The annual Medicare Open Enrollment period seemed longer than usual in 2019. The total period of time spanned from October 15, through December 17. During these fifty-three days, how many phone calls, letters or emails did you receive from different health insurance providers and/or health insurance brokers? Even Medicare.gov jumped into the fray! Each and every touch had a frantic tone, mentioning deadlines, which caused so many seniors, as well as soon to be seniors some anxiety. We know this at Healthlink Advocates, as many reached out and asked us what they had to do. Were they going to have to decide on a new plan? Were they losing their prescription plan? Did they have to make a change? Were they going to lose their health plan?
Why were things so hectic and pressing this year? The insurance companies would call it health care coverage – we would call it MARKET SHARE!
On July 30, 1965, President Lyndon B. Johnson signed into law the bill that originally led to what we now know as Medicare. The original bill included Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). This bill was not by any means quick legislation. The formal initiation for the legislation originated with a lone line in a 1935 Social Security Bill, which authorized the study of health insurance for seniors. The process was a long one spanning thirty years.
PART A – PART B
When Medicare first started, things were much simpler. Seniors signed up for Part A (Hospital Insurance) and Part B (Medical Insurance). Things remained status quo for a while, but then, during the 1980’s, the implementation of Medicare Supplement (or Medigap) plans started. The Government created this voluntary program to enable Medicare recipients to buy coverage for gaps in Medicare coverage. The big player back then was AARP. Many people signed up and things remained steady for a while.
PART D
Things changed again in January 2006 when Medicare implemented the Medicare Part D prescription drug benefit. The implementation was authorized by Congress under the “Medicare Prescription Drug Improvement and Modernization Act” of 2003. This was a welcome relief for many seniors, as drug prices were increasing rapidly, and seniors, many who were on fixed incomes were found to be taking drastic measures for relief, some cutting pills in half, other unable to afford to fill prescriptions at all.
PART C
Yes, I am out of alphabetical order here as Part C was formalized by legislation in 1997 – nine years before Part D. I’ve put Part C last, because early on Parts A, B & D were the major players. Part C, also known formally as “Medicare Advantage Plans” is a program authorized to provide Part A, Part B and, many plans include or offer Medicare Part D, prescription drug coverage by private insurers. Early on, the plans were not so popular, as seniors did not want to move from Original Medicare into Medicare Advantage (Part C) as public opinion perceived most as an “HMO” (Health Maintenance Organization) plan, which was at inception a wildly unpopular idea. Not only was the plan unpopular in more affluent areas, but the lack of physicians participating in an HMO, especially in the rural areas of the country was limiting. Things have changed a lot in the years since the Part C legislation passed. Medicare Advantage Plans were administered by more and more major players (AARP/United Healthcare/Cigna, Blue Cross & Blue Shield, etc.), all private companies approved by Medicare. Medicare pays these private companies a fixed amount monthly in return for following the rules set by Medicare. Many Medicare Advantage plans offer extra benefits, such as vision, hearing dental and/or health and wellness programs – additional benefits not covered by Original Medicare.
What is the downside to Part C?
Although the entities offering Medicare Part C are legally obliged to follow the rules set by Medicare, each Medicare Advantage Plan can charge different out-of-pocket fees and have different rules regarding referrals for specialists, facilities, urgent care and emergency treatment. In addition, many plans are considered a HMO, which means that if you are out of your home area and need treatment, you could be on the hook for the entire bill. Many of the PPO (Preferred Provider Organization) plans will allow treatment in other areas, but there are parameters to being out of network. These rules can change each year. Medicare Advantage brings private plans into the mix and today; about thirty percent of those eligible for Medicare receive coverage from independent, private plans. There is a lure to choosing a Medicare Advantage, or Part C plan….they offer much more in comparison to coverage offered by Original Medicare, such as hearing, dental and vision services and treatment. Original Medicare offers extremely limited coverage for these services.
