In 2010 Medicare Open Enrollment Season, Seniors Concerned Over Costs and Choice

Tuesday, December 22, 2009 Health Insurance News
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SHELTON, Conn., Dec. 21 The 2010 annual enrollment period for individuals with Medicare plans ends Thursday, December 31. According to customer service specialists at Health Plan One, an online insurance brokerage and Medicare information portal, while seniors have been inquiring about plans' physician networks, changes to drug formularies, and plan eliminations and introductions in their states, the top three most discussed topics surround plan cancellations, premium increases and Medicare supplement alternatives.

"A year is a long time to wait to make plan changes, particularly in this economic environment," said Bill Stapleton, president and chief executive officer of Health Plan One, which provides online plan comparison tools for Medicare Advantage, individual and commercial health plans. "But, there is still time for seniors and their adult children to review benefits and make adjustments to address cost and coverage concerns."

What is the difference between Medigap and Medicare Advantage? - While Medigap and Medicare Advantage plans provide seniors additional coverage on top of Medicare Part A and Part B coverage, they offer uniquely different benefits. While Medigap - or Medicare supplement plans - typically have higher monthly premiums, these plans pay a member's share of the costs of Medicare-covered services thus eliminating or reducing out-of-pocket payments, including coinsurance, deductibles, preventive services and at-home recovery services. Enrollees would have to purchase a stand-alone Part D drug plan.

Under Medicare Advantage, seniors typically have lower monthly premiums with a Part D drug plan included but have some out-of-pocket expenses. They also have incentives for staying in health insurers' provider networks. Seniors also receive value-added benefits, including discounts on gym memberships, health and wellness service and a variety of discount programs, at no additional charge.

"As seniors continue to worry about their financial stability and their ability to pay for needed health care, the questions around medigap coverage have soared. While individuals like the Medicare Advantage benefits, some are willing to forgo these and pay more for the safety net offered through the supplement plans," said Stapleton, a 15-year veteran in the health insurance industry. "In the case of Medigap plans, price should guide your decision since benefits are identical. However, some states do allow for different pricing based on age and gender."

Why did my Medicare Advantage plan get cancelled? - Health insurers withdraw plans for a variety of reasons, including the introduction of similar plans or an inability to meet CMS enrollment thresholds. For 2010, many insurers cancelled their private fee-for-service (PFFS) plans in anticipation of the termination of all PFFS plans after December 31, 2010. When insurers cancel plans, those members may be automatically enrolled in a similar plan; however this "automatic roll-over" does not mean that seniors cannot choose other plans that are more suited to their needs, even if that means opting for other carriers. Contact a local health insurance broker or visit plan comparison sites like to obtain information on other available options.

"We are surprised to be getting this question so late in the enrollment season, but individuals now may be realizing that they are not locked in to the choices that the health plans have made for them," said Stapleton. "Again, there is still plenty of time to make changes for 2010. In addition, beginning January 1 through March 31, there is a special enrollment period where seniors - under select circumstances - may make additional changes to their coverage."

Why is my Medicare Advantage premium going up? - The primary reason why health care premiums and out-of-pocket cost rise is that medical costs increase at a faster rate than government payment increases to health insurers. If premiums are an issue, seniors can compare insurance plans to find a more economic option. However, since cost is not the only issue when selecting a plan, research provider networks and drug coverage available under Part D offerings before making any final decisions. To compare Medicare Advantage plan premiums, visit or call (800) 328-7305.

"We also continue to receive a fair number of calls from seniors worried about how the economy may hurt their ability to pay for health care services care," Stapleton said. "Seniors may be eligible for federal and state programs should their income reach a certain level at any time during a given year. These safety nets help ensure that individuals do not sacrifice their health due to an inability to pay."

For seniors worried about their ability to cover their insurance and medical expenses, Medicare Solutions' customer service advocates also can help individuals determine if they are eligible for federal and state programs and help them apply for these funds by calling (800) 328-7305.

Founded in 2005, Health Plan One is a licensed health insurance agency and a leading online health insurance market, providing one of the broadest selections of health plans to individuals and Medicare recipients in all 50 states. Through its comprehensive web sites, which include health plan comparison tools and extensive educational information, and its enhanced customer service model, seniors can purchase the best Medicare plans to meet their health care coverage and affordability needs. For more information, visit

SOURCE Health Plan One, LLC

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