Seniors enrolled in Medicare plans through the state’s largest health insurer are reaching out to area senior centers with worries that they can’t afford monthly increases that have spiked by as much as one-third in 2017.
Blue Cross Blue Shield of Massachusetts told the Boston Globe this week that it is increasing monthly premiums for comprehensive Medicare plans to offset a decline in federal reimbursements and because of the higher costs of medical care and prescription drugs.
That has left many seniors in the Valley with a case of sticker shock, say senior center counselors.
“It’s definitely caused a little bit of a stir,” said Brendan Rogers, an outreach worker who consults with clients on a daily basis at the Easthampton Council on Aging and Enrichment Center.
Medicare is the federal health care program for Americans 65 and older.
While elders whose incomes and assets qualify them for MassHealth have their Medicare Plan B monthly premiums covered by the state, those who want more comprehensive coverage, also known as Medicare Advantage, could see the monthly premium rise by as much as $60 depending on the plan. Other plans are increasing in smaller amounts.
The most popular plan provided by Blue Cross Blue Shield — Medicare PPO Value RX — is going up by 34 percent, from $59 to $79 a month, while the second most popular — Medicare PPO Blue Plus RX — is rising by 30 percent, from $180.50 to $235 a month. The Medicare PPO Blue Saver RX, though, continues to have no monthly premium.
Tyll van Geel, a volunteer counselor at SHINE (Serving the Health Needs of Everyone) for the Amherst Senior Center, said he has worked with people who have switched plans to ones that are comparable but more affordable.
Plans with zero premiums, though, come with higher copays and less protection against potential out-of-pocket expenses, van Geel said.
Michele Dihlmann, a senior social worker at the Northampton Senior Center, said there are always concerns when Medicare copayments increase and prescription drug payments go up, while Social Security payments stay flat.
“Premiums generally go up every year, and they generally are going up higher than people’s income,” Dihlmann said.
For those already enrolled in Medicare, the premiums for Medicare Part B are not allowed, by law, to increase faster than Social Security, Rogers said.
Rogers said with a lot of the older seniors he consults, they fall within this “hold harmless provision” and are seeing a small monthly premium increase, from $105 to $109.
“That prevents about 70 percent of beneficiaries from seeing an increase,” Rogers said.
These payments are typically taken directly out of Social Security.
But for new Medicare enrollees, people who are turning 65 and others who chose to join Medicare during the enrollment period that ended in December, they will be paying $134 a month, up from the $121.80 premium in 2016.
The costs for Medicare Advantage plans offered by other insurers in Massachusetts are increasing more slowly or going down.
In Hampshire County, United Health Care provides a regional PPO. Its monthly premium dropped from $50 in 2016 to $47 in 2017. Other plans, such as Blue Cross Blue Shield’s Local HMO, were set at monthly premiums of $29, $99 and $235 in 2016, and are at $39, $99 and $295, respectively, in 2017.
Tufts’ Local HMO plan premiums ranged from $0 to $110.20 monthly in 2016, and are $9 to $119 in 2017. Health New England Medicare Advantage Plans Local HMO plans ranged from $27 to $164 in 2016, and range from $38 to $173 in 2017. Fallon Health’s Local HMO plans ranged from $0 to $110 in 2016, and range from $0 to $120 in 2016.
The Centers for Medicare and Medicaid Services reviews and approves plan benefit packages and premiums, but does not have the legal authority to hold premiums to a specific level.
Still, if people want solid health insurance, they have to invest money, Rogers said. “There’s this misconception that Medicare is comprehensive coverage,” Rogers said.
Dihlmann said she will meet with clients and go over options, and see if they are eligible for state and federal programs, particularly ones that are aimed at helping lower- and middle-income people. She helps to examine their income and assets.
Van Geel said the most generous MassHealth plan is limited to people with a monthly income of about $1,300 and no more than $7,200 in assets. This also comes with “extra help” from the federal government that will pay for the prescription drug benefit.
For a lot of those on MassHealth, the entire premium is taken care of by the state, Rogers said. But there are risks that people who get cost-of-living adjustments could lose this, and then be forced to pay the monthly premiums. They would also lose access to the full “extra help” from the federal government.
Scott Merzbach can be reached at smerzbach@gazettenet.com.
