Medical Deadlines Approaching

November 29, 2011 Updated Nov 29, 2011 at 2:10 PM EDT

By WKBW News

November 29, 2011 Updated Nov 29, 2011 at 2:10 PM EDT

BUFFALO, NY ( WKBW ) December 7th is an important date for Medicate coverage applications. Dr. Raul Vazquez visited Channel 7's "Eyewitness News This Morning" with important information on how plans are now rated.

It is important that if you need to sign up for Medicare coverage, that you contact your primary care physician, and health insurance provider now!

Here are some important facts you need to know.

Medicare health plans are rated on how well they perform in five different categories:

1. Staying Healthy: Screenings, Tests, and Vaccines
2. Managing Chronic (Long-Term) Conditions
3. Plan Responsiveness and Care
4. Member Complaints, Problems Getting Services, and Choosing to
Leave the Plan
5. Health Plan Customer Service

Medicare drug plans are rated on how well they perform in four different categories:

1. Drug Plan Customer Service
2. Member Complaints, Problems Getting Services, and Choosing to
Leave the Plan
3. Member Experience with Drug Plan
4. Drug Pricing and Patient Safety

Here is more from U.S. News & World Report from
Use New Medicare Ratings to Select a 2012 Plan
By Philip Moeller | US News – Wed, Oct 12,

Medicare has been rating health plans since 2007, but the health reform law has added new muscle and meaning to the ratings. The 2012 ratings are now available for Medicare beneficiaries who want to buy either Medicare Advantage or standalone prescription drug plans (Part D of Medicare). The enrollment period for 2012 plans extends from October 15 through December 7.

Under Medicare's 5-star rating system, private health insurers whose plans have ratings of 3, 4, or 5 stars will receive small reimbursement bonuses next year from Medicare, according to Jon Blum, the program's director of the Center for Medicare. Bonuses for 3-star plans will be phased out, he said in a recent interview, while larger bonuses for 4-star and 5-star plans will be phased in over the next several years.

While the eventual scale of the bonuses will not exceed 5 percent of a plan's reimbursements, Blum said, the government plans to aggressively encourage consumers to move their Medicare policies to the higher-ranked plans. And while there are relatively few 5-star plans in the 2012 rankings, he said, the plans that receive that grade will get a big boost from Medicare in adding more customers.

While health plans have been able to sell to consumers only during each fall's open enrollment period, the rules have been changed for 5-star plans. These plans will be able to sell to consumers throughout the year. Next year, for example, consumers with the choice of a 5-star plan in their service area will be able to change their current plan in favor of that plan at any point in the year.

If that sounds like a big competitive edge, Blum said that Medicare hopes it becomes just that. "We want to get beneficiaries into 5-star plans," he said. Providing the best plans with reimbursement bonuses and year-round marketing rights is designed to encourage health insurers to make the improvements in their plans needed to earn the top grade.

Blum said there are signs the approach is working, with plans and consumers. "We're seeing some positive results," he said. "We're seeing some plans improve their rankings, and we're seeing beneficiaries choose higher star plans at a faster rate" than other plans. "Our observation is that the plan community is paying more attention" to plan quality.

Consumers who use the Medicare Plan Finder will find that 2012 plan rankings include three dozen ratings measures for health plans and 17 variables for drug plans. You can look only at the top-level star rank or click on a specific plan and find its rating details.

There are 446 Medicare Advantage plans (part C of Medicare) rated for 2012, including 19 plans with 5 stars, 40 with 4.5 stars, and 66 with 4 stars. The 5-star plans listed are KelseyCare Advantage, Kaiser Permanente Senior Advantage (two different plans), Medical Associates Health Plan, Inc., Tufts Health Plan Medicare Preferred, HealthPartners, MVP Health Care, Excellus BlueCross BlueShield (Lifetime Healthcare), Group Health Cooperative, Community Health Partnership, Advocare (Marshfield Clinic), Gundersen Lutheran Health Plan, Inc., Dean Health Plan, Inc., Martin's Point Generations Advantage, Erickson Advantage (UnitedHealth Group), Capital Health Plan (Blue Cross and Blue Shield of Florida), Kaiser Permanente Medicare Cost, Indiana University Health Plans - Medicare, and Health New England, Inc. (Baystate Health).

There are 560 rated prescription drug plans (part D of Medicare), including 12 plans with 5 stars, 44 with 4.5 stars, and 80 with 4 stars. The 5-star plans listed are Kaiser Permanente Senior Advantage (four different plans), Martin's Point Generations Advantage, Group Health Cooperative, Gundersen Lutheran Health Plan, Inc., Providence Health Plans, Simply Prescriptions (Excellus Health Plan), HMSA's Medicare Rx Plan (Hawaii Medical Service Association), MedicareBlue Rx, and ODS Health Plan, Inc.

Not all plans are offered in all states and counties, and plans with the same name may not have received 5 stars in every state and county where the plan is available. Many areas have very few or even no high-rated plans. Ratings and other details on all 2012 Part C and D plans are included in two very large source files.

In the ratings for 2012, Blum said, Medicare added additional weight to the rating variables that deal with patient outcomes and beneficiaries' satisfaction with their health plan. To push for plans that have good health outcomes and meet consumers' needs, he explained, "we've placed greater emphasis on how well plans take care of beneficiaries and on how satisfied beneficiaries are with their plans."

"Historically, we've given equal weight to all of these measures," Blum said. By providing more weight in the ratings to some areas, "we want to help elevate the overall performance of the care being provided."

Twitter: @PhilMoeller