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Mercy enters Medicare market

JANESVILLE — As if Medicare isn't confusing and overwhelming enough, