Seniors urged to dump low-rated Medicare plans

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If you insist on sticking with your underperforming, overpriced Medicare Advantage plan, the federal government has some advice for you:

Please reconsider.

For the first time since 1997, when Medicare Part C, or Medicare Advantage, came on the market via private insurers, the Centers for Medicare & Medicaid Services, or CMS, is trying to push seniors out of badly rated plans and into better ones.

It's doing so via letters sent to 525,000 or so beneficiaries who subscribe to 26 Advantage plans or drug plans, telling them that, "You are currently enrolled in [a plan] that has been rated 'poor' or 'below average' for at least the last three years" by way of Medicare's five-star rating system.

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

Two of those "poor" or "below average" plans are offered in Pennsylvania, the Medicare Rx Rewards plan offered through Wellpoint Inc. and UnitedHealthcare MedicareComplete offered by UnitedHealth Group.

Medicare Rx is offered in West Virginia as well, while WellCare Value, sold by Wellcare Of Ohio, is also on the list.

Medicare officials also have warned the poorly performing plans that they could be cancelled in the future, though the agency has no timetable for such a move.

"We are giving them a chance to correct deficiencies" in the plans, Medicare spokeswoman Isabella Leung said. "We don't have a hard date as to when [the plans might be canceled]. ... We don't want to disrupt coverage for seniors, obviously."

If the seniors who subscribe don't switch to another, better-rated Medicare Advantage plan by Dec. 7 -- which is the end of the annual "open enrollment" period, during which seniors may tweak their health coverage -- they still will be able to do so throughout 2013, Ms. Leung said.

That's a perk, if you could call it such, that most seniors don't have. Typically, a choice of plan must be set by the end of the enrollment period and is locked in for the following year. The other exception is for those who want to enroll in a top-rated five-star plan, who likewise may enroll throughout the year. (Medicare also recently announced it would be extending the enrollment period for seniors in New York, New Jersey, Pennsylvania and elsewhere still dealing with the effects of Superstorm Sandy.)

Insurers say they are on board with quality-measurement initiatives, but believe it's "premature" to send letters to seniors and threaten plans with cancelation.

"We strongly support the goal of recognizing and rewarding quality," said Robert Zirkelbach of America's Health Insurance Plans, a trade group representing health carriers.

But, "The question becomes, how do you measure and what are you measuring?" he said.

For example, among its more than four dozen performance and quality metrics, Medicaid seeks to measure things such as patient experience, overall satisfaction, how well the physicians followed up with the patient.

While much of the star-rating system is based on claims, cost and outcomes data, patients' answers to more subjective satisfaction-related survey questions are "impacted by more than just their Medicare Advantage plans," Mr. Zirkelbach.

Insurer concerns aside, Medicare seems committed to weeding out the lower-quality plans.

Those who visit the website will find that if they search for the plans available in their area, the low-rated ones are marked with a red and black caution sign, warning potential subscribers.

And while the Medicare website allows visitors, with a click of a mouse, to apply for a plan online, that option has been disabled for the low-rated plans, meaning a potential subscriber would have to contact the insurer directly.

About 14.5 million people -- or about 30 percent of all Medicare beneficiaries -- will be buying Medicare plans through private insurers in 2013. The star-rating system began in 2008, and starting this year Medicare plans can receive bonus payments from CMS for having highly rated plans.

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Bill Toland: or 412-263-2625.


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