For the first time this year, Medicare is sending home bad report cards on its under-performing private plans.
Americans with Medicare-managed care plans or stand-alone drug plans started receiving notices last month if their coverage had been rated 2.5 stars or less in the past three years in the government insurer’s five-star system. The government is so serious about steering people away from low-rated plans, it has disabled the electronic enrollment tool for those offerings on Medicare’s website.
It’s all part of Medicare’s push to force chronic underachievers to improve care quality. And there’s reward as well as punishment: Plans with higher ratings can get bonus payments of up to 5 percent of their contracts, expected to total $3.1 billion this year.
Edith Gooden-Thompson, the Broward County, Fla., coordinator for the Serving Health Insurance Needs of Elders Medicare counseling program, anticipates getting calls from puzzled seniors as the letters start hitting mailboxes, just in time for Monday’s start of Medicare open enrollment. She stresses that no one will be forced to leave the lower-starred plans or lose coverage.
The notices just encourage beneficiaries with low-ranked coverage to carefully review what they’re being offered and shop around — something everyone on Medicare should do anyway, Gooden-Thompson said.
Medicare officials, when announcing early 2013 plan details last month, said they wanted to make it increasingly challenging for seniors to enroll in low performers. Medicare HMO participation was projected to increase by 11 percent next year. The stars are based on several factors including patient satisfaction surveys, the availability of screenings and vaccines, and the plan’s ability to manage chronic conditions.
Insurers support the concept of rewarding quality care, said Robert Zirkelbach, spokesman for America’s Health Insurance Plans, and rankings overall have been inching higher. But he said the industry remains concerned that the ratings truly reflect things that benefit consumers and don’t unfairly penalize certain plans operating in rural or poor areas.
Doris Einhorn, an 80-year-old Tamarac, Fla., resident, has switched Medicare HMOs several times over the years, willing to jump ship if premiums rise or if drugs she needs are no longer covered. She’s checking the changes in her Humana plan and shopping around.
And yes, she’ll look at the ratings, although her current plan isn’t an underachiever. “If a plan has two stars, they either aren’t giving you something or they are charging too much,” Einhorn said.
About 9 percent of enrollees nationwide are in plans with fewer than three stars and another 7 percent are in plans not rated by the federal Centers for Medicare and Medicaid services, according to the nonprofit Kaiser Family Foundation.
Seniors have until midnight Dec. 7 to enroll in managed care or stand-alone drug plans. Those who later decide they are unhappy with their choice will be able to drop that coverage and go back to traditional Medicare, starting Jan. 1 through Feb. 14.
Doug Goggin-Callahan, director of education at the Medicare Rights Center, said there could be cases where a low-starred plan could be a senior’s right choice, depending that person’s finances, doctors and medical needs. So far, the center hasn’t determined any commonalties among low performers, he said.
But ultimately, he thinks the star ratings will be good for consumers. “If you are in a low-rated plan, you should check if this is your best option,” Goggin-Callahan said.
Diane C. Lade writes for The Sun Sentinel (Fort Lauderdale, Fla.).
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