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Brand names don’t mean diddly in Medicare

When Medicare's 2012 health plan sign-up season starts Saturday, beneficiaries need to do some homework to see which plan is best for them and comes at a reasonable cost.

There has been a great reshuffling in coverage, co-pays, and premiums. Also, this year Medicare officials have listed star ratings on a 1-to-5 scale that offer a guide to quality.

So the first step is to go to www.medicare.gov/find-a-plan.

Plug your zip code in and you may be surprised at the results. The highest-rated plans in some zip codes are from companies you may never have heard of.

In Naples’ 34101, for example, the highest-rated plans – with 3.5 stars -- are from Freedom Health and Optimum HealthCare, relatively new firms based in Tampa.

Two much larger and better-known companies, Blue Cross and Blue Shield of Florida and Humana, score slightly lower on the plan-finder, with just three stars. Those plans also have higher estimated annual cost to the patients, according to the plan-finder.

Beneficiaries who do this exercise aren't through; there's a second step: Go to www.MedicareNewsWatch.com. (But be careful to do the following: Click on the blue bar at the left for 2012 Cost Comparisons, choose F for Florida, and look for the nearest city. Click on that and you'll get the information you want. You may even see an icon that indicates which plans have received the "Senior Choice Gold Award" for best value.

(If you follow those steps, you shouldn't be asked for any personal information; if you are, don't fill it in unless you want to get a call from an insurance agent.)

This website, which uses data from HealthMatrix Research Inc., supplies two pieces of information that are missing from Medicare's own plan finder site.

It lets beneficiaries check which plans are best-value for their health status -- good, fair or poor. HealthMatrix founder Alan Mittermaier says he added the feature because a beneficiary who is in poor health might not get a good deal from a plan that looks least expensive on the Medicare government site.

The private site also corrects a significant omission that skews the Medicare site's calculation of out-of-pocket costs for beneficiaries. HealthMatrix, unlike the government, factors in offers of a Part B payback or buydown that some plans offer, especiallty in Central and South Florida.

Mittermaier said such rebate offers make a significant difference -- up to nearly $1,200 a year for a full Part B refund. (Usually beneficiaries must pay a premium of $96.40 a month out of their Social Security checks for Part B, which covers doctor visits and other outpatient treatment). 

"Florida's kind of the exception" for rebates, Mittermaier said. "In other parts of the country that had them, they're disappearing."

After going to the Medicare News Watch site, click on the blue bar at the left for 2012 Plan Comparisons and then plug in your zip code. Look for an icon that indicates which plans have received the "Senior Choice Gold Award" for best value.

The results can be quite different from those you get at the Medicare plan finder site. In the Naples area, for example, the best value for all health statuses according to HeathMatrix is the Medicare Masterpiece plan from Universal Health Care, based in St. Petersburg.

The zip code plug-in exercise can't be put off for long. Annual enrollment season has been pushed forward by a month to Oct. 15 and will end in seven weeks, on Dec. 7. In prior years it started later but ran through the end of the year.

And there will no longer be a plan-switching period between January and the end of March, as there was before. This time the Medicare phrase "lock-in period" really has to be taken seriously. (The lock-in doesn't apply to certain low-income beneficiaries). 

Medicare is offering the highest-rated five-star plans a sales advantage by allowing beneficiaries to switch to them at any time during the year. However, Florida has no five-star plans this year, according to data from Medicare released this week.

Those beneficiaries who don't know how to use the Internet and can't find anyone to help them can either call the Medicare hotline at 1-800-333-4114 or call the state program of volunteer counselors, Serving Health Insurance Needs of Elders (SHINE).

SHINE can be reached at 1-800-963-5337 (1-800-96-ELDER).

--Health News Florida is an independent online publication dedicated to public-service journalism. Editor Carol Gentry can be reached at 727-410-3266 or by e-mail at Carol.Gentry@HealthNewsFlorida.org.