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Originally published Sunday, November 7, 2010 at 10:01 PM

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Departing Medicare Advantage plans leave 40,000 seniors seeking coverage

Dozens of Medicare Advantage plans are no longer being offered in Washington state, leaving more than 40,000 seniors in search of new plans.

Seattle Times health reporter

Medicare parts and options

Medicare Part A: Hospital insurance, hospice care and some home health care.

Medicare Part B: Medical insurance covering doctor visits, outpatient care, physical and occupational therapists and some home health care.

Medicare Part C: Medicare Advantage plans, an alternative way to get Parts A and B, often along with other services. The government pays a private insurance company to manage care; clients can add prescription-drug coverage if it is not already included. Because many of these plans are no longer being offered in Washington, many seniors have to find different Advantage Plans or opt for traditional Plan A and B coverage.

Medicare Part D: Prescription-drug coverage — an option for those enrolled in Part A or B.

Source: Washington State Office of the Insurance Commissioner

For more information:

Medicare Advantage plan leaving? Here's help:

Washington Office of the Insurance Commissioner's SHIBA site: www.oic.wa.gov/shiba/index.shtml or call toll-free number 1-800-562-6900.

Center for Medicare and Medicaid Services: www.medicare.govor 1-800-MEDICARE (1-800-633-4227) or for TTY, 1-877-486-2048.

CMS "find-a-plan" site: www.medicare.gov/find-a-plan/questions/home.aspx

Medicare's "Extra Help" for prescription-drug costs for low-income: www.socialsecurity.gov/prescriptionhelp/ or 1-800-772-1213 and ask about the "Extra Help" program.

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The exodus of dozens of Medicare Advantage plans from various counties or from the state entirely is leaving 40,588 seniors across Washington to wade through charts in search of new plans.

In some counties, most Medicare Advantage plans no longer will be offered, leaving patients with little choice. Some will opt to fall back on "original" Medicare, paying additional premiums for a prescription-drug plan and a supplemental "Medigap" plan, and likely forgoing some of the extras many Advantage plans provided.

Offered by private companies, Advantage plans combine original Medicare services and often offer drug coverage and such extra benefits as eye or hearing exams, dental care, wellness classes or health-club membership.

Some also require extra premiums and, until now, have had extra payments from the federal government. But those subsidies are being phased out.

All seniors can change plans between Nov. 15 and Dec. 31, and are encouraged to review plans to see if the one they're in works for them.

Those whose Medicare Advantage plans have left their areas should have been notified, and have until Jan. 31 to change. However, the state Insurance Commissioner's Office advises signing up before Dec. 31 to make sure there's no break in coverage.

Although Medicare Advantage (MA) plans come and go every year, turnover here and nationally is much higher this year than last, when almost 18,000 Washington residents lost their plans.

Stella Ng, regional trainer for the Office of the Insurance Commissioner's Statewide Health Insurance Benefits Advisors (SHIBA) Helpline, said that while only about 7 percent of Advantage enrollees in King County are losing their plans, more than 94 percent of those enrolled in Chelan County will have to find new plans for next year.

Insurers canceling plans here, mostly for-profit companies, are responding to changes in Medicare rules and the new federal health-care law's timetable for cranking down MA reimbursements to original Medicare levels.

According to the state Insurance Commissioner's Office, UnitedHealth Group cancellations affected the largest number of seniors — nearly 16,000 Washington residents.

In a statement, the company said it examines many factors each year, including local-provider networks, reimbursement rates, regulatory changes from the federal government and "other local market dynamics" to decide whether to continue plans in particular areas.

One change that affected many plans was the Medicare Improvements for Patients and Providers Act of 2008, (which was not part of this year's federal health-care changes, said Stephanie Magill, spokeswoman for the local office of Centers for Medicare & Medicaid Services (CMS).

For 2011, for the first time, most private fee-for-service Medicare Advantage plans must formally sign up doctors and clinics to create a provider network, whereas before they did not have to do that, Magill said.

Other consumer protections encouraged consolidation of similar plans offered by the same company and limited out-of-pocket expenses, CMS said. For 2011, plans must limit patients' out-of-pocket expenses to $6,700 for all in-network hospital and outpatient services normally covered under original Medicare.

This year's federal health-care bill added some benefits, such as free wellness visits and health screenings, and discounts on brand-name drugs for seniors in the drug-coverage gap known as the "doughnut hole."

Most other changes from the federal law, including payment reductions, won't begin until 2012, Kaiser noted. In 2014, plans must spend at least 85 percent of total premiums on care.

Nationwide, on average, 2011 premiums will be a bit lower than last year, CMS says, and most enrollees should find little or no change in benefits.

Around the country, all but 2,300 Advantage patients will be able to enroll in a different Advantage plan, according to CMS statistics. Last year, 86 percent of those whose plan wasn't renewed joined another MA plan.

Ng, the SHIBA trainer, cautions Washington seniors switching plans to read the details carefully, factoring in the particular drugs they're taking as well as co-payments and deductibles — not premiums alone. "Sometimes, they see low premiums, but the out-of-pocket expenses can be huge."

Seniors should also check that their doctors accept the plan, she advised.

Seniors whose Medicare Advantage plan is no longer available have some special rights, Ng noted, including being able to buy Medigap, or supplemental, policies without health screenings.

Low-income seniors may be able to get extra help with premiums or drug costs.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

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