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Making sense of Medicare supplemental plans

Valley forum

I am an investment advisor and insurance broker in Sonoma with 26 years of experience. I share the frustration expressed in Janice Lehne’s Oct. 21 letter to the editor (“Why can’t I use my local doctors and SVH?”), and by others, with having to change insurers for 2012 if they want to keep a Medicare Advantage policy while living in Sonoma.

  The only company now offering a Medicare Advantage plan for people in Sonoma, with a decent network of doctors and Sonoma Valley Hospital to choose from, is Anthem Blue Cross, which recently dropped its $0-Premium Blue Plan statewide, but implemented a new, $40 premium LPPO plan in selected counties (including Sonoma), which is essentially a regional PPO.

  What has taken place with United Healthcare and Sutter has absolutely nothing to do with “Obamacare.” It is about whether doctors and hospitals are part of a network or not.

  United Healthcare’s 2011 Medicare Advantage plan had a good network in Sonoma of doctors and Sonoma Valley Hospital, with the Marin IPA. It also had a good network away from Sonoma in the Santa Rosa area and other parts of the county.

  Unfortunately for Sonoma and Petaluma residents, United Healthcare signed an exclusive network contract with Sutter for the 2012 product rollout. This works great for Santa Rosa-area people, as the Sutter network there is quite decent. Plus, the new $0 premium and $78 premium plans have been designed quite competitively.

  The problem is, there are very few, if any, Sonoma doctors or Petaluma doctors, and no local hospitals, that are part of Sutter’s network. So, the new network arrangement with Sutter does not help our local population at all, unless you are one of the few seniors who does not mind driving to Santa Rosa for all of your network care. (Not my preference).

  For my local clients facing this challenge, I am recommending Anthem Blue Cross. There is another way out of this, but it is more costly. It does give you freedom to go anywhere and not be bound by a doctor network issue – that is to purchase a Medicare Supplement plan. These plans cost more than Medicare Advantage plans, but you can see any doctor or go to any hospital that accepts Medicare and end up with little if any out of pocket expenses. Customer complaints should be aimed towards United Healthcare.

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  Howard Gorbach has lived in the Sonoma Valley since 1994 and is an agent and investment advisor.