Saugus Advertiser, February 5, 2004

Medicare HMO Rates Falling

Finally, some good news. But first, an update on the hoped for override of Governor Romney’s veto concerning the expanded estate recovery. The expanded estate recovery provision allows MassHealth to lien property that had been protected in the past. There has not been a vote as of yet, but we are hoping that the House of Representatives will be able to vote for this and send it on to the Senate.

The expanded estate recovery, also known as Outside Sec. 329, was discussed in my August 28, 2003 article, Elders Lose Home Protection. This, as well as all of my prior articles may be retrieved at my web site, www. elderlawcenter.org.

Now for the good news! On January 16, 2004 the Center For Medicare & Medicaid Services (CMS) announced significant increases in federal payment rates for Medicare Advantage Health Plans. These plans were formerly known as Medicare + Choice and include choices such as Secure Horizons and Blue Care 65 from Blue Cross Blue Shield. This means that your premiums are going down.

The increased payments from the federal government to Medicare Advantage Health Plans will take effect on March 1, 2004 and are part of the Medicare Prescription Drug Improvement and Modernization Act signed by President Bush on December 8, 2003. The purpose of the increased funding is to:

· Reduce beneficiary premiums or co-pays

· Enhance benefits, and

· Stabilize or expand the network of doctors available to seniors.

Currently, 4.1 million of the 41 million Medicare beneficiaries have chosen to enroll in a Medicare Advantage plan. These plans, such as Secure Horizons, take the Medicare premium that is withheld from the beneficiary’s social security check along with monthly premiums to provide HMO coverage to the individual that in some cases provides superior medical coverage than staying on the Medicare plan.

Deciding which health coverage to select can be difficult. Help is available. If you have questions and need help in figuring out what health insurance options are available to you, call Nancy McKenzie at the Outreach Department of the Senior Center at 781-231-4178.

On January 28, 2004 Blue Cross Blue Shield announced that it was reducing the monthly premium for it’s Medicare Advantage Health Care plan, Blue Care 65, because of the increased funding by the federal government. For Essex County the current premium of $162 will drop to $82, effective March 1, 2004. Secure Horizons has also announced a reduction in their monthly premium from $162 down to $127.

Secure Horizons will be using some of the funding to stabilize the physician participation in the plan. Since 2002, Secure Horizons has seen a 31% drop in the number of primary care physicians in the plan due to inadequate federal funding for the program.

These rate drops and the prescription discount cards that will be available around May are the first benefits available under the Medicare Improvement law passed last December. The full benefits under this law don’t go into effect until the year 2006.

This article gives general information and not specific advice on individual matters. Persons wanting individualized advice on matters discussed should contact an advisor experienced in those matters. To the extent this article provides information on legal matters, it is based on law in effect in Massachusetts on the date of posting (laws in effect in other states are often quite different).

Ronald H. Surabian is a CPA and attorney who works at the Elder Law Center in Saugus, Ma. He also holds a masters in accounting and a masters in tax law. He currently serves on the board of directors of the Massachusetts Chapter of the National Academy of Elder Law Attorneys.

This web site may be considered "advertising" under Massachusetts Supreme Judicial Court Rule 3:07. The information presented on these pages does not constitute legal advice. An attorney client relationship can only be established after personally meeting with each other. After consideration of all the facts in your case during a personal meeting, and payment and acceptance of a retainer, will an attorney client relationship begin. Likewise, electronic mail to Elder Law Center through this site cannot be guaranteed to be confidential and does not create an attorney-client relationship.