Medicare Advantage Plan update

Posted

As I write this month’s HIICAP article the number of cases of the COVID-19 virus seem to be stabilizing.

The positivity rate is also lower in many areas of upstate New York.By the time this article appears, I hope that many of you have received at least one dose of a vaccine. COVID-19 vaccines are becoming more available for people in all the approved categories, including everyone over the age of 65. All vaccinations are provided at no cost to you.

How to sign up for a vaccine appointment.To sign up for an appointment to receive the vaccine the place to start is with the New York State COVID vaccine website at https://covid19vaccine.health.ny.gov/. If you do not have computer access or are having trouble signing up for an appointment, you can call the New York State COVID-19 Vaccination Hotline at 1-833-697-4829 to schedule an appointment. Up-to-date vaccination information is also available on the Oneida County Health Department website at https://www.ocgov.net/health.

But even if you receive the vaccine it will still be some months before you can let your guard down. Please continue to follow the Oneida County, New York and CDC safety guidelines. That means wearing a mask, maintaining social distancing, washing your hands often and avoiding unnecessary trips and indoor gatherings.

Medicare.gov Nursing Home Compare website. Many consumers are familiar with a service provided on the Medicare.gov website known as Nursing Home Compare. Using data provided by the Centers for Medicare and Medicaid Services (CMS) the site uses a five-star rating system that allows consumers to compare the quality of care provided by nursing homes.

The star rating is assigned using data from three sources of information: the 3 most recent state health inspections, staffing information and 15 different quality of care measures. With the numerous deaths in nursing homes from COVID-19 it is expected that the rating system will be updated soon. However, the website is easy to use and remains the best source of unbiased information for consumers who are looking for any information about the quality of care provided by nursing homes.

Medicare Advantage Plan star ratings.While many may be familiar with the Nursing Home Compare feature of the Medicare.gov website discussed above, others may not know that Medicare Advantage Plans are also assigned a star rating. If you are looking for a Medicare Advantage Plan you can find the star ratings for the plans you are interested in by going to Medicare.gov/find-a-plan. While many of you may have used this site, you may not have noted that each plan available in your zip code is assigned a rating raging from 1 to 5 stars. Some plans will not have a star rating because they are listed as too new to be assigned a rating.

Are these star ratings helpful in choosing the best Advantage plan?According to new research published in February issue (vol. 40, no. 2) of the journal Health Affairs, David J. Meyers and his colleagues attempted to answer this question.Meyers and his team found that “higher Medicare Advantage star ratings are associated with improvements in patient outcomes.”

The authors found that that participants who enrolled in higher star rated plans were less likely to change their plan or return to Original Medicare. Participants were also more likely to use a higher-quality hospital and to be less likely to be readmitted to the hospital within 90 days. So, while the results are not definitive, the authors suggest that the star ratings may be a very good indicator of the quality of a plan.

Members’ rating of Advantage plans. As I have discussed in a previous column, each year everyone participating in Medicare receives a copy of Medicare and You, the official Medicare handbook. Section 11 provides a list of all the Medicare Advantage plans available in upstate NY (there is a separate edition for the New York City metro area).

The first column tells you if the plan is available in your area followed by information, such as premium amounts and out-of-pocket expenses, to help you narrow your choices. One piece of information that may be overlooked is the Members` Rating of Plans feature found at the end of each blue bar listing the name of the provider. Keep in mind, these percentages are an overall rating for all the plans offered by a provider and not ratings of their individual plans.

These consumer ratings are stated in terms of a percentage of the plan participants who are satisfied with the providers performance.

The ratings are derived from the most recent Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey is conducted by the Agency for Healthcare Research and Quality which is part of the Department of Health and Human Services.

Surveys conducted by this agency are among the most widely used by health care professionals and researchers.These consumer ratings are also one of the measures used by Medicare to give the plans an overall rating of between 1 and 5 stars. If a plan provider does not have a rating you will see a note that explains why.

Overall, it appears that most plans are rated in the 80 percent range. There are some in the 70 percent range and a few with 90 percent ratings. Keep in mind that there may be a significant difference between an 81 and an 89-percent plan rating.

Between Jan. 1 and March 31 each year, if enrolled in a Medicare Advantage Plan you can switch to a different Advantage Pan or change back to Original Medicare with a separate drug plan. However, you cannot disenroll from Original Medicare and switch to an Advantage Plan, which, except under certain conditions, can only be accomplished during the annual Open Enrollment period. Medicare Special Enrollment periods will be discussed next month.

Who do I contact with my Medicare questions? If you would like to switch to a different Medicare Advantage Plan or return to Original Medicare, HIICAP counselors are available to help you through the process. Because of the pandemic, all counseling sessions are conducted remotely and are now being provided directly by Oneida County Office for Aging and Continuing Care/NY Connects HIICAP program. Anyone who needs help anytime this year should call the HIICAP office directly at 315-798-5456 and select option #2. You will probably be asked to leave a message and your call will promptly be returned. A trained counselor will provide you with the same high-quality service over the phone that they have provided in-person over the years.

Dr. William Lane is the owner of William Lane Associates, a gerontological firm located in Homer, NY. He writes a monthly column on HIICAP related issues for the OFA. Dr. Lane does not sell insurance, work for any insurance company or recommend any insurance products.

Comments

No comments on this story | Please log in to comment by clicking here
Please log in or register to add your comment