Seniors advised on using Medicare

Plans, enrollment queries addressed at Turlock meeting

By Ken Carlson
kcarlson@modbee.com

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TURLOCK — Seniors and disabled people in this city of 70,000 may have to travel 15 miles to Modesto if they need more than routine medical care.

On Thursday, they only needed to attend a meeting at the Turlock Senior Center to get advice on navigating the Medicare system.

The Stanislaus County Health Insurance Counseling and Advocacy Program held meetings in outlying cities this month to educate more county residents about the national health program for people ages 65 and older and the disabled.

At A Glance

Here is a comparison of the Medicare Advantage plans in Stanislaus County:

• Kaiser Senior Advantage Basic: Zero monthly premium, with co-payments of $225 per day for one to 10 days of hospitalization, $30 for physicians, $175 for outpatient surgery, $300 for ambulance, $30 for lab and X-rays, $10 for generic drugs and $35 for brand. Generic drugs are still covered in the gap after drug costs exceed $2,830 for the year. Routine dental is $20 per month. 888-448-9400.

• Kaiser Senior Advantage Enhanced: $60 monthly premium, with co-pays of $150 per for one to seven days of hospitalization, $10 for physicians, $100 for outpatient surgery, $200 for ambulance, $20 for lab and X-rays, $7 for generic drugs and $35 for brand. Covers generic drugs in the gap. Dental is $20 a month. 888-448-9400.

• CareMore StartSmart: $19 monthly premium, with co-pays of $200 per day for one to five days of hospitalization (60-day benefit period), $15 for physicians and $30 for specialists, $150 for outpatient surgery, $50-$100 for ambulance, zero for lab and X-rays, $5 for generic drugs and $40-75 for brand, no gap coverage. Dental is $25 a month. 985-9417.

• CareMore Value Plus: $49 monthly premium, with co-pays of $100 per day for one to five days of hospitalization (60-day benefit period), zero for physicians and $20 for specialists, $100 for outpatient surgery, $50-$75 for ambulance, zero for lab and X-rays, $5 for generic drugs and $15-$60 for brand. Coverage for generics and some brand drugs in the gap. Dental is $12.90 a month. 985-9417.

• SecureHorizons: $85 monthly premium, with co-pays of $200 per hospital stay, $10 for physicians and specialists, zero for outpatient surgery, $150 for ambulance, zero to $10 for lab and X-rays, $6 for generic drugs and $42 for brand, no gap coverage. Dental is $19 a month. 629-4475.

• HealthNet Healthy Heart: $109 monthly premium, with co-pays of $100 per day for one to four days of hospitalization, $10 for physicians and specialists, $100 for outpatient surgery, $180 for ambulance, zero for lab and X-rays, $7 for generic drugs and $42 for brand, no coverage in the gap. Dental is $15-$18 a month. 800-935-6565.

On the Net: www.medicare.gov.

HICAP advisers answered questions about the 2010 Medicare enrollment period, from Nov. 15 to Dec. 31, and offered help in comparing the Medicare Advantage plans available in Stanislaus County.

The premium for Medicare Part B, which covers physician fees, will remain at $96.40 per month next year.

Another layer of insurance is offered by Medicare Advantage plans that cover hospitalization and physician services, surgeries, X-rays, lab tests and prescription drugs. Four insurers are offering the government-subsidized plans in Stanislaus County in 2010, at premiums ranging from zero to $109 per month on top of the Part B premium.

SecureHorizons is raising its premium from $79 to $85 a month effective Jan. 1. A plan called HealthNet Healthy Heart is going even higher with its premium to $109 a month, compared with $82 per month this year.

Other plans are offered at a lower monthly cost. Kaiser Permanente is keeping its premium at $60 a month for Senior Advantage Enhanced and has a basic plan at no monthly cost. CareMore Health Plan is rolling out a StartSmart option at $19 a month and a Value Plus plan at $49 a month. Plans sold at no or low monthly cost have higher copayments and fewer benefits.

All of the plans offer dental coverage for an additional $15 to $25 a month.

Some Turlock residents had questions about Southern California-based CareMore Health Plan, which opened a neighborhood care center this week on McHenry Avenue in Modesto. Representative Cherri Brown said more care centers — providing extra services such as health assessments and exercise programs — could be added in Turlock or Oakdale, depending on enrollment.

Primary hospitals in Modesto

CareMore has agreements allowing patents to see physicians in Modesto and Turlock, with Doctors Medical Center in Modesto designated as their primary hospital. Turlock residents enrolling with CareMore would go to Emanuel Medical Center in an emergency and be transferred to Doctors when their condition is stable.

Turlock residents enrolled in SecureHorizons and HealthNet also are supposed to use Modesto hospitals in nonemergencies. Kaiser Permanente still has an agreement allowing patients to use Emanuel for certain services.

Seniors who travel should ask brokers about coverage levels in case they need medical attention in other states or abroad. For example, CareMore has a $10,000 coverage limit on emergency services outside the United States; SecureHorizons has no limit on emergency care.

People wishing to enroll or switch to another Medicare Advantage plan should make sure their doctors accept the insurance and that it covers their prescription drugs.

Bee staff writer Ken Carlson can be reached at kcarlson@modbee.com or 578-2321.