Medicare Advantage beneficiaries must re-enroll


By PETER SUR

Tribune-Herald staff writer

Some 1,525 Medicare Advantage beneficiaries on Hawaii Island who are relying on insurance from Kaiser Permanente need to re-enroll in a new Medicare plan by the end of the year.

This new plan that Kaiser is offering features the same benefits and premiums as one that is being discontinued.

The federal Centers for Medicare and Medicaid Services, or CMS, informed beneficiaries of the change earlier in October, with a notice that beneficiaries are losing their current health plans as of Dec. 31.

What the notice didn’t say, however, is that Kaiser is offering a new plan for Hawaii Island residents that will offer the same benefits as their old plan, but beneficiaries will have to re-enroll.

Medicare Advantage health plans are operated by private insurers under contract to CMS, the federal agency that oversees Medicare, Medicaid and the State Children’s Health Insurance Program.

“The immediate situation here, I gather, is that Kaiser Permanente’s pulling their service out of the Big Island of Hawaii,” said David Sayen, Medicare’s regional administrator for Hawaii, said by phone from the regional office in San Francisco. He couldn’t speculate as to why Kaiser would do that.

But Kaiser spokeswoman Laura Lott said that’s only half of the story, and she hit at CMS’ tendency to over-regulate.

“They’re very fussy with lots and lots and lots of rules and regulations,” Lott said. “So we can’t make changes to an existing plan. They (CMS) actually require us to stop the plan, one, and then start a second plan. In addition to that, they require us to send their very confusing, very governmental-speak letter to the seniors, and they (the seniors) get all confused.

“So actually, nobody’s going to lose the coverage. We want everybody, plus anybody that wants to join to come and they’ll be a Kaiser member.

Lott called it a “bummer” that seniors will have to fill out more paperwork to re-enroll in the program.

“We would never choose to do it this way, but it’s what the government requires, so we have to follow their rules.”

In a follow-up phone call, Lott said that the changes in the new plan are superficial.

“The reason for this change is we’re actually renaming Big Island Medicare plans versus the Oahu and Maui Medicare plans,” Lott said. “Benefits are the same, premiums stay the same for all plans, but what it does is Big Island is a big part of our strategy moving forward and separating these two will give us this flexibility.”

Kaiser isn’t the only health insurance company making its Medicare Advantage beneficiaries re-enroll. Humana is doing the same to 1,230 beneficiaries in Honolulu and 669 on Kauai

Pamela Cunningham, manager of the Sage PLUS program, which offers counseling and assistance to Medicare beneficiaries and their families, praised Kaiser Permanente for getting the word out about the change.

“Kaiser has the two plans, and they are closing those down. But they have two plans to replace them,” Cunningham said. “But because of Medicare rules, they cannot automatically enroll people in those plans. So they have to let people know so that people can decide, can I enroll in the Kaiser plan or do I want to look at other options?”

Kaiser had sent out its letters in early October and has held 18 informational meetings, Cunningham said, attracting hundreds.

“It was kind of scary because the way they had to write the letter, and it’s according to Medicare guidelines, is that the letter they got said, ‘Your health plan is ending as of Dec. 31st.’ And so that scared a lot of people. We had that day, that first couple days, we had a lot of phone calls of people really concerned.”

Kaiser then sent another letter that said, in essence, “we have this other option that’s available, so we’re still going to be on the Big Island,” Cunningham said. “And that really calmed people down.”

She said that Medicare Advantage beneficiaries who want to stay with Kaiser can call the firm and request to be re-enrolled.

Those Kaiser beneficiaries who do not re-enroll in a new Medicare Advantage plan will be placed in “Original Medicare” come Jan. 1, but they won’t have drug coverage. They will then be eligible for a special enrollment period to get drug coverage, but “we don’t want that to happen,” Cunningham said. “We want to do something before.”

Kaiser beneficiaries may also consider looking for other plans, Cunningham said, but that also involves changing doctors, and on the Big Island finding a new physician is often a challenge.

Email Peter Sur at psur@hawaiitribune-herald.com.

 

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