Health & Fitness
Changes to Fallon Part C Medicare Plan in Worcester County: Pay Fallon Same; Pay Docs a Lot More
One of the big questions facing public Part C Medicare Advantage health plan subscribers (almost 30% of Medicare beneficiaries nationwide; about 20% in Massachusetts) over the next month is what changes will result from the reduced funding to Part C Medicare enacted into law as part of the Patient Protection and Affordable Care Act (PPACA) of 2010.
- Nationally, a large research firm has said there would be fewer plan choices this year than in 2013 for the increasing number of seniors who want such plans (the now almost 30% of us who choose Part C is up from almost zero when the program started 15 years ago).
- Another possibility according to the people that work for the government doing Medicare research (the Medicare actuaries) is that insurers will cut back on benefits to make up for the lost funding.
The first big change I notice -- although it is never explained in the package -- are those letters 'POS.' That's not the name of my plan this year and it stands for Point of Service. Sorry, but I'm certified by the Medicare bureaucracy to help people with Medicare questions and that term 'POS' is a new one on me. You'd think FCHP would explain it somewhere. (It looks like it means it's easier, but not cheap, to go out of network -- such as to a Boston hospital. But that's just an educated guess.)
The second big change I notice is that "Maximum out of pocket (OOP) amount" has almost doubled from $3400 to $6700 (the legal maximum). That's bad news depending on how risk averse you are. The good news is that the monthly premium remains the same at $69. Pay the same, get less coverage, just like when they started raising auto and fire insurance deductibles. (Then they raised the premiums a few years later, remember?)
The third change I notice is a much more complicated tiering system (5 vs. 3) for prescriptions and -- in general -- the usual nickel/dime increases in co-pays (except for rehab; it will be a good year for that knee replacement).
However I can't use the stuff in this FCHP package to make a decision. The package does not even tell me what other plans FCHP offers, and of course I'll need to look at competitors. What I would need to do (but -- again -- see Note) is compare the monthly premium for what is now a very poor Part C plan against other options and decide how the $69 a month monthly premium stacks up against plans with the normal $3400 Maximum OOP.
All in all, what a waste of a good Oregon forest this material is.
NOTE: My doctor/clinic has dropped FCHP Part C plans as an accepted insurance so I would probably have been changing Medicare coverage anyways. That doesn't mean I have to drop FCHP; it offers a private Medigap supplement that my doctor/clinic will accept.
