Empire BCBS MediBlue Freedom I PPO Medicare Advantage Plans being cancelled in Nassau and Suffolk

October 9, 2015

Uncategorized

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.
For those of you who have been notified by EBCBS that your existing Freedom I MediBlue PPO plan will be terminated on 12/31/15, you might be asking “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 are recommending to clients who are losing coverage, and those aging into Medicare, to enroll into one of the following 3 scenarios:

1- Our most robust coverage option recommendation would be to enroll into an AARP Medicare Supplement Plan F. Pair this with an AARP Medicare Part D Rx plan for your prescription needs. Total premiums for this type of plan combination run approx $261 for Plan F plus $65 for the Preferred Rx Part D plan on Long Island. You will have NO limited network of providers under this scenario…you get to go directly to any provider or hospital who participates in the Medicare system.

2- A slightly lower cost coverage option recommendation would be to enroll into an AARP Medicare Supplement Plan N. Pair this with an AARP Medicare Part D Rx plan for your prescription needs. Total premiums for this type of plan combination run approx $178 for Plan N plus $65 for the Preferred Rx Part D plan on Long Island. You will have NO limited network of providers under this scenario…you get to go directly to any provider or hospital who participates in the Medicare system.

3- Our lowest cost recommendation is to enroll into a High Deductible Medicare Supplement plan F (HDF)thru Globe Life of NY. This plan runs $62 per month on Long Island. While the deductible for this plan is set each year by Medicare, 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 portion of each claim – such as 80% of doctor visits after the part B deductible, so you will only be responsible for the 20%. Once your share of what Medicare does not pay for covered services reaches $2180, the HDF plan then pays all covered costs.
Pair this plan at $62 with a Part D Rx Preferred plan from AARP for $65 to get a reasonably priced program that allows you to see any provider or hospital that accepts Medicare.

Just like the case is with Medicare Advantage plans, all scenarios above require you to continue to pay your Medicare Part B premiums in addition to the premiums noted above.

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. Most Medicare Advantage HMO plans have limited networks, require referrals, and require pre-certification. Medicare Supplement plans follow Medicare, which has no pre authorization requirements, no referral requirements and no network.

This article should not be considered a sales piece and is only our personal recommendation and opinion. For full plan details including rates, applications, and any questions please email or call us.