Health News Florida
5:32 pm
Tue October 30, 2012

Medicare Letters Alert Seniors to Substandard Plans

In a week or two, seniors enrolled in certain Medicare health plans and drug plans will get a letter from the federal government. It is not good news.

The Centers for Medicare and Medicaid Services (CMS) letter will say their plan is substandard, "rated 'poor' or 'below average' for at least the last three years."

It continues: "We encourage you to compare this plan to other options in your area and decide if it is still the right choice for you." Hint, hint.

Then it offers the steps to take to find a better plan -- one rated at least three stars on a five-star scale -- and enroll in it during the open-enrollment period, Oct. 15 - Dec. 7.

If the beneficiary who is enrolled in the subpar plan misses that window of opportunity, he or she has another chance to switch to a plan with three stars or more on Jan. 1. 

On CMS' scale for 2013, none of Florida’s Medicare Advantage plans won the top rating of five stars. Most were average. The lowest score was a "2," below average. (See how your plan rates.)

The letter ends by giving the Medicare toll-free number (1-800-MEDICARE, or 1-800-633-4227) and a volunteer advisory program, which in Florida is called SHINE (Serving Health Insurance Needs of Elders). SHINE's number is 1-800 -963-5337.

The letters are likely to come as a surprise, since most beneficiaries don't use the CMS quality scale for choosing a plan, said Carol Radin, a city of St. Petersburg employee who advises seniors at the Sunshine Center. "I don't think that they even look at the star ratings," she said.

And even if they do, she said, they are more likely to follow the advice of their doctor, family or friends.

Medicare chief Jonathan Blum explained to reporters on a conference call recently that CMS wants beneficiaries to move into better-quality plans so that companies will have an incentive to improve.

"We want to make it easy for beneficiaries to find and select the  highest quality plans but make it more difficult for beneficiaries to enroll in and stay in those chronically low-performing plans," he said.

CMS uses a carrots-and-sticks approach, with the letters as sticks.

The tastiest carrot, awarded only to five-star plans, is permission to enroll customers all year long. Other Medicare contractors are limited to open-enrollment season in most cases.

The Quality Bonus Payment Demonstration offers  extra money to plans that are average and above, with three-star plans getting 3 percent bonus and so on this year and next. As of 2014, the bonuses improve for four- and five-star plans.

--Health News Florida, journalism for a healthy state, is a service of WUSF Public Media. Question? Comment? Contact Carol Gentry at 813-974-8629 (desk) or 727-410-3266  (cell) or by e-mail at Carol.Gentry@HealthNewsFlorida.org.