Ron Beazely recently learned CareOregon will no longer offer Medicare Advantage. The letter was a shock, since he relies on Social Security for income and pays only $34 a month for health care premiums. He could face a spike when he is forced to switch health plans in January.
Beazely, of Cannon Beach, is among 300 Clatsop County seniors looking for an alternative as CareOregon, following national trends, concentrates coverage in urban cores.
Jeanie Lunsford, a spokeswoman for CareOregon, said the move is about better serving the majority of customers in Clackamas, Columbia, Washington and Multnomah counties.
“It’s really that it’s a very small program, and we had a really small population in Clatsop, and it made more sense to focus in the metro area,” she said.
The move leaves someone like Beazely with two Medicare Advantage plans in Clatsop County — Moda Health and FamilyCare. CareOregon will keep its Medicare Advantage Plus program in Clatsop County for lower-income customers also supported by Medicaid, the government health insurance program for the poor and disabled.
Public and private
Medicare is a federal health insurance program for people 65 and older. The plan covers hospital care and outpatient treatment and offers other services such as prescription drug coverage through supplemental policies.
More than 7,800 seniors were on traditional Medicare in Clatsop County as of August, according to the Centers for Medicare & Medicaid Services.
Another 2,343 people were using Medicare Advantage plans, with coverage provided by federally approved private insurers such as CareOregon, Moda Health and FamilyCare. Insurers negotiate with private health care providers to find the lowest-cost options.
Beazely, 71, has been covered through CareOregon’s Star Medicare Advantage plan for the past year and a half, since he and his wife, Jan, moved to Cannon Beach. The couple uses providers in the Providence Health & Services network, the primary health care provider in South County.
Out of town, out of luck
Michelle Lewis, a local representative of the Senior Health Insurance Benefits Assistance program, helps seniors find health care coverage along with volunteer counselors during the open enrollment period from Oct. 15 to Dec. 7.
Lewis has seen a continuing trend of rural areas losing their plan options. Clatsop County had seven plans in 2009, compared to two as of next year, she said.
“It doesn’t surprise me,” Lewis said. “You have to have a certain number of patients to make a profit.”
A report in August by the Kaiser Family Foundation, a nonprofit focusing on health care issues, found that 147 mostly rural counties across 14 states have no Medicare Advantage plans, including Washington’s Pacific County.
“It is not entirely clear why insurers are not offering Medicare Advantage plans in these mostly rural counties, but it could be because they have less leverage to negotiate rates with hospitals and other health care providers, making these counties potentially less profitable than others,” the report said.
The lack of counties offering Medicare Advantage is about eight times that of counties that might lack insurance carriers under the federal Affordable Care Act next year. But unlike people relying on the Affordable Care Act, Medicare Advantage customers like Beazely can always fall back on traditional Medicare, although he said that option would be too expensive for him and his wife.
Beazely can also switch to Moda Health or FamilyCare, the two Medicare Advantage plans left in Clatsop County next year. But he is not a fan of Moda Health, he said, and FamilyCare’s provider network is 20 miles north in Astoria.
Beazely attended a recent town hall by U.S. Rep. Suzanne Bonamici to voice his concerns, and said he recently sat down with executives at Providence Seaside Hospital, who are trying to work out a deal with FamilyCare to expand its provider network in Clatsop County.
Beazely is waiting to hear what comes of that deal, he said. “I’m waiting on Providence Seaside Hospital to see if they can pull this rabbit out of a hat with FamilyCare.”