Seniors shopping for private Medicare have many new choices

The financial pain of a two-week hospital stay 15 years ago for a heart ailment gives Patricia Johnstone a sharp focus when she shops for private Medicare insurance.

"The hospital is the main thing I'm concerned about," said Johnstone, 75, who with her husband, Robert, attended a Health Partners Plans information session last week at the Wegmans market in Collegeville.

The Johnstones were unsettled when they heard that hospital stays would cost up to $295 a day for the first six days under Health Partners, which is expanding its Medicare business into the Pennsylvania suburbs next year.

The Johnstones felt good about their current plan, which has a $400 co-pay per stay of any length. Still, with no Social Security benefit increase next year, "it's good to shop around," said Robert Johnstone.

Open enrollment for Medicare Advantage - under which the federal government pays private firms a per-member monthly fee to insure Medicare beneficiaries - runs until Dec. 7 for plans that will take effect Jan. 1.

In Burlington, Camden, and Gloucester Counties, three firms are competing with eight plans. By contrast, in Southeastern Pennsylvania, seven insurers are offering 47 plans, though not all are in each county.

Prices rise with choice, and a higher monthly premium means lower out-of-pocket costs. Monthly premiums for plans with drug coverage range from zero to $272 for Independence's Keystone 65 Preferred HMO.

Nine plans had hikes in monthly premiums of 25 percent or more, Medicare records show.

In New Jersey, AmeriHealth, a unit of Independence, went the other way, reducing rates for one plan by more than 40 percent in certain counties, a spokeswoman said.

Premiums garner much attention, but the key for consumers is to evaluate total out-of-pocket costs, including premiums, co-pays, and other charges.

"You just have to do your homework," said Jerry Gratton, 75, a Schwenksville resident who has a ritual of using a spreadsheet to analyze plans.

The Johnstones have to weigh the cost increases in their Advantra Gold plan vs. other options. Their current $400 co-pay for an in-network hospital stay of any length is rising to $600 next year. And their monthly premium will rise to $123 from $92.

With a dizzying array of choices, insurers are competing for what consulting firm Mark Farrah Associates called "one of the most attractive growth targets" in the industry. Since 2012, private Medicare has grown 23 percent nationally, to 17 million clients, the firm said.

Locally, next year insurers and hospitals will be doing more to jointly manage the care of patients - matching an industrywide trend that aims to reduce costs and improve care:

Aetna and Main Line Health have a new HMO for residents of Chester, Delaware, and Montgomery Counties. Main Line Health will get bonuses if it meets targets for managing the care of members.

Cigna-HealthSpring is adding Abington Memorial Hospital and Lansdale Hospital to its network as part of an expanded relationship with Jefferson Health. Jefferson doctors will have access to Cigna data to improve care.

In Bucks and Montgomery Counties, Humana tapped Doylestown Health Partners, a joint venture of Doylestown Hospital and about 440 primary care and specialist physicians, to manage Humana's Medicare members in those two counties.

Another major change is the entry of behemoth UnitedHealthcare with AARP MedicareComplete Choice, said Allen Heffler, president of My Medicare Advisor, a Willow Grove company that helps seniors pick plans.

"AARP is a monster with Medicare plans" that is just entering Southeastern Pennsylvania, said Heffler, who receives the same commission from an insurer whatever plan his clients choose.

UnitedHealthcare could be a formidable competitor for Independence, which had 97,331 Medicare Advantage members in the region last month, far outpacing the next-biggest insurer, Cigna, with 53,927 members.

Independence is hoping to build that lead with its new Keystone 65 Focus Rx HMO, which has no monthly premium in Philadelphia and Bucks County and a $25 premium in Chester, Delaware, and Montgomery Counties. It also has a relatively small hospital network.

Many people don't decide until late November, said Lovell T. Harmon, senior vice president of business development for nonprofit Health Partners:

"Black Friday is busy."

hbrubaker@phillynews.com

215-854-4651 @InqBrubaker