Many people my age are living in continuing care or assisted living retirement communities, with younger family members or with home healthcare services. My husband and I discussed our future plans at length, always in consideration of our ages and relative health. We had thought we would decide what to do when Andy, the youngest, was ready.
In anticipation of a potential move, we looked at options with several of our friends in hopes that we would all end up living close together in one of the New England states. At the time we began looking, we were both healthy … until Andy wasn’t. But even then, he was 15 years younger than I, and we both always knew he would be the one left to pick up the pieces … until he wasn’t.
When Andy died, I was the one left to make these decisions and realized I was not yet ready to live in a more restricted format than I currently do, surrounded by my gardens, a house set up to suit my lifestyle, and a neighborhood of friends and acquaintances that has been home for over 41 years. But I know I must also be realistic and plan for an inevitable loss of strength and mobility, not to mention any sudden onset of ill health.
When comparing health insurance options, we all considered the differences between the quality, number, and types of plans offered by various states. Many of our friends are from Massachusetts, where the health care system is much more user-friendly than in New Hampshire. This means that, with the threatened continued cuts in the type and quality of health insurance available through Medicare Advantage Plans and original Medicare to New Hampshire residents next year and in the future, some are considering eliminating our state as a place to retire.
I realize I’m not the only one in Wilton, the Monadnock region or even the entire state who has questions about why this is happening and where this is all going. That is why I decided to speak with a few people who may have better answers than the ones I found online. I did learn that some answers must wait until the state receives further notice about plans offered and changes taking place in 2027.
I called a variety of resources to find some immediate answers to my questions. I started by reaching out to the New Hampshire Navigator’s office, which is in West Virginia. It is a resource geared to help people understand Medicare Marketplace and Medicaid options, find affordable plans, find coverage during life changes and understand benefits. This unbiased program is operated by the Foundation for Healthy Communities and First Choice Services and is funded by a grant from the Centers for Medicare & Medicaid Services, under the U.S. Department of Health and Human Services. It turned out not to be the best place to answer all the questions I had, but they gave me good advice on where to look.
My next call was to the Hillsborough County Disabilities and Aging Resource Center. Before doing this research, I had thought little about the impact state economics and demographics have on the type and quality of health care services and number of insurers offered within each state. To be specific, I was told, “The services a state can provide are based upon the taxes taken in and the amount states can offer insurers through highly specific, structured public programs. This goes hand in hand with the pharmaceutical company offerings to insurers and meeting Federal Government requirements. The final decision on what each state offers is made by the insurers that have negotiated their policies with the state. It’s a trickle-down effect with people at the bottom of the list.”
Another person said, “Without a broad-based tax system, New Hampshire will never have a health care system like that offered in Massachusetts.”
Other facts I gathered from my discussion with people at the Hillsborough DARC are:
a) New Hampshire is an aging state and demographics like these make a difference in the kind and quality of health care offered by insurers.
b) State economics is one way health insurance companies determine whether to offer plans in a state.
c) Advantage Plans are federally run programs which the state has no control over. Changes to what is offered in New Hampshire are based upon changing federal regulations and are county-specific, with some counties offering more plans than others. Currently, some counties have only one Advantage Plan offered to those on Medicare.
d) New federal regulations for monitoring and invoicing Advantage Plans make it likely more plans will be eliminated.
e) Providers decide which insurance policies to accept from those offered in the state.
My final call was to the New Hampshire Insurance Commissioner’s office, where I learned more about why health insurance offerings vary each year, particularly for seniors served by Advantage Plans.
The most surprising thing I learned was that Advantage Plan insurers are not required to notify the state whether they are coming in, remaining, or leaving, except that the federal government requires they give at least 30 days’ notice to a state if they are leaving. Otherwise, the state has no say over nor knowledge about who offers plans or leaves. This is because Advantage Plans form Part C of Medicare services and are under complete federal control. I was informed that the federal government then leaves Medicare Advantage Plan decisions completely up to private industry and insurers, including what is offered and what it will cost plan enrollees. This means an insurer’s financial bottom line could be more important than the impact of rising costs, lack of adequate coverage, and few or no choices for the consumer.
One small bright spot is if a person qualifies financially to enroll in Medicaid or is on disability. These plans are partially funded by the state and offer choices and more affordable rates, but these rates are also in flux based upon what help a state receives to fund them.
I then asked the question that was foremost on my mind, “What happens if every Advantage Plan insurer pulls out of a county?” The only answer I received was, “I don’t know. That’s a good question.”
What may be true if this happens is an individual can reenroll in Medicare without restrictions. Whether the restrictions imposed by Part D Prescription Medicine insurers will also be waved is a question for which I have no answer.
Even though Medicare Plans with Part D offer less and may cost more than Advantage Plans, there are pluses for those seniors who choose to pay for supplemental Medicare insurance. They can travel anywhere in the country for medical care without restrictions, have more stable plans available and have more facilities and doctors that accept their insurance. Part D supplemental plans also are all offered at the same rates for similar services, the only difference being the variety of choices available. Not all offer every choice.
Note: There are additional costs for Medicare Pare D enrollees with additional costs for dental, vision and hearing insurance while all these services are offered as part of Advantage Plan packages. This has made Advantage Plans the choice of many. But consumers should know that once on an Advantage Plan, it is very difficult to transition back to Medicare and supplemental plans.
Finally, I wanted to ask how the continual changes in health care packages, payments and requirements impact users not yet retired, providers, hospitals, and all those individuals and industries related to the health care industry. No one I spoke with seemed to know who to ask. Every department may have part of the answer, but there doesn’t appear to be a central source with most of the answers.
This means the question implicit in the title of this article, “Who IS Minding Our Healthcare,” is still to be fully answered. I’m planning a future article that will be more inclusive, covering all types of health insurance issues as well as those faced by people working in the healthcare industry.