New Medicare offering could improve access to affordable health care for Eagle County seniors
Medicare Advantage Plans with $0 premiums will come to the county next year, but officials warn they may not be right for everyone
Eagle County seniors will have access to new Medicare plans next year, meaning more options and, for some, more affordable care in a valley known for a high price tag on health costs.
For the first time in years, United Healthcare has announced that it will offer Medicare Advantage Plans in Eagle and Pitkin counties, said Jonnah Glassman, the coordinator of the Medicare State Health Insurance Program run out of the Northwest Colorado Council of Governments. The company will expand advantage plan offerings in Summit County next year as well.
This announcement has the potential to help many seniors have access to more complete and more affordable coverage as well as new benefits like an $80 monthly food stipend, routine vision, hearing exam and hearing aid coverage and subsidies for a gym membership, according to Sharie Rutherford, principal for Bridlewood Insurance Denver.
The newly available Medicare Advantage Plans combine the two basic components of original Medicare – coverage for hospital stays/inpatient care known as “Part A” and coverage for doctor visits/outpatient care known as “Part B.” For this reason, advantage plans are sometimes referred to as “Medicare Part C” plans, Rutherford explained.
The advantage plans also add in prescription drug coverage, known as “Part D,” and essentially eliminate monthly premiums, swapping them for copays amounting to no more than $5,900 annually in out-of-pocket costs, according to a United Healthcare brochure on the new offerings.
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Don Douglas, a broker with Bridlewood Insurance Denver, said the local clients he has worked with thus far have been very excited to have an additional option available to them.
“They were all like, ‘Oh, this is great,’” Douglas said. “Our clients need to know about this stuff because this has really been a void in the county.”
The new plans sound great, and will be for some seniors, but Glassman warned about the difference between marketing and education when it comes to navigating the insurance market.
“It’s not like a one-stop shop where, now that these advantage plans are available, everybody should hop on them,” she said. “Everything is so individual as to where your health is, how much money you can afford and so it is really individual to your specific needs.”
Three Medicare Advantage Plans will be offered starting Jan. 22, two with $0 monthly premiums and a third with a $24 monthly premium with a “$20 over-the-counter credit” resulting in a net $4 monthly payment, Douglas said.
However, copays under the advantage plans are higher, meaning seniors who have upcoming surgical needs, require physical therapy or frequent doctor visits should do an assessment of the financials to determine whether a switch is right for them, Glassman said.
More in-network care options
This isn’t the first time that advantage plans have been available in Eagle County, Glassman said. Rocky Mountain Health Plans, a Colorado-based insurance provider, offered the plans years ago before the agency was acquired by United Healthcare.
Now, the plans are back and being offered by a larger player in the insurance market, meaning subscribers have more options as they can tap into United Healthcare’s nationwide network of specialists, Douglas said.
“If there’s a specialist that is not right out their back door, they have the ability to come to, you know, Denver,” Rutherford said. “It just provides them great access, which is needed in your region.”
While there have been significant efforts to improve access to specialized care in the Western Slope, many people still travel great distances for specialists, which adds travel and overnight stay costs on top of the cost of care.
The PPO, or preferred provider organization, offered in these advantage plans give subscribers more options for in-network care and do not allow for exclusions based on preexisting conditions, Rutherford said. This differs from the more restrictive HMOs, or health maintenance organizations, contained in some other advantage plans or “Medicare Part C” plans, she explained.
Vail Health is currently finalizing its contract with United Healthcare to be in network for the Medicare Advantage Plans beginning in January 2022, according to a statement from the company. Colorado Mountain Medical is already considered in-network for the plans, effective next year.
“Any health plan that provides more access to care, especially specialized care, is a benefit to the community,” Wendy M. Spirek, Vail Health’s director of managed care contracts and payer relations, said in a written statement.
“We support plans that provide access to care as close to home as possible, especially for the older population,” Spirek said.
The plans also have preventative health care elements that Douglas said aim to improve the overall public health of seniors and their communities.
Even still, they may not be the best fit for everyone.
