Humana Gold Plus drops 2,063 Medicare members in Santa Cruz County

Oct. 05--SANTA CRUZ -- Some 2,063 people in Santa Cruz County are getting letters saying their Medicare Advantage plan will not be available in 2017.

"Humana Gold Plus is pulling out of our county," said Pamela King, program manager at the nonprofit Senior Network Services, which runs the Health Insurance Counseling and Advocacy Program to educate the community on Medicare-related coverage.

"That means Medicare beneficiaries, many of whom have had a Medicare Advantage plan for many years, will be without one," she said.

They will have the option to sign up for a Medigap supplemental plan and a Part D prescription drug plan. Those who go without a Part D drug plan can be charged a monthly financial penalty for the rest of their lives.

A Medigap policy sold by private companies can help pay some health care costs that government-funded Medicare doesn't cover, like copayments, coinsurance, and deductibles.

But King said she worries the combination of premiums for the Medigap policy and the "must-have" Part D plan may be unaffordable.

Part D drug plans vary greatly in terms of costs and coverage.

The Medicare Plan Finder website shows 24 drug options for Scotts Valley residents, sortable by lowest annual deductible, lowest monthly premium, lowest annual retail cost, lowest annual mail-order cost, formulary drugs, drug restrictions and overall star rating. Premiums range from $17 a month to $160 a month, with the annual retail cost ranging from $1,836 to $2,866.

Plans can change each year, so it's important to review the costs, drug coverage and pharmacies in the network to see if the current plan meets your needs.

The seniors being dropped by Humana Gold will not find another Medicare Advantage plan, according to Pamela Fugitt-Hetrick of DCD Financial & Insurance Services in Santa Cruz.

In Santa Cruz County, the only options are Medigap policies and "stand alone" Medicare drug plans coupled with original Medicare, she said.

In Monterey County, Community Hospital of Monterey Peninsula has its own Medicare Advantage plan called Aspire, the only one in that county.

Here is why insurers have backed away from Medicare Advantage plans.

For years, Medicare Advantage plans provided through employers boosted insurers' bottom line. Insurers had no incentive to submit competitive bids to Medicare; the employee enrollment is already set so insurers did not have to offer perks to get signups.

In April, Medicare officials announced payment rates for insurers selling Medicare Advantage plans would increase by 0.85 percent for 2017, less than the 1.35 percent increase proposed in February.

That affected UnitedHealth Group, Humana, Kaiser Foundation Health Plan and Aetna, which cover almost 9.72 million Medicare Advantage members, 53 percent of the 18.2 million people in the program, according to Bob Herman, a writer with Modern Healthcare.

___

(c)2016 the Santa Cruz Sentinel (Scotts Valley, Calif.)

Visit the Santa Cruz Sentinel (Scotts Valley, Calif.) at www.santacruzsentinel.com

Distributed by Tribune Content Agency, LLC.