Medicare chief Jonathan Blum was in Chicago this week to get the word out about changes to the federal health insurance program, which begins open enrollment Saturday.
Among the changes this year: fewer health plans, lower premiums and an earlier deadline.
We sat down with Blum, deputy administrator and director of Medicare for the Centers for Medicare and Medicaid Services, to find out what the nearly 2 million Illinois residents enrolled in the program need to know. This is an edited transcript:
Q: Why did you travel to Chicago just before Medicare open enrollment?
A: We're going across the country (because) we at CMS want to make sure beneficiaries take an assessment of their health benefits every year. The time period for beneficiaries to decide whether they want to change their coverage starts Saturday, and it runs through Dec. 7. The timetable is sooner in the calendar than it was last year, so we want to make sure beneficiaries know about the change. It starts sooner, but the time frame is longer.
Q: What are the biggest changes in the program this year?
A: Benefits are stronger than they were a couple years ago. New benefits were added to emphasize wellness and prevention. We're working hard to shift the program's emphasis to be not just a program that cares for you when you get sick, but also one that keeps you healthy.
The prescription drug coverage is more generous than it was a couple years ago.
We believe choice is good, but too many choices oftentimes lead to confusion and to folks not making a choice. So we have reduced the number of (health plans) to place emphasis on the best possible choices.
Q: Why are changes being made to Medicare now?
A: Health care reform was broad sweeping and made very important changes for the Medicare program. One was that it added new benefits: a focus on wellness, a focus on prevention, a focus to make sure the Part D (prescription drug) benefit did not have any gaps in coverage.
Q: What about costs?
A: The health care reform legislation included a lot of provisions to reduce the overall costs of the program — not the benefits, but the costs. Many of the cost savings come from care improvements. We know that when care is improved, care is safer, care is better coordinated, and when you promote the quality of care, it's also going to reduce the cost of care, which is going to keep the program affordable over the long term.
Q: Is there any way to quantify the cost savings? Can you give an example?
A: Since Jan. 1, more than 1 million beneficiaries who receive benefits from the discount drug program (people who fell into the so-called doughnut hole) have saved $500 on average in out-of-pocket costs. In Illinois, it was $524 as of Aug. 5. Those numbers will increase over the course of the year.
Roughly 18 million beneficiaries across the country have access to free preventive and free wellness benefits with no out-of-pocket costs — no deductibles, no co-payments.
Q: What are the new star ratings all about?
A: We are putting in place new quality star ratings for health plans, now on our website, that beneficiaries can check. Plans that perform at the top of their game get five stars. The lowest rating is one star. Our goal is for all our benefits, our health plans, our hospitals, to assess the overall quality of the care they provide and also to tie our payments and reimbursement to those quality ratings.
Q: How many one-star and five-star plans are there in Illinois?
A: We currently don't have any plans that are one star. There are very few five-star plans across the country; we have very high standards. We want to make sure our five-stars are the cream of the crop. Roughly 25 percent of our beneficiaries are in the private plan options, and about 25 percent are either in four-star or five-star plans. So the bulk of our beneficiaries are in three- or three-and-a-half-star plans.
We want to set a high bar because plans that get a higher star rating get a higher bonus payment. Our goal is to provide strong financial incentives for plans to improve their performance and also to give a strong signal to beneficiaries to choose five-star plans whenever they are available.
In the Chicago area, as it turns out, there are fewer four- and five-star plans relative to other parts of the country. I'm not sure why.
Q: How do people go about deciding what's best for them?
A: The first thing they should do is take stock of their current plan and the current use they have — look in their medicine cabinet and understand the drugs they are taking today and make an assessment. They should go on our website if they have access to the Internet and type in their medications and ZIP code and look at the choices they have. If they don't have access to the Internet, they can call the senior health insurance program in Illinois (SHIP) or call the toll-free Medicare number. But the first step is to understand what they have and what they need.
The next step is to ask if they are satisfied. If the answer is yes, then they don't need to do anything. If they want to shop around and see if there are ways to reduce costs, then this is the time to do that. Changes take effect Jan. 1.
Q: Any warnings for beneficiaries during enrollment period?
A: If anyone is asking for their Social Security number or their Medicare number, that's a sign that something is wrong. If someone is asking to come into their house, something is wrong. There is no reason for beneficiaries to ever give their personal information to anyone over the phone.
For more information, visit medicare.gov or stopmedicarefraud.gov, or call 1-800-Medicare (633-4227). Illinois residents can go to insurance.illinois.gov/ship/ or call 1-800-548-9034.