The popular Piedmont Wellstar Medicare Advantage HMO plan will not be available in 2016. Existing members have received their non-renewal notice and now begins the task of finding new coverage.
Piedmont Wellstar tried to put a smiley face on their announcement ……….
“While PWHP has chosen to exit the Medicare Advantage program, largely because of premium deficiencies, our success … can be measured against the ‘triple aim’ health care goals of improving the patient experience and quality of care, while reducing the trend in health care cost,” the statement read. “To this end, PWHP has been successful as demonstrated by our members’ satisfaction, our quality of care and our ability to keep healthcare cost trends per member flat for the past 18 months.” – Marietta Daily Journal
“Premium deficiencies” is just another way of saying the plans provided way too many benefits which resulted in attracting sicker patients that led to losses.
Premium deficiencies and success do not belong in the same sentence.
Roughly 12,000 existing members will lose their P-W coverage as of 12/31/15.
Post summary
- Piedmont Wellstar discontinued for 2016
- Pick a new Advantage plan and you may have to change doctors and hospitals
- Original Medicare, keep your doctor
- Original Medicare and a supplement plan
- Sleep well at night knowing you made the right choice
If you are tired of having coverage dropped and want to pick your own doctors and hospitals, perhaps it is time to return to original Medicare and a supplement plan.
Medicare does not have doctor or hospital networks.
Medicare will never cancel your coverage.
When you select the right Medigap plan you can keep it for life.
Table of Contents
Piedmont Wellstar – What Next?
The 2016 Medicare open enrollment kicks off October 15 and ends on December 7. Current members can pick from any of the following.
- Enroll in another Medicare Advantage plan
- Return to original Medicare
- Return to original Medicare and enroll in a Medicare supplement plan
The first two options are straight forward. Keep in mind that changing to a new Advantage plan means checking to make sure your doctors and hospitals are in the new network and cross-referencing your medications with the drug formulary.
It also means being prepared to repeat this process every 1 – 3 years in the future.
One couple losing Piedmont Wellstar coverage had 13 doctors between them and numerous medications. After spending more than an hour researching options they still did not have a workable solution.
Who wants to go through that again?
Medicare Advantage plans are great when you are healthy but the numbers change when your health goes south.
Return to Original Medicare
Some Piedmont Wellstar orphans will simply go with original Medicare, maybe a drug plan, and take their chances.
While that approach does guarantee access to any doctor or hospital it may not be the best financial option. Medicare alone is an open ended plan that pays 80% of covered Part B charges while you pay the remaining 20%.
Open ended means you pay the 20% portion until you are well again, dead, or run out of money.
Two of those three options are not good.
Medicare Plus Supplement
All of my clients want the freedom to pick their own doctors, find a drug plan that fits their needs and don’t want the hassle of trying to change plans every year.
With original Medicare and a supplement you can sleep well at night.
Almost every conversation I have with prospective clients begins with them saying “I don’t want to change my doctor”. I can certainly understand that position. When you have health issues you want a doctor you know and one that knows you. Conditions that require frequent checkups to make sure that mole on your skin is not changing or making sure your medications are controlling your sugar levels give you comfort when dealing with someone you like and trust.
If you are in good health you can purchase any Medigap plan you want from any carrier. This opens up a wide range of plan choices and premium savings that are not otherwise available.
But if you are in poor health you are not frozen out of the Medicare supplement market. Instead your choices will be limited to a handful of plans and high prices. The most common “guaranteed issue” option is Medigap plan F.
It is also the most expensive.
A female, age 67, non-tobacco user in zip code 30060 will see plan F premiums from popular carriers at $154 (Aetna), $159 (Omaha), $180 (AARP) and $183 (BCBSGA).
That same female that can qualify medically will have the ability to enroll in a Medigap plan N without the network hassle. Plan N premiums for this lady start at $89 and the out of pocket maximum is normally less than $500 vs the cap on the Piedmont Wellstar plan at $4000.
Plan N is very similar to Medicare Advantage plans except without
- provider networks
- annual notice of change
- pronounced increase in your out of pocket cost sharing
- threat of cancellation (when you pick the right carrier)
- insurance carrier bureaucracy
Georgia Medicare Plans has rates for over 170 different Medigap plans available throughout the state. You can also review instant online quotes, comparing multiple plans side by side. The image below links to our quote engine. This is a secure, private site. Your information is never sold.
This might be the right time to replace your cancelled Piedmont Wellstar plan and return to the security of original Medicare and a quality Medicare supplement plan.
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