How Medicare Advantage plans are approaching a 'tumultuous' open enrollment

Long Beach, Calif.-based SCAN Health Plan is trying to maintain calm amid a tumultuous Medicare open enrollment.  

"Our hope is that we can really provide some peace of mind during this AEP, because it's not just a season of growth and selling like any annual cycle," Karen Schulte, president of SCAN Group's Medicare division, told Becker's. "It's really a time of great turmoil for everyone." 

Two major changes in Medicare Part D benefits laid out in the Inflation Reduction Act take effect in 2025 — a $2,000 out-of-pocket maximum, and an option to spread out-of-pocket costs into even payments over an entire year. 

Premiums will remain stable in Part D, but plans have had to shift benefits to accommodate new out-pocket limits. 

"Consumers, their out-of-pocket expenses will be reduced, but we may see some of those costs shift[ing] into other areas of the Part D plan or the Medicare Advantage plan," Shannon Drotning, market president of consumer and specialty at Providence Health Plan, said. 

In addition to changing benefits, fewer Medicare Advantage plans will be available in 2025 than in 2024, as rising medical costs and lower reimbursements from CMS have led insurers to exit markets. 

Nearly 2 million Medicare Advantage enrollees will need to choose a new plan in 2025, according to an analysis commissioned by the Better Medicare Alliance, a pro-MA group. 

The No. 1 question members have had during open enrollment, so far, is drug costs, Ms. Schulte said. 

The group created a calculator to help members understand how their drug costs will change from 2024 to 2025, Ms. Shulte said. The best strategy SCAN has found is to have providers, service representatives, brokers and peer advocates help members go through their prescriptions and understand how the costs will change. 

Providence Health Plan is also focused on educating members about the upcoming changes. 

Ms. Drotning says Providence Health Plan's local focus is an advantage in educating members.

"We're going to the local art museum, going to the community center and providing outreach to people to explain in-person. We're working with all our independent agents. We're doing mailings, we're online. I think one of the advantages of our plan is we can meet the members where they are, and explain to them what changes will be." 

Medicare Advantage open enrollment runs from Oct. 15 to Dec. 7. 

Ms. Schulte said her goal for the open enrollment season is "no surprises." When members' new benefits take effect Jan. 1, she does not want any member to experience a change they were not previously aware of. 

"Is that really realistic? Probably not," she said. "But I'm going to hold the team to that goal, because this is a very unsettling time." 

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