With the presidential election two days away, David Adamson, of Oklahoma City, is worried about losing the comprehensive health insurance he and his wife have under AARP's Secure Horizons Medicare Advantage plan.
“If it's axed,” he said, “we figure we'd have to pay an extra $450 a month for supplemental insurance and prescription drug plans. And to us seniors, that's a real fear.”
Across town, Sharon Beasley, of Newcastle, rues the day in May she turned 65.
“I find health insurance with Medicare even more mind-boggling than before we got old,” said Beasley, who unsuccessfully tried to make sense of the Medicare payments for her husband's hip surgery a few years ago.
“Talk about the runaround,” Beasley said. “Each entity referred me to another. I finally gave up and hoped no one was padding the bill.”
Though Beasley and other Medicare recipients understandably have questions about Medicare's future, they should be more focused on Dec. 7 than the election Nov. 6, say officials with the Oklahoma Insurance Department.
Dec. 7 is the deadline for Medicare beneficiaries to change drug or health plans for next year, said Ray Walker, director of the department's free Medicare Assistance Program. If seniors don't make changes by then, most will be locked into their drug or health plans for another year, he said.
Walker strongly recommends seniors every year seek counseling on Medicare Part D, which covers prescription drugs through private insurance companies. Insurers can change the drugs they cover from year to year, and a plan's rate and cost structure can go up annually, Walker said.
By entering beneficiaries' medications, ZIP codes, age and other information in search engines on medicare.gov, counselors can help seniors find the most cost-effective and best plans, Walker said.
“One of our volunteers in Marietta, who's a retired CPA, found beneficiaries on average save $300 by changing plans annually,” he said. Walker said he saved his uncle $7,000 by moving him from a plan that didn't cover his costliest medication to a plan that did.
Though most seniors in Oklahoma who carry drug plans choose Part D Medicare insurance, nearly 16 percent of the 626,000 Medicare beneficiaries in Oklahoma, or some 100,000, opt for Medicare Advantage network plans that include prescription drug coverage, Walker said.
During this annual election period, counselors can help seniors pick up or drop a Medicare Advantage plan or switch to a new one, he said.
“Seniors in rural areas should be particularly cautious about agents selling them Medicare Advantage plans,” Walker said. “Many plans may not have hospitals or physicians located within their community, and traveling to Oklahoma City or Tulsa would be inconvenient or impossible for them.”
Several providers of Medicare Advantage plans have dropped service in certain areas, though some seniors on those plans still may be unaware they no longer have coverage, Walker said.
“Plan participants were sent notices in September, but many may have just opened that piece of mail,” he said, “or only recently heard from a friend that their plan is going away.”
Walker said Windsor Sterling had the largest reduction, which affected 3,540 beneficiaries from 59 counties across the state, including 724 beneficiaries in Tulsa County and 392 in Oklahoma County. Meanwhile, Ardent, which operates the Lovelace Medicare Plan HMO in Oklahoma, reduced its service area, affecting beneficiaries in Oklahoma, Mayes and Payne counties and a reduction by Humana affected 690 residents in Creek County.
Licensed independent insurance agent Linda Clure cautions beneficiaries to consider more than monthly premiums when choosing drug and health plans.
“You need to think about the maximum out-of-pocket, and whether you've got that amount set aside for emergencies,” Clure said. “Meanwhile, some drug plans require greater physician involvement than others, and you may not want that hassle.”
While consumers grapple with election choices for next year's plans, industry observers can't help but look to Tuesday's election.
To control rising Medicare costs, President Barack Obama's health reform plan, among other things, calls for cutting federal subsidies to Medicare Advantage plans, which have proved significantly more costly than original Medicare. Meanwhile Gov. Mitt Romney wants to give future beneficiaries — people now 54 and younger — federal vouchers to help buy insurance from traditional Medicare programs or competing private health plans when they become eligible.
Studies indicate the uncertainty of the future of health care, and reduced Medicare reimbursement payments, may be causing many doctors to opt out of Medicare or quit seeing new Medicare patients. Only half of doctors will continue their current practice during the next three years, according to a survey of nearly 14,000 doctors released in September by the Physicians Foundation.
Many respondents told Merritt Hawkins & Associates, a doctor recruiting firm, they plan to cut back on hours (22 percent), retire (13.4 percent), seek hospital employment (5.6 percent), transition to a cash/concierge model (6.8 percent) or close their practices to new patients (4 percent).
In Oklahoma, few physicians — 99 — have opted out of Medicare, according to the website of Trailblazer Health Enterprises LLC, which currently administers Medicare payments for state doctors.
“It's hard for physicians in rural Oklahoma, in particular, to stop seeing Medicare patients because seniors represent their patient base,” said Melissa Johnson, director of health care policy for the Oklahoma State Medical Association (OSMA).
Oklahoma physicians, Johnson said, are concerned with what they view as an inevitable lack of access to health care as the U.S. population ages and 30 million more people are added to insurance rolls under health care reform.
Oklahoma is short about 400 family physicians alone, the OSMA told The Oklahoman after health reform passed in March 2010. And Bloomberg recently reported the current doctor shortage across all disciplines is some 13,000 and is expected to balloon to 10 times that number by 2024.
As for Ada endocrinologist Curtis Harris, he opted out of Medicare 13 years ago.
“I was being reimbursed some 80 percent of my overhead, excluding wages, and nowhere close to my time,” Harris said. “I was not only not making any take-home, but losing money and had to charge others more.”
The cost of billing Medicare alone cost him $24 to $30 a bill, he said.
Still, he lost only two patients in the transition, Harris said.
“Once they realized they could continue to use Medicare for hospitalizations and labs, and wouldn't be stuck with huge hospital bills, they were fine,” Harris said.
Today, his costs billed to patients are $500 a year at most, Harris said.
“Try to get that kind of specialty care for much less, even if you have insurance,” he said.
AT A GLANCE
Medicare election period closing
• For free counseling to make sure you're on the right plan, call the Medicare Assistance Program at the Oklahoma Insurance Department at (800) 763-2828, from 8 a.m. to 5 p.m. weekdays. Counselors can answer questions or set appointments for their office at 3625 NW 56, Suite 100. If you live outside the metro area and you'd like free face-to-face counseling in your local area, Medicare Assistance counselors can connect you to a qualified agency such as the Area Agencies on Aging or the Community Action Agencies.