MARKETSHARE
Why do we mention Marketshare? Easy. Marketshare is the reason for the enormous amount of outreach and marketing by insurance companies executed during the fifty-three days of Open Enrollment (and for many days preceding it). In April 2018, the Centers for Medicare & Medicaid Services (CMS) announced an expansion of benefits that private insurance companies would be allowed to cover as part of a Medicare Advantage Plan - benefits that are not covered by Original Medicare. This expanded Medicare Advantage benefits list includes items such as:
Transportation to doctor’s offices
Air conditioners for people with asthma
More coverage for home health aides
Installation of wheelchair ramps
Silver Sneakers (Wellness Programs)
Insurance providers saw an opportunity for a larger market opening for them with the addition of so many new benefit options. The race was on….who could offer the most options to encourage seniors to leave their old plan and consider new, more extensive plans? The advertising, mailings and reach into the senior community was huge – and confusing! With all of the noise going on, just about every senior worried that “they had to sign up” – or would lose their coverage. Of course, that was not true. Medicare Parts A, B & D roll over – without any action on the part of the insured. The entire thing made for a whole lot of confusion and worry, especially for those advanced seniors who had a hard time grasping the idea that they did not have to do anything – all of the mail was informational.
NEW ON THE HORIZON
As I started to write this blog, I was heartened to come across an article covering a Senate Subcommittee on Primary Health discussing a growing health care crisis in America – basic dental health. The Senate Subcommittee on Primary Health and Aging held a hearing to discuss the growing dental crisis for seniors, and came to the conclusion that most people who rely on Traditional Medicare go without basic dental care due to a lack of coverage. The report speaks to the possibility of a new addition to Medicare - dental insurance. That could be a game changer. The ongoing discussion about dental care here at HealthLink Advocates is based on the fact that oral health is a health issue, thus a health-care problem and not purely a dental problem! It just does not make sense that seniors, many who naturally with age develop oral health issues are unable to regularly go to a dentist, even for a basic cleaning and have the treatment covered by Medicare.
Having a dental option rolled into Original Medicare would be an expanded option for those who prefer Original Medicare to a Medicare Advantage plan. For those who prefer to remain on Original Medicare and not jump into the world of Medicare Advantage, it would allow many to comfortably remain within their Original Medicare plan without the worry of a lack of dental care. Access to primary dental care would help to ensure that seniors have access to care needed to stay healthy, properly nourished and avoid more intense health issues and health care expenses down the line due to the lack of adequate care.
With the possibility of a new potential down-the-line dental benefit being offered through Medicare for Original Medicare plans, I reached out to a well-seasoned dentist in the metropolitan area, asking for his take on such a benefit and how that would look in the dental community. Dr. Dominic Pisano, currently teaching at Rutgers School of Dental Medicine in Newark, NJ was able to speak to this change, having experience with dentistry in an affluent area, as well as treating patients in inner city Newark. He is taking a wait and see attitude, as there are so many directions where this could go. In the more affluent area where he once practiced, Dr. Pisano said, “The lack of coverage in more affluent areas has not been a large issue. In these areas, patients willingly pay out of pocket or use a discount plan to cover their dental expenses, dutifully taking care of their dental health. The problem lies in the inner city, where many do not have any dental coverage at all. In these areas, large numbers of seniors struggle with dental health issues and eventually lose their teeth as they struggle with major health issues which affect dental health as they do not have access to proper dental care”.
The dental option is way down the line, as you can see from the timeline above that all of these implementations have been years in the making. This bears watching, as many in our inner cities do not opt for the expense of a Medicare Advantage plan, or even buy a Medigap plan to add to their Medicare Coverage. These are expensive options and financially it is more affordable to stay on the Traditional Medicare plans – A, B, and D. If dental coverage is eventually added, it would be good to know that dental benefits would be available for all and not just thought of as an added or unnecessary expense for those unable to afford traditional dental care.