2011 Medicare Advantage Changes

Six months ago I was predicting big changes for Arizona Medicare Advantage plans in 2011.  I was wrong.  There will be very few changes to most of the Arizona Medicare Advantage plans in 2011. Most HMO plans still have $0 premium.  Co-pays for doctor visits and hospital stays have not changed much. Plans are still offering free gym memberships.  Some Advantage plans are being canceled and this will require about 2000 people in southern Arizona to find a new plan.  Plan cancellations are more about the “business model” of the canceled plans than changes brought about by health care reform.


Every Medicare Advantage plan must cap enrollees’ out-of-pocket expenses. This means all the co-pays for doctor visits, hospital stays, chemo and radiation treatment, and other services (when added up during the year) are capped at a certain limit for that year.  The highest allowable maximum-out-of-pocket (MOOP) is $6,700, but most plans have set their MOOP at $5,000 or less. $3,400 is the lowest MOOP being offered by two companies.

Relief in the Part D Donut Hole: In 2011, if a person reaches the donut hole, he will get a 50% discount on the price of his brand drugs and a 7% discount on generics.  A person reaches the donut hole when what the enrollee and the Part D plan have spent (added together) totals $2,840.  If a person has total monthly drug costs of $400 (even if his co-pays are just $100), he would hit the donut hole after 7 months ($400 x 7 = $2,800). Starting in August he would be responsible for 100% of his drug costs ($400), but he will get a 50% discount if these are brand drugs.  Thus he would pay only $200 for his brand name prescriptions each month from August to December.

A new Medicare Advantage plan in Pima County: SCAN (Senior Care Action Network) is a California-based not-for-profit which began operating in Maricopa County two years ago. They say they will have a good doctor network in Pima County, though that could take some time to accomplish.  Their Part D drug plan could make it worthwhile to look into SCAN as it will cover generics through the gap. I’ve met some people with expensive generics that put them in the donut hole.


The Annual Election Period (November 15 – December 31) will be the only time to change your Medicare Advantage plan or Part D plan.  In previous years seniors had another chance to switch Advantage plans during the Open Enroll Period from January 1 – March 31. The Open Enrollment Period has been eliminated.  If a person decides in January that she doesn’t like her Advantage plan….too bad.  She cannot change to another Advantage plan – but she can dis-enroll from her plan and go back to Original Medicare (between January 1 and February 14).  She would probably want to purchase a stand-alone Part D plan as well as a Medicare Supplement, both of which have monthly premiums. As of February 15th she is “locked into” her advantage plan unless she qualifies for a special enrollment period due to certain chronic illnesses, limited income subsidy, or moving out of her plan’s service area.

A number of plans are being canceled for 2011 and people enrolled in them will have to shop for a new Advantage plan – or go back to Original Medicare, get a stand-alone Part D plan and a Medicare Supplement.  See my recent post about “guaranteed issue” for Medicare Supplements if your Advantage plan is canceled: http://tucsoncitizen.com/medicare/2010/09/27/medicare-advantage-cancellation-your-options/

Health Net’s Amber plan is changing to a “Dual Eligible” Advantage plan.  The Amber plan has always been a plan for people who get their co-pays covered by AHCCCS (Arizona Health Care Cost Containment System, aka Medicaid).  But the Amber plan has also covered people who had incomes less than $1,240 (single) or $1,660 (couple) if they applied for Medicare Cost Sharing help.  These seniors on limited incomes (but not low enough to qualify for Medicaid) have been helped by the low co-pays that came with the Amber plan.  As of January 1, 2011, the Amber plan will have 20% co-pays (which will be paid by AHCCCS for “full duals”). That means that people who do not get their co-pays paid by AHCCCS will need to shop for another Medicare Advantage plan. Unfortunately,  most Advantage plans have co-pays that are double the Amber co-pays.  Seniors who have to move off the Amber plan will face sticker shock as their co-pays double for doctor visits and hospital stays. They will still get help with their prescription costs. There is one plan in Tucson with co-pays similar to the Amber plan, but it has a limited doctor network.  People leaving the Amber plan will have to choose between plans with a bigger network of doctors and hospitals or a plan with low co-pays and a limited network.


What Next?

Related Articles

6 Responses to "2011 Medicare Advantage Changes"

Leave a Reply

Submit Comment