Insurers put out lures as Medicare recipients face big changes

Free rides to the doctor. Smartwatch fitness trackers. Hearing aid discounts.

Health insurers are dangling extra benefits in front of roughly 1 million Minnesotans on Medicare who have the chance in the coming weeks to pick a health plan for next year.

Always a busy time for some Medicare consumers, this year's insurance shopping season is particularly volatile as a federal law forces more than 300,000 people in Minnesota to find new coverage. While there are more extra benefits in the mix this year, many consumers seem focused on just trying to figure out the basics of what's happening.

"The thought of a change is very alarming to people," said Susan Foote, 72, of St. Paul, a retired health policy professor at the University of Minnesota who has been advising friends on the transition. "It almost feels like something is going to be done to you, when there's a disruption like this."

Medicare open enrollment runs through Dec. 7 and is bringing big changes in the lineup of options for Minnesotans. Federal law is forcing health insurers next year to eliminate Medicare Cost plans across 66 counties in the state, resulting in more than 300,000 people switching coverage all at once.

Those consumers face a choice between enrolling in a Medicare Advantage health plan sold by an insurance company, or coverage through the original Medicare program run by the federal government. Many who opt for original Medicare also purchase a Medigap supplement policy plus a Part D prescription drug plan, both of which are sold by private insurers.

While there's been a lot of discussion this fall in Minnesota about the choice facing people in Cost plans, the majority of Medicare beneficiaries in the state already have original Medicare or a Medicare Advantage plan. Those beneficiaries don't have to make a change.

Cost plans will continue in 21 counties where there isn't currently significant competition from Advantage plans, including most counties in the northeast corner of the state. The Cost plans will be lost across most of the state, however, including much of the Twin Cities metro.

People who are losing the coverage have a one-time right to buy a Medigap supplement without answering health questions that could block their enrollment later. So, consumer advocates say it makes sense for people to look closely at their Medigap options now.

Medigap policies tend to have higher premiums than Medicare Advantage (MA) plans, but they also provide broad and easy access to doctors and hospitals. MA plans have networks of doctors and hospitals, which in Minnesota means consumers will pay significantly more money out-of-pocket if they see a health care provider that's not in-network.

Across the country, MA plans have been growing in popularity for several years, with health insurers touting extra benefits the plans offer beyond original Medicare. Earlier this year, the federal government expanded the chance for extra benefits, which insurers say is part of how MA plans coordinate care to help enrollees.

"Many Medicare Advantage plans provide extra benefits," said Gretchen Jacobson, an associate director on Medicare policy with the California-based Kaiser Family Foundation. "That's part of the allure — and the trade-off."

The joint venture company launched by Minneapolis-based Allina Health System and the health insurance giant Aetna, for example, is offering up to 14 home-delivered meals over a 7-day period after an inpatient hospital discharge. Kentucky-based Humana is introducing a transportation benefit for 2019 in Minnesota, where subscribers are entitled to 12 one-way trips per year of up to 25 miles each.

Minnetonka-based UnitedHealthcare, which is making its debut in Minnesota's Medicare Advantage market, is offering one health plan in the Twin Cities that gives members a smartwatch to track activity at no additional cost. Minneapolis-based UCare is offering a program that provides discounts on healthy foods at the grocery store.

The big providers in Minnesota of Medicare Cost plans — Blue Cross and Blue Shield of Minnesota, HealthPartners and Medica — are offering a variety of extras in their Advantage plans including hearing aid discounts.

"Competition is good for Medicare beneficiaries particularly when they are willing to shop for better options and switch plans if they are able to maintain or increase benefits for the same or better value," the Centers for Medicare and Medicaid Services said in a statement.

While extra benefits with Medicare Advantage plans can help some consumers, advocates warn that shoppers shouldn't get distracted.

Beyond the network limits, Advantage plans have out-of-pocket spending requirements when people use care. People who buy the coverage and want Part D benefits must buy them from the Advantage plan, whereas Medigap plans can be paired with drug coverage from any of more than two dozen companies. And the benefits with Advantage plans can change from year to year, said Jerry Maher, a volunteer insurance counselor with the Metropolitan Area Agency on Aging.

"The basic message is: What do you have to give up in terms of coverage in order to get these extras?" Maher asked. "How likely are you to use them, and what is their value?"

There's concern that the federal government has been trying to promote Medicare Advantage plans over Medigap coverage, even though supplements in some cases might be a better deal for consumers, said David Lipschutz, senior policy attorney with the Washington D.C.-based Center for Medicare Advocacy. One way to level the playing field, Lipschutz said, is to make sure the extra benefits with Advantage plans are also available in original Medicare.

"These extras can provide access to things that can be really helpful for people and things that they otherwise would not have access to," Lipschutz said. "However, our caution is, do not let your choice of plan be governed by what extras you may or may not be entitled to by virtue of enrollment."

"Take a look at the entire package," he said. "A lot of these plans with the new bells and whistles also charge considerable cost-sharing, if and when someone uses services."

For now, extras don't seem to be playing a big role in consumer decisions in Minnesota, said Kelli Jo Greiner, health policy analyst with the Minnesota Board on Aging. The focus instead has been health care provider networks, prescription drug coverage, pharmacy participation and monthly premiums, Greiner said.

Foote, the retired health policy expert from the U, said she has mixed feelings about the extra benefits.

On the one hand, they could be important in helping some people maintain their health by making it easier to visit doctors, exercise and eat healthy foods. On the other hand, the extras might simply be frills that attract subscribers without adding much value.

For her part, Foote, is currently in a Medicare Cost plan that's going away. She's been focused on maintaining access to the doctors and hospitals she knows well. She was reassured that things will go smoothly after a meeting this fall with several hundred U retirees, but wonders how people who aren't part of an employer plan are managing the complexity.

"I think it's alarming because of the importance of health care to people, especially to older people," Foote said. "All of us have minor, and many of us have major, issues and we want that safety. We want to know we can get things taken care of."