Quincy Medical Group will no longer participate in Medicare Advantage plans as of Jan. 1.
Any senior enrolled in these plans no longer will be covered for services provided by a specialist or cancer physician affiliated with QMG. About 1,600 area seniors will be affected by the change, according to figures provided by QMG.
"They do have options, and we want them to know what their options are," said Lynn Niewohner, director of the West Central Illinois Area Agency on Aging. "I bet people are going to have a bunch of questions, and we want to answer them."
Two informational sessions for seniors covered by a Medicare Advantage plan will be held at the Senior and Family Resource Center, Sixth and York, at 9:30 a.m. and 1:30 p.m. Wednesday.
Representatives of the Senior Health Insurance Program (SHIP) in Springfield and Blessing Hospital will be on hand to answer questions. SHIP also will provide additional training to Senior Center staff. Staff will set up individual appointments with seniors to help them fill out paperwork and discuss what would be the best move for them to make.
Blessing Hospital has been holding informational meetings since October to inform its patients about changes to the hospital's acceptance of Medicare Advantage programs. The hospital will accept Advantage plans offered only by Humana and Pyramid next year.
"We're busy trying to educate the community as well," said Lisa Neisen with Blessing's public relations staff.
Open enrollment for the Medicare Part D program begins Nov. 15 and runs through Dec. 31. The federal Medicare program opens enrollment annually for seniors whose needs have changed during the past year.
The Medicare Advantage program enables seniors to buy private health insurance as an alternative to participating in the standard Medicare program. Benefits and premiums vary among Advantage programs and differ from traditional Medicare coverage.
"If you're a healthy person, it's saving you a lot of money," Niewohner said. "But it's the whole ball of wax. ... (That's why) it's crucial we get the word out."
In a press release, QMG cited several reasons for deciding to no longer participate in the Advantage plans. QMG said the plans are difficult to administer and error rates on claims are higher than with traditional Medicare plans.
QMG also states that patients often do not understand the plans and are both confused and surprised by the amount they owe for care due to co-payments and co-insurance.
Blessing also cited administration costs as the reason for limiting the plans it would accept.
"Things could change," said Karen Brown, director of managed care at Blessing Corporate Services.
QMG will continue to see traditional Medicare patients, according to CEO Aric Sharp. More information is available by calling QMG's Patient Services Department at 222-6550, ext. 3444.
Seniors' options may depend on how long they have been enrolled in the Medicare Advantage program. They may be able to go back to the general Medicare program if they've been in an Advantage program less than a year, Niewohner said.
"There are all kinds of quirky little rules," she said. "This is a little bit -- this is a lot -- confusing.
"I really worry about 1,600 people. I want them to know that they maybe -- might -- have some problems after Jan. 1 ... but we can't do anything for anybody until Nov. 15."
Niewohner predicts her staff will be busy nonstop until the enrollment period ends. Evening and Saturday hours may be added.
"You can't do this in a group ... We really do want to meet individually with 1,600 people. We are committed to spend a whole lot of time (to) get all these people seen and taken care of," Niewohner said. "I hope we have enough time."
-- hwagner@whig.com/221-3374
