Medicare Advantage enrollees face declining coverage

A number of insurance companies will no longer carry Medicare Advantage policies starting next year, which has forced some Spokane residents to search for other plans to continue receiving coverage.

Officials from three providers sent letters in October announcing that they would no longer be offering the advantage plans, which are types of health insurance that can be used instead of Medicare – the federal-health insurance program for residents who are 65 or older and also for younger people with disabilities.

PacificSource, Premera and Health Alliance will no longer offer Medicare Advantage plans in 2025. MultiCare also sent letters to let patients know it also would no longer be accepting Humana’s advantage plan.

Monica Kudrna is a statewide health insurance benefits adviser for Aging & Long Term Care of Eastern Washington. She said her organization started receiving calls from seniors in October once they began getting notices about the ending plans.

“I’ve been doing this for six years,” Kudrna said. “It’s the first time I’ve been doing this that I’ve seen this many completely drop out.”

However, she noted that the loss of plans is also relative. When Kudrna began as an adviser, she knew only a handful of Medicare Advantage plans.

Even with the three recent departures, some 10 other companies offer plans for Spokane residents.

“So, beneficiaries really need to explore other Medicare Advantage plans to see what their doctor’s offices are accepting,” she said. “A key thing is to look at is the cost of prescriptions and where they get them filled and whether they are in network. All those things factor in.”

Kevin Maloney, spokesman for MultiCare, which operates MultiCare Deaconess Hospital, MultiCare Valley Hospital and MultiCare Rockwood Clinic, said the health care system made the decision to no longer offer Humana’s Medicare Advantage plan.

“Each year, we evaluate those partnerships to ensure they are meeting the needs of our patients and the communities we serve,” Maloney said in an email.

He noted that MultiCare sent patients a letter informing them about dropping Humana in October.

“MultiCare partners with Chapter, a licensed Medicare advisor, to provide current and potential plans with free, no-obligation help navigating Medicare coverage choices and enrollment,” he wrote.

Kudrna said she has not heard of any similar cancellations, other than the three known discontinued plans, by Providence, which operates Providence Sacred Heart Medical Center and Providence Holy Family Hospital.

Providence spokeswoman Beth Hegde could not immediately be reached Friday for comment.

Aging & Long Term Care uses about 30 volunteers who work to help seniors when they call with questions about coverage.

“We have probably had about 20 calls a day since Oct. 5,” Kudrna said. “We are extremely busy.”

The advantage plans offer several options, and some focus on health care or in-home care or prescriptions. That means seniors need to do some homework about which plan is best for them, she said.

“We take our time with the beneficiaries because Medicare is confusing,” Kudrna said. “Whether they are new or receiving plans, it all takes time. It takes about an hour to talk to an individual” about the options.

The plans have certain windows, called open enrollments, where seniors can either find a new plan or switch from the ones they had been using. The current enrollment deadline plan ends on Dec. 7.

She noted that her organization’s volunteers use what’s called Medicare Plan Finder, which is a tool that can be found at Medicare.gov.

“There are quite a few plans in the Spokane area. It is different for each county. So, it’s really important to shop for a Medicare Advantage plan that’s in your county so you are not out of network,” she said.

If seniors miss the Dec. 7 deadline, another open enrollment period begins on Jan. 1.

“If you are not proactive and check with your doctor, sometimes you can’t make changes until the next open enrollment,” she said. “It is very important for people to open their mail and ask questions. Things change. Prescriptions change. People’s health changes, so it’s important to check every year.”

Aaron VanTuyl, a spokesman for the Washington state Office of the Insurance Commissioner, said his organization has also fielded questions about the canceled plans. Like Kudrna, he noted that seniors have options.

“If you’ve received notice that your Medicare Advantage plan is leaving the market and won’t be around in 2025 (a plan non-renewal), you have special rights to enroll in another Medicare Advantage plan, Medicare Part D, or Medigap plans, or can return to Original Medicare,” he wrote in an email. “This special enrollment period runs through February.”

Those folks who had plans that have left the area also have “guaranteed issue” rights to buy a Medigap plan up to 63 days after the Medicare Avantage plan ends.

“This means you can buy one of the new plans without having to pass a health screening or pre-existing condition waiting period,” he wrote.

While the forms and options can be daunting, Kudrna’s organization offers other ways to help.

“We offer education classes all the time in Spokane County libraries,” she said. “If they are new to Medicare and want information, we offer free classes through them so they can learn more.”