Coverage options for Triad likely to cost more after Blue Cross ends 2 Medicare plans

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Triad residents affected by the Blue Cross Blue Shield of N.C. decision to eliminate two popular Medicare HMO plans in 11 counties have choices, though they may cost more, according to the Winston-Salem Journal. 

There is no shortage of other Medicare Advantage plans available for 2015, including four from Blue Cross, according to information provided Thursday by the N.C. Department of Insurance.

For example, in Forsyth, there also will be five plans from Humana, four from UnitedHealthcare and one from Cigna.

The not-so-good news for many people: They could pay either a higher monthly premium or lose their prescription drug coverage with some of the other plans.

The insurance helps fill in the coverage gap in what retirees get from Medicare.

Blue Cross sent a four-page letter this week to participants in Alamance, Davidson, Davie, Forsyth, Iredell, Rowan, Stokes, Surry, Wake, Wilkes and Yadkin, spokesman Blue Cross Lew Borman said Wednesday. He did not have a total for how many people are affected.

The letter said the insurer was not offering its standard or enhanced plans to them in 2015, which includes the Silver Sneakers exercise perk program.

Melissa Smith, transition specialist with Senior Services, said Thursday her agency expects to be “inundated” with calls from local clients asking for advice on what to do next. Silver Sneakers is an exercise program.

“I can see where some of them are feeling abandoned because Blue Cross has always been here, and they really like the Silver Sneakers benefit,” Smith said. “They feel they may not be covered again so well.”

Blue Cross has not made public why those counties were selected. Borman said the insurer “evaluated the changing landscape” as part of its attempt to “offer sustainable products across the state.”

“These counties represent the areas with the most federal government reimbursement impact,” Borman said. Borman did not provide further details when asked whether the impact represents a reimbursement cut.

Affected members can make a 2015 choice throughout the annual enrollment period, which begins Oct. 15 and ends Dec. 7. Because their plan is ending, members are affected also will be eligible for a special enrollment period from Dec. 8 through Feb. 28.

Smith said Blue Cross likely chose the 11 counties for elimination of the two plans because they weren’t cost effective.

There was no additional premium cost with the Blue Cross Medicare HMO standard plan; there was an $18.50 monthly premium with the enhanced plan.

The four plans Blue Cross is offering for 2015 in the 11 counties are: HMO medical only (no additional premium); HMO essential ($63.40 per month, including parts C and D); PPO enhanced ($57.40 per month, including parts C and D); and PPO enhanced freedom ($142 per month, including parts C and D).

Some competitors’ plans offer a lower premium cost but include a required drug deductible.

There is also the option of the original Medicare plan, which has a prescription drug component for an additional monthly premium fee.

“The monthly premium for a Medicare drug plan could be minimal enough that this option is just as cost-effective, if not, more cost-effective than a Medicare HMO, depending on their medications, health issues, geographic location, etc.,” Smith said.

Many of the affected individuals could be R.J. Reynolds Tobacco Co. retirees. They may have chosen one of the two Blue Cross plans after Reynolds began making an annual $1,000 contribution in 2013 to a tax-free, health-reimbursement account in their name rather than allowing them to continue to participate in the company health plan.

Reynolds retirees go through Extend Health, a company hired by Reynolds for the health insurance transition, to choose individual coverage for medical, prescription, dental and vision care.

Another notable local example came in 2007, when Hanesbrands initially cut, then eliminated, its contribution to retirees’ health-insurance premiums for those younger than 65.

Although Reynolds declined to provide a number, there likely are thousands of local retirees ages 65 and older, as well as past or current companies affiliated with Reynolds. Many Reynolds workers over the past 30 years had volunteered for early-retirement packages in part because they could stay in the company health plan.

Ronnie Lauten, 72, and his wife, Barbara, 69, worked at Reynolds for a combined 68 years. Ronnie Lauten retired in 1996, while Barbara Lauten retired in 1999.

“Blue Cross may be feeling they are losing money or not making enough money on Reynolds retirees, so they may have gotten rid of those plans here for those reasons,” Ronnie Lauten said. “Perhaps they decided the Reynolds retirees can afford to pay for.”

Smith said Senior Services has clients who come in during the annual enrollment period “with their prescription drug list in hand wanting to discover their best option.”

“We’re worried that other clients who get the letter from Blue Cross may think it is just another explanation of benefits letters and not open it.

“Then in January, when they try to use their Blue Cross Advantage plan, they are turned down and wonder what’s happening.”

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