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Upcoming Changes to California Medicare Plans

Anthem Blue Cross PPO Changes for 2014

California Medicare beneficiaries with coverage from Anthem Blue Cross PPO plan (called Medicare Preferred Standard) have seen a number of changes the past few years. Over 100,000 members received cancellation notices effective January 1, 2012 for the plan then called Freedom Blue. It was available in 13 counties in 2012 with monthly premiums as low as zero in Los Angeles to over $100 in Riverside.

For 2013, all counties had premiums with Los Angeles still reasonable at $28. As of January 1, 2014, that same plan will increase the cost to $80 monthly. Anthem Blue Cross PPO is still the only Medicare Advantage PPO available, but with the increased cost – $960 per year – it may not provide the value it once did.

The High Price of Anthem Blue Cross PPO

Before discussing the alternatives to Anthem Blue Cross PPO, here are some of the in-network costs of care with this plan. Out of network costs are considerably higher. (Please refer to plan documents for more details – this is only a quick look). All pricing and benefits are for Los Angeles County residents.

Premium – $960 per year
Deductible – $300
In-Network Out of Pocket maximum – $4,500
Specialist office visit – $50
Outpatient Services – Up to 20% of the cost
Hospital Admission – $800
Ambulance Ride – $275
Brand Name drug deductible – $149

It’s pretty easy to see that costs of care could mount up quite quickly and a policyholder could find him or herself out many thousands of dollars in addition to the almost $1,000 premium.

Two Alternatives to Anthem Blue Cross PPO

There are two alternatives to Anthem Blue Cross PPO to consider. The first is an HMO plan and the other is to go back to Original Medicare and purchase a supplement to contain most of the potential out of pocket costs.

The negative with an HMO is provider access. Your doctor may not be in the medical group and even if the doctor is available, the specialist you wish to see may not be available. Furthermore you need referrals for most specialist visits.

The big positive is these plans generally have a zero monthly premium. (Again, this is referring to Los Angeles County). Many plans have no cost for doctor, hospital, outpatient services, etc. So although access to care may be a bit more difficult, cost of care is extremely low if not zero.

The second option is to return to Original Medicare and then purchase a Medicare supplement along with a Part-D drug plan. Depending on one’s age and needs, the cost for the supplement/drug plan “package” can range from $125 to almost $300 per month. However, the cost of care is likely under $250 a year.

Concerned About the Upcoming Changes to Anthem Blue Cross PPO? Worried How They Might Affect You? We Can Help!

Call us for a quick review of your options. We’re here to serve you. The Annual Election Period ends on December 7, 2013 so please take a few minutes now to allow us to help.

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