage plans in 2019 in Alpine, Calaveras, Colusa, Del Norte, Humboldt, Mendocino, Modoc, Plumas, Siskiyou and Trinity counties.
Health care can be confusing enough to navigate, and there are four different parts of Medicare coverage. Part A is original Medicare, and covers hospital visits; part B covers doctors’ fees; part C is known as the Medicare Advantage Plan, and covers parts A, B and D or only parts A and B, depending on which Advantage Plan is selected by the client. Part D covers prescription drugs.
Original Medicare covers parts A and B, but part B has a monthly fee of approximately $135.
Those who are affected by this change will have a special enrollment period from January 2019 to the end of February 2019 to elect Medicare part D for separate prescription drug coverage.
Medicare Advantage coverage typically includes extra forms of coverage, in addition to drug coverage, such as dental and vision. Individuals wanting insurance coverage for these types of items will have to pay an extra premium.
With the discontinuation of Medicare Advantage in Calaveras County, subscribers will need to enroll by the February deadline.
All affected individuals have the opportunity to choose a new Medicare plan during the annual enrollment period (AEP), which is from Oct. 15 to Dec. 7. They will also have an opportunity during the special election period (SEP) from Dec. 8 to Feb. 28.
Fred Gerard, broker for Gerard Insurance services in San Andreas, was personally affected by this recent change. A similar change in coverage happened 12 years ago when provider Anthem decided not to renew its Advantage plan locally. Gerard said all of his affected clients switched to the Medicare Advantage plan offered through United Healthcare.
Tuolumne County has been without an Advantage plan for 12 years. Amador has a couple, but they are HMOs, which have restricted networks, according to Gerard.
United Healthcare put an outreach program into place in October to inform members and to help guide them through the process of finding health care coverage that fits their needs.
“We are working with our members to ensure they understand these changes and the options available to them,” said Taylor R. Joseph, the associate director of external communications for United Healthcare.
According to Taylor, United Healthcare has nearly 1.2 million members who are Medicare beneficiaries in California. He confirmed that, although United Healthcare tries to keep its plans as stable as possible from year to year, the company made the difficult decision to close some of ita Medicare Advantage plans in 2019.
Part D plans and pricing can be compared on the Medicare website (medicare.gov). The plans include ratings based on overall user satisfaction.
“You want to pick the highest number of stars,” Cheevers suggested. “If you can pick four stars or five stars, pick those; better quality. Go for the highest star rating that makes sense for you.”
Cheevers recommended applicants make sure that their prescription drugs are covered. Individuals should also make sure that there is a pharmacy in the selected plan that is relatively close to where they live. Individuals can always call Medicare and tell representatives which drugs are on their lists to make sure those drugs are covered, especially if an individual requires name-brand medication, as sometimes there are exemptions.
Subscribers can also contact health insurance counseling and advocacy programs (HICAP). The nearest HICAP center is in Sonora, which serves Alpine, Amador, Calaveras and Mariposa counties. Unfortunately, HICAP did not receive notice of this change until Oct. 5, which did not allow time for the agency to reserve space or allow for time to conduct educational seminars for Medicare recipients.
Debby Schug, the local HICAP program manager, emphasized that if people have drug plans, they will need to take action and enroll in a plan before Dec. 31. “That’s the biggest problem we’ve seen,” said Schug.
Schug said her office is booked for appointments until January of 2019, due to the influx of appointment requests received. HICAP is also reliant on volunteers, who have been worn thin due to the volume of appointments they have completed, she said. Schug said that there are still appointments available in January and after.
The local HICAP office can be reached at 532-6272 from 8 a.m.-4 p.m., Monday through Friday.
Those needing help in signing up for a stand-alone prescription coverage plan can either do so at medicare.gov, or by calling 800-633-4227, 24 hours a day, seven days a week. TTY users should call 877-486-2048.
This article has been updated with the correct phone number for Medicare.