MEDICARE 2019

No. UCare and Humana medical plans are not impacted as they are Medicare Advantage plans. The BCBS Senior Gold and Medica’s NEW Signature Solution plansare also not impacted as they are Medicare Supplement plans. Clients on Advantage and Supplement plans will experience their typical renewal (meaning, if they do nothing you will be on the same plans in 2019).

Contact us during the Annual Open Enrollment (10/01-12/7) with any questions. Try to use email (meganh@thecriterionagency.com) as it will be VERY busy with the changes below.

NOTE: You do NOT need to read below if you have the above Advantage or Supplement plans

The following plans will close in most MN countieson 12/31/18: BCBS Platinum Blue, HealthPartners Freedom and Medica Prime Solutions. These are called COST plans; and they must close and transition into ADVANTAGE plans for 2019 due to federal law. The insurer and government will send you letters if your plan will close at the end of the year.

Aitkin, Carlton, Cook, Goodhue, Itasca, Kanabec, Koochiching, Lake, Le Sueur, McLeod, Meeker, Mille Lacs, Pine, Pipestone, Rice, Rock, St. Louis, Sibley, Stevens, Traverse, Yellow Medicine. In these counties, the Cost plans listed above will CONTINUE for the time being and will experience a typical renewal (meaning, if you do nothing you will be on the same plan in 2019).

BCBS, HealthPartners and Medica will offer Medicare ADVANTAGE and SUPPLEMENT plans in 2019. You will be allowed to enter ANY plan during the annual enrollment period (10/15 – 12/07). There are also other Advantage and/or Supplement plans available by UCare, Humana, UHC/AARP, Cigna etc.

If your medical and drug plansare with the SAME insurer, you should have an AUTOMATIC ENROLLMENT offer into your insurer’s Advantage plan. You should review the plan offer (just as in past years) and if you do nothing, you will continue with your current insurer on their ADVANTAGE plan.

If your medical and drug plan are with DIFFERENT insurers, you should receive anADVANTAGE plan offer from your medical insurer. HOWEVER, you will most likely need to contact them by phone or electronically to sign up for that plan. Please read their instructions this fall or contact us

Check the network of clinics/hospitals first to see if your important clinics are in-network. Cost plans have had minimal networks. Advantage plans WILL have some clinics/hospitals covered in-network. If a clinic is not in-network, you may still go but you will pay more. The amounts can be found in the out-of-network area of your plan offer.

 
You should also look at premium, co-pays, co-insurance and the out-of-pocket maximums. Finally, be sure to look at the drug coverage for any changes.

All insurers do allow you to go on-line to their member website to search network and drug information. This is a nice option for the do-it-yourself client with a simple situation. Of course, we will assist all, particularly those with complicated situations or limited computer access/skills, on a first-come, first-served basis.

Be sure to let us know the non-network clinic name, drug issue or concern with the Advantage plan. I will be happy to make a recommendation to another plan and help you with the paperwork.

The Advantage plans will be the automatic offer since they will be “deemed equivalent” to you current Cost plan. These plans have co-pays or co-insurance for most services (with no or a small deductible) and will include a drug plan. They will have a network of clinics or hospitals that you must use for in-network coverage (as your Medicare will be managed by the insurer for the year). They will also have a variety of levels of coverage and premium.The premium should be similar to your Cost plan premium. You may change these plans yearly to go up and down in coverage with no health underwriting.

The Supplement plans allow you a wider network of hospitals/clinics (in generally any clinic that accepts Medicare). Your Medicare stays with the government so this allows for a wider network nationwide. Many plans offer full coverage with no co-pays (however there are some high-deductible plans, etc). These plans, generally,will be more expensiveor have high deductibles when compared to your Advantage offer. These plans only open on occasion so you may or may not be able to purchase one in the future. However, all Supplements are available to those losing Cost plans this fall for a Jan. 1 effective date. You will need to purchase a separate drug plan with a Supplement

In a nutshell, you should think carefully about how comfortable you are with a network of clinics/hospitals. You should also think carefully about premium as well. A wide network typically comes with a higher premium or deductible.

Yes! We will be making recommendations on a first-come, first-served basis. Due to the volume of changes this year, we do expect our service time to be slower than usual. We will not be able to sit down with each client, but we will give recommendations to all. Also,be open to direct communication from your current insurer and utilizing their on-line services if you are capable.

Yes, for Cost plan clients losing coverage please contact us asap. With the information below, we can give you an initial recommendation this fall. (Note: if you have already contacted me with the information below do NOT resend)

Let us know the information below:

Your important clinics/hospitals
Your drug list (particularly expensive drugs)
Your interest level in a Supplement plan (note that they cost approx.. $250/mo/person)
Do you LIVE somewhere part of the year? Travel benefits are available on all plans.
Your county & any other concerns (current medical concerns/chronic conditions etc.)

Feel free to email your information to: meganh@thecriterionagency.com OR if you would prefer to mail or fax any confidential information, go to our Contact Page for our address and fax number.

FINALLY, you may want to log-on to your insurer’s member website to make sure you get the latest updates and get take advantage of any tools available there.Also all insurers will provide town hall meetings so you can get an overview of the new plan with questions answered