By Carol Gentry
10/2/2009 © Health News Florida
Florida has always been a magnet for companies that cater to seniors, and that remains true for drug and health plans vying for Medicare enrollment for 2010.
Beneficiaries in the state can choose from four dozen drug plans or -- depending on the county -- two to five dozen health plans, including some with zero premiums. A separate list offers "special needs" plans for those who have more health problems or need unusual services.
The list of drug plans fell only slightly, from 54 this year to 49 next year -- and may still grow if companies currently under suspension, WellCare and Citrus health plans, are allowed to return to the market, as many analysts expect. That decision is up to the Centers for Medicare and Medicaid Services (CMS).
The number of Medicare Advantage plans fell somewhat, as well, with a loss of 20 plans on average per county, according to Avalere Health consultants' initial report, released today. Some counties, such as Orange and Hillsborough lost more than 40 plans.
But here's the bright side: The plans that went away were mostly of the "private-fee-for-service" variety, the ones that caused so many marketing complaints and access-to-care problems that CMS created arduous rules to drive them out.
Also, consumer groups have complained that the massive number of plans -- especially in Florida -- actually made decisions harder for Medicare beneficiaries, not easier. So CMS encouraged companies to drop plans that had few enrollees and consolidate into no more than three per county per company.
That's because the federal government pays the bills, and in some parts of Florida, the rates it pays are among the highest in the country.
Here are highlights:
Prescription drugs
Drug plans cover the entire state, with the same premium in the Panhandle as in the Keys.
It will take some time to analyze all those choices, but here are some quick observations about the drug plans, which are offered statewide:
--Monthly premiums range from just under $20 from First Health Secure to just over $100 from Humana Complete.
--Five plans have monthly premiums of under $25. Those all carry a sizeable deductible -- the amount the patient must spend before coverage takes effect.
--Twenty plans are available without deductibles; they tend to have somewhat higher premiums.
--One in three beneficiaries who enroll in Part D, the standalone drug-plan program, has an income low enough to qualify for "extra help," a subsidy of the premium from the government. Five plans are available at zero premium for beneficiaries who qualify for extra help.
Sixty percent of Medicare beneficiaries get their drug coverage through Part D. They will receive a letter soon from Medicare telling them what may be changing in their current plans so they can decide whether to switch.
A plan-comparison feature will be made available online by mid-October, according to a CMS press release.
Medicare Advantage
This program, also called Medicare Part C, allows beneficiaries to enroll in health plans such as HMOs that cover doctor and hospital care and usually drugs as well.For 2010, the CMS charts show that every Medicare beneficiary in the state has the option of a zero-premium Medicare Advantage plan. Also, all are eligible for plans that cap out-of-pocket expenses for the year at $3,400 or less.
The charts released Thursday don't indicate whether any of the Medicare Advantage plans will offer a refund of part or all of the Medicare Part B premium -- a boost in the Social Security check that has proven popular among smaller plans that want to grow fast. It should become apparent quickly now that plans are allowed to start advertising.
Unlike drug plans, which are the same statewide, Advantage plans vary by county on availability, benefits and price. Broward boasts a whopping 66 Advantage plan choices, almost twice as many as Orange County. But no one in Florida gets neglected; even rural centers of poverty such as Gadsden County have more than two dozen plans out prospecting for enrollees.
The already-long list could still grow if CMS lifts the suspension on WellCare Health Plans and Citrus Health Plans. Both were ordered to stop enrolling and marketing earlier in the year, but many analysts are betting on a return by the kickoff of enrollment season Nov. 15.
Open-enrollment runs through Dec. 31, but sales season continues after New Year's, since beneficiaries who have drug coverage can switch plans until March 31.