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FL’s 352 plans: too many?

By Carol Gentry and Ruth Morris
11/5/2009 © Health News Florida 

When Medicare shopping season begins Nov. 15, Florida beneficiaries who are interested in an HMO or other Medicare Advantage plan will have to drink from a fire hose to select one. Companies are offering 352 options here, more than in any other state. 
 
Florida draws health insurers like a magnet because the government pays premiums that are mostly pegged to the historic rate of spending in traditional Medicare. This state's rate of spending is dramatically higher than others', the result of a peculiar medical culture mixed with high incidence of fraud. While no county offers all 352 plans, many have 50, 60, or 70. All different.

But isn’t choice a good thing? Not that much choice, say some advocates and beneficiaries
 
"It's so complicated, it's unbelievable," said Jerry Stein, 68, a retired charter boat captain in Miami. 

Nelson Lugo, 70, a retired security guard, agrees. "It's very, very confusing," he said. "They give one benefit on one side, and with the other hand they take something away."

He's talking about the fine print. Companies use actuaries to help them adjust the benefits and co-pays for each of several plans in a given county. They can change co-pays for specialist visits, hospital stays, brand-name drugs, and so on. They refigure the maximum out-of-pocket limit. Then they set premiums. Sometimes, they offer rebates.

“The confusion that faces consumers with the sheer number of plans and infinite variety in how they can tweak their cost-sharing makes it very hard,” says Paul Precht, director of policy and communications for  the Medicare Rights Center in Washington, D.C. 

Horacio Soberon-Ferrer, vice president of planning and finance at Alliance for Aging Inc. in Miami, agrees. "Most people are comfortable with three or four choices. They're not happy if they have to choose between 15 or 20 plans."
 
They decide on the outlines of what they want, he said, but end up in a quagmire: Should they go for free transportation or prescription eyeglasses?

"Most elderly people go with word of mouth," said Soberon-Ferrer. "So if I have a neighbor who is very happy with a plan, before I even do any research, I might switch to my neighbor's plan. They are not high-intensity information seekers." 

Then there's the fear of change. Even though their plans may be trimming drug coverage or raising co-pays, as long as they can keep their doctors, seniors often hesitate to switch plans, especially if it means a mountain of paperwork and hours of research.

Jose Luis Diaz, 65, said when he signed up for a plan he did it the easy way: "The first one I opened (in the mail), I chose that one," he said. "Some people say this plan is better, or that other one is better. I think they're pretty much the same."

While Medicare offers an interactive online service that beneficiaries can use to winnow choices, most seniors prefer talking to someone on the phone, Soberon-Ferrer said. So he recommends the volunteer counseling service called SHINE.

By comparison, shopping for a Medicare supplement policy – one that simply pays the 20 percent of medical bills that the government insurance program doesn’t cover -- is easy. Florida requires insurers to adopt one of six plan types, making it simple for customers to compare. 

Medicare Rights Center and other consumer groups have pushed Congress to include simplification of the Medicare Advantage choices in health overhaul legislation. Precht said an attempt to include that in the House bill didn't survive. The Senate bill has some language that would help a little, he said, but wouldn't go far enough.

--Carol Gentry, Editor, can be reached at 727-410-3266. Ruth Morris is a free-lance reporter in Miami.