Medicare Advantage Network Chaos

As a broker, I think there is Medicare Advantage network chaos in Tucson.  My head is spinning trying to remember which doctors are no longer with which plans.  But my clients don’t seem very concerned about their Medicare Advantage plan being cancelled, or being told they must change their Advantage plan if they want to keep their doctor(s).

Several Medicare Advantage plans in Pima County are being cancelled for 2015 – but on top of that, several plans are changing their networks, or losing large doctor groups.  It’s one thing to help my clients change to another Medicare Advantage plan, but it is more difficult because of the Medicare Advantage network chaos.

Yesterday I had my third visit with Frances (not her real name) who is 90 years old.  Frances received a letter saying her Health Net Ruby 1 plan is being cancelled as of December 31st, 2014.  During visits 1 and 2, we talked about Frances going back to original Medicare and getting a supplement with guaranteed issue. By moving back to “original Medicare”, she  would not have to worry about doctor networks.  (See my recent post: http://medicareblog.org/medicare-supplement-guaranteed-issue/)

Frances has decided that a supplement (Plan N for $163 per month) plus a drug plan ($18 per month) is too much money to spend each month – and the process is too complicated.  She keeps talking about “Medicare Complete” and how it combines drug coverage with Medical coverage for no premium.  I explained to her the pros and cons of “Medicare Advantage” as compared to Medicare + a supplement + Part D. I then looked at the “Medicare Complete” plan which is being heavily advertised in Tucson.  Keep in mind that Frances has been enrolled in Medicare Advantage for at least 10 years.

I checked her doctors and they are in this plan’s network. For some reason, we decided to call her primary care physician’s office to double check. It’s a good thing we did because the person we spoke with said the doctor is not taking “Medicare Complete” and he prefers that his patients return to “Original Medicare”.  I told the woman in the doctor’s office that the doctor is in the database for contracted physicians for this plan, so she said she would double check with her supervisor.

I told Frances we need to wait to hear from the doctor’s office as we don’t want her to enroll in a plan that does not include her PCP.  So I will see her for a fourth time when we hear from the doctor.  I think her PCP is in the network, but if he is not, then Frances has a problem – and the solution would be to go back to original Medicare and get a supplement + Part D.   Frances is one of my original clients from eight years ago, so I told her I’m happy to see her (four times!) to get her coverage settled.

UPDATE:  The doctor is in the network but takes no new patients in the Medicare Complete plan.  Since Frances is a current patient, she can change to the new Advantage plan and see the  doctor.

NETWORK CHAOS AND WRONG INFORMATION

ARIZONA COMMUNITY PHYSICIANS:  Health Net decided to cancel three of its Medicare Advantage plans in Pima County and continue with just one plan. That change must be affecting several thousand residents of Pima County.  On top of this, Health Net lost its contract with Arizona Community Physicians (ACP), a group of over 100 primary care doctors and some specialists.  ACP has sent letters to patients telling them about the change and that they  will need to move from Health Net to another  Advantage plan company if they want to keep seeing their primary care physician (PCP) or any other doctor with ACP.

NORTHWEST ALLIED PHYSICIANS (NWAP) seem to think they are no longer contracted with Health Net’s Medicare Advantage plan – but they are mistaken.  NWAP sent out a letter to all their patients with Health Net insurance to inform them that their contract with Health Net’s “COMMERCIAL INSURANCE”  will end as of December 15th.  Health Net says this does not apply to their Medicare Advantage contract, but NWAAP doctors’ office staff don’t seem to know this.

THE UNIVERSITY OF ARIZONA HEALTH NETWORK has mailed and emailed patients who have Humana’s Medicare Advantage HMO plans to advise them they University of Arizona Medicare Center and University Physicians will no longer be contracted with Humana. Over 400 patients will need to change their Advantage plan if they want to keep seeing their doctor(s).

SCAN has decided to change its network and focus on Arizona Community Physicians for their primary care doctors.  That means anyone in SCAN whose PCP is not with ACP, will be getting a letter.  These folks will also need to change their Medicare Advantage plan if they want to keep their PCP.  SCAN is also making changes to its netowork in Maricopa County and  I have clients there who have called me to say they got the letter.

I wonder how many thousands of people in Pima County are affected by these changes?  And I wonder how many people have not read their mail and do not know about these changes?  I have called all of my clients who are affected and some of them had no clue.  Some are losing plans and have not seen the letter from their doctor or their Advantage plan.

Lilo is another long-time client who has stayed with the same Advantage plan for years.  She is 95 years old and her husband died two years ago.  I called Lilo to tell her about her Medicare Advantage plan being cancelled and she did not understand me.  I said I would visit her and she said she had moved to an assisted living facility – but she could not remember her new address.  I asked Lilo to find a piece of mail so she could read me her new address and I will visit her today.  I can’t move Lilo to another plan if she doesn’t understand what I’m telling her, so I will ask her for her son’s phone number so I can talk to him.

If I had not been able to find Lilo, she would be returned to original Medicare when her Medicare Advantage plan ends on January 1st, 2015.  Then she would not have a drug plan and she would not have a Medicare supplement, or a Medicare Advantage plan.  Lilo and her husband had some savings and too much Social Security income to qualify for any financial help.  Lilo’s son would be in for a big surprise if his mother ends up with big medical bills, so I need to talk to him and explain Lilo’s options.

I wonder how many Lilos are out there?  And how many people are going to be very surprised in January when they realize their Advantage plan was cancelled, or their doctor is no longer contracted with their plan?  The full extent of the Medicare Advantage network chaos might not be known until 2015.

 

 

 

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