2016 PPO Medicare Advantage Plans Being Cancelled in Nassau and Suffolk

September 15, 2015


As has been the trend for the past few years, carriers are shrinking their Medicare Advantage offerings, especially in the PPO market. With ever increasing premiums and rising member copays and out of pocket costs, it was only a matter of time before PPO options in the Medicare Advantage market would cease to exist in Nassau and Suffolk counties on Long Island. There are strong indications that one of the only Medicare Advantage PPO carriers will be cancelling the PPO plans for all existing members as of 12/31/2015. So you ask, “What should I do?”

While we have promoted Medicare Advantage PPO’s in the past to our clients as they allowed members to be seen by both in network and out of network providers, the loss of that option means beneficiaries will only have limited HMO providers to choose from when they are at their highest risk of having health issues. Because of this, we will be advising clients who are losing coverage, and those aging into Medicare, to do one of the following once open enrollment for 2016 begins:

1- Enroll into one of the Medicare Supplement plans we offer. There are multiple plans available with the most popular being Plan N and Plan F. Pair this with a Medicare Part D Rx plan and you will have what we call the ‘Cadillac of coverage’ that provides excellent coverage with no limiting doctor network you would otherwise have with an HMO Advantage plan.

2- Enroll into a High Deductible Medicare Supplement plan we offer. In 2015 you pay the first $2180 of charges not paid by Medicare A and B, and then most charges are covered in full. Keep in mind Medicare A and B will be covering a good amount of each claim, so you might never reach the deductible limit. Pair that with a Part D Rx plan and you have what we call a ‘Value Medicare Supplement w PDP’ plan with no limiting provider network like the HMO.

While the options above might cost slightly more than having a Medicare Advantage HMO, I believe that having more choices of doctors and hospitals using traditional Medicare A&B coupled with a Supplement and Part D plan far outweigh the slight savings you might find from enrolling in a limited network HMO Medicare Advantage plan.

*James Eckardt is a licensed Life and Health Agent as well as P&C Broker in Suffolk County NY. 2016 Medicare Open enrollment starts 10/15/15 – 12/7/15. Medicare Supplement and Part D premiums have not been released as of the writing of this article and should be expected to differ from 2015 rates. Plans not available in all locations. This blog is not a solicitation for insurance and is written to provide one professional’s opinion and to educate Medicare beneficiaries. Suggestions and opinions are those solely of the writer.

2016 PPO Medicare Advantage Plans Being Canceled in Nassau and Suffolk