Local seniors upset about health insurance letters. Here’s what you need to know.

A doctor talks to a senior patient
A doctor talks to a senior patient Submitted

Stanislaus County has a healthy amount of competition between health plans offering services for seniors in the Medicare program.

Perhaps one downside were letters sent a week ago to members of the CareMore Medical Advantage plan, which stirred confusion as Medicare’s fall enrollment period drew to a close Friday.

Counselors who assist Medicare beneficiaries said the letters from physicians tied to AllCare Independent Physician Association suggested that patients enroll in another health plan or they may lose access to their doctors. Some, but not all, of the physicians in the network gave permission for AllCare to send the letters on their behalf.

There is no reason for those patients to make any changes this fall, said Sandy Howell, a community educator and counselor for the Health Insurance Counseling and Advocacy Program in Modesto.

Under a contract, CareMore members are able to receive health care from AllCare physicians, and that contract won’t expire until 13 months from now — on Dec. 31, 2019. Many patients have been confused because the contract expiration date is not printed on the letters.

Many patients thought they were up against Friday’s enrollment deadline for making coverage changes for 2019.

“We are telling them that their doctors have not dropped them,” said Maria Profeta, program director at Stanislaus County’s HICAP office. “Most people are relieved that they won’t lose their doctor.”

CareMore members might have to make decisions during Medicare’s fall enrollment window next year if AllCare and CareMore don’t agree to terms of a contract to replace the one expiring Dec. 31, 2019. About 2,000 seniors are affected.

In the health care industry, negotiations between provider groups and insurers sometimes result in expiration notices, but patients are typically informed 60 days before the contract is set to expire — not a year in advance, Howell said. Even when patients receive a 60-day notice, the negotiating parties often work out a new agreement.

A regional manager for CareMore said Friday that the Medicare health plan, known for its care centers and exercise programs for mature adults, hopes to continue its relationship with AllCare. CareMore has been owned by Anthem Blue Cross or a predecessor since an acquisition in 2011.

“We are trying to work with them,” said Mike Montoya, Northern California manager for CareMore. “Our members use the AllCare network of doctors and will continue to see those physicians in the community for the next 13 months. If the contract can be successfully renewed, they will still have access to AllCare physicians.”

AllCare didn’t return messages from The Modesto Bee to discuss their interest in a contract renewal with CareMore.

One of the recent letters, sent to a 94-year-old woman in Modesto, was dated Nov. 28 and had the name of the patient’s primary care doctor at the top.

The letter states that ”in the foreseeable future (the doctor) may no longer be contracted with CareMore Health Plan through AllCare, and may not be able to care for you under your CareMore plan.”

The letter provided a phone number of an insurance agency that could help the patient compare other available Medicare Advantage plans, so the patient could keep her doctor. A customer service representative with the agency said the idea was to give people time in advance to choose another health plan that meets their needs.

Medicare Advantage health plans offer additional benefits and services on top of the basic benefits of Medicare, the federal health program for seniors 65 years and older. The plans are offered by eight approved carriers in Stanislaus County. An enrollment period for benefits effective Jan. 1 ran from Oct. 15 to Dec. 7.

Howell said some CareMore patients have received calls from insurance agents, and she’s looked into complaints that insurance agents have steered patients to one particular health plan.

Profeta said three drop-in clients had questions about the letters Thursday and the office fielded calls from eight people Wednesday and Thursday. Some seniors who took their questions to CareMore were in tears, an employee said. Physician offices also were hearing from CareMore members.

Profeta said any patients who felt pressured to change plans can reverse the decision during a Medicare Advantage special open enrollment Jan. 1 through March 31. “They will have the plan for the month of January and we can switch them back effective Feb. 1,” Profeta said.

The special period is for one-time changes such as dropping a Medicare Advantage plan, switching to a new one, returning to original Medicare or signing up for Medicare prescription drug coverage.

Starting in January 2019, low-income seniors with dual Medicare and Medi-Cal coverage will lose the month-by-month option of choosing a plan that meets their needs, but can select a plan for the first nine months and then make a choice during the annual enrollment time held by Medicare.

Starting in 2020, the “dual eligible” seniors can make a one-time choice for the year, Profeta said.

The Modesto HICAP office, 3500 Coffee Road, Suite 19, offers free assistance with navigating Medicare. Call 800-434-0222.