Glassman oversees a network of Medicare State Health Insurance Program volunteers spread across the region, who are charged with distributing unbiased information and counseling seniors on the various Medicare options available to them.
The annual enrollment period for 2022 has begun and extends until Dec. 7. As her phone rings with calls from seniors who have questions about the new plans, Glassman encouraged everyone to make use of this time period to check in with a Medicare counselor.
Different needs for different folks
Eagle County’s Medicare counselor is Karen Eyrich, an EagleVail resident who finds joy in helping other seniors navigate an increasingly complex system to find the best options for their specific needs.
“I turned 65 and I was kind of looking around and it was really hard to put all of these different options together,” Eyrich said. “It can be really overwhelming having all these different options so I just enjoy helping people navigate that and especially those that don’t have email or the internet and they’re basically stuck unless someone sits down with them.”
When it comes to the new advantage plans, Eyrich said seniors should consider their health, their current premiums and upcoming appointments and their tolerance for risk, among other things.
For example, the new plans were a good fit for Eyrich’s husband who is relatively healthy and less likely to incur a large amount of copays for surgeries or outpatient services. It makes sense for him to take a risk on out-of-pocket costs in exchange for the $0 monthly premium, she said.
Eyrich, on the other hand, ultimately decided the advantage plans were not for her because of differing health needs and a personal desire to err on the side of being overinsured, she said.
“I go on a cruise and I buy travel insurance and my husband doesn’t,” she said, illustrating that another deciding factor is each individual’s tolerance for risk.
One subset of the local senior population that will certainly benefit from the new Medicare Advantage Plans are low-income people over the age of 65 who are eligible to be covered by a combination of Medicare and Medicaid through a program called Qualified Medicare Beneficiary.
For this demographic, Medicaid covers some or all of subscribers’ copays, meaning the benefits of the $0 monthly premiums would very likely outweigh any increase in copays or out-of-pocket costs, Eyrich said.
Low-income seniors may also have a greater need for additional benefits offered in the plan like dental and hearing coverage or the monthly food stipend, she said.
However, Glassman said she has been unable to ascertain whether the extra benefits included in the new advantage plans can be offered in rural mountain communities like Eagle County.
The new plans offer transportation to medical appointments, but utilize transportation services that are not available in the mountains, she said. Similarly, the gym membership offered is run through a company that may not operate facilities in the Western Slope region.
She said she has yet to receive conclusive answers as to whether these benefits will be available in the region but fears that these kinds of benefits may lead seniors to switch over even if the new plans are not the best or most affordable option for them.
“These plans they sound really good because they have all of these extras,” Glassman said. “I just don’t want people to be pulled in with all the extras because it’s not clear how these extras are going to help beneficiaries in our communities yet.”
The first year of implementing the advantage plans in Eagle County will be an interesting “trial period” to better understand how their pros and cons play out in our community, Glassman said.
The new plans will also benefit from increased competition as more insurance companies begin to bring advantage plans to Eagle County in the future, Eyrich said.
Overall, Glassman, Eyrich, Douglas, Rutherford and Vail Health officials voiced their support for the emphasis on preventative healthcare that the Medicare Advantage Plans have.
“We just want to make sure everybody is making educated decisions and that it’s not just because they heard about it in a commercial,” Glassman said. “So, ask the questions, make the phone calls … it’s just good, at least once a year, to understand what your drug coverage is and what your health coverage is to make sure it’s going to meet your needs.”
Seniors who would like to connect with Glassman or Eyrich for more information on the best Medicare option for them can visit YourVintage.org, click on the “Your Care” tab and then select “Medicare” to book an appointment. They can also be reached at (970) 315-1328.
Douglas has two upcoming informational sessions on Medicare options planned in Eagle County. The first is at 10 a.m. on Nov. 6 in the El Jebel Community Center and the second is on Nov. 11 at the EagleVail Pavilion with two sessions — one at 2:30 p.m. and one at 5:30 p.m.
Email Kelli Duncan at firstname.lastname@example.org