Health care plan choices abound for Stanislaus County seniors [The Modesto Bee]

Oct. 20--MODESTO -- A federal official said Stanislaus County stands out among its neighbors for its growing choice of Medicare managed-care plans.

Peter Bauer, a regional liaison for the Centers for Medicare and Medicaid Services, spoke Thursday at an informational meeting attended by 250 people at the Modesto Senior Center. The meeting is held every year by the Health Insurance Counseling and Advocacy Program.

As an enrollment period began this week, seven insurers are pitching Medicare Advantage plans in the county, all of them offering discount options with no monthly premiums.

Some of those plans include transportation benefits and dental coverage for 2013. Other plans that provide more benefits will range in cost from $49 to $135 a month, on top of the Medicare "Part B" premium, which hasn't been announced for next year.

The period through Dec. 7 is for enrolling in a plan or making coverage changes that will take effect Jan. 1.

With all those choices, people need to give careful consideration to the benefits, the fine print and possible ramifications of changing from one plan to another, Bauer advised.

Many seniors enroll in Medicare Advantage plans for the extra benefits not provided by basic Medicare. The co-payments for seeing a primary care doctor are usually zero to $10, or $5 to $30 for specialists, compared with the 20 percent deductible with basic Medicare.

The plans also cover hospitalization, surgery, ambulance service, prescription drugs and other services, and pay for emergency and urgent care for people traveling outside the United States. In a deal with insurers, the government pays a set amount for each person enrolled and patients agree to receive their Medicare benefits through the HMO-style plan.

Patients select a primary care physician to manage their care. Counselors at the meeting said another option is Medicare supplements, which often cost more per month but offer more freedom to choose physicians and hospitals. Supplements don't cover prescription drugs.

The newest Medicare Advantage plans in the county are Citizens Choice and Easy Choice, both at no monthly cost. Easy Choice's first-year pricing has no co-pays for doctor visits and hospitalization and includes a transportation benefit providing 50 one-way trips to medical appointments. It has an annual limit on out-of-pocket expenses of $6,700, compared with limits of $3,400 to $4,900 for the other plans.

Citizens Choice, Easy Choice and Care 1st, another zero-premium plan, include dental benefits at no extra cost. Care 1st representative Daniel Baker said the plan has an agreement with Delta Dental for next year.

Other plans with no premiums (and varying co-pays) are Secure Horizons Plan 2, CareMore Start Smart, Kaiser Senior Advantage Basic and Health Net Amber 2. The Health Net plan is for people eligible for Medicare and Medical and includes routine transportation.

People enrolling in the zero-premium plans have access to doctors in the AllCare Independent Physician Association and would use Doctors Medical Center in Modesto. Newer plans coming from Southern California have contracted with AllCare, an association of more than 500 physicians and specialists.

Bauer said he advises people to closely read the fine print in zero-premium plans for costs of cancer treatment, power chairs or other medical equipment. Some of the plans charge higher co-pays for doctor visits and hospital stays and can increase their charges in future years. People also need to know if their doctor accepts the plan and their medication is covered and whether the plan pays for medication in Medicare's coverage gap.

Effective Jan. 1, the monthly costs for Secure Horizons Plan 1 and Kaiser Senior Advantage Enhanced will be $89 and $63, respectively. Secure Horizons has agreements with Sutter Gould Medical Foundation, Central Valley Medical Group, Memorial Medical Center, AllCare and DMC.

The monthly rates will be $49 for CareMore Value Plus and $59 for the CareMore plan with extra benefits for people with diabetes, heart disease or other special needs. The health plan has care centers in Modesto and Turlock providing serv- ices beyond what's usually provided at primary care appointments.

No changes in 2014

Bauer said there won't be changes for Medicare Advantage plans in 2014, when key provisions of the Affordable Care Act go into effect. That's when California's insurance exchange will start offering health plans for adults who lack insurance, but not to those age 65 or older.

He added that if a Medicare Advantage plan were to declare bankruptcy, the Medicare program would allow those affected to enroll in another plan or guarantee supplemental coverage.

People can review the benefits and costs of health plans in their county by using the "Medicare Plan Finder" at www.medicare.gov. In Stanislaus County, free, impartial advice on navigating the Medicare system is available at the HICAP office at 121 Downey Ave. in Modesto. Call (209) 558-4540.

Bee staff writer Ken Carlson can be reached at [email protected] or (209) 578-2321.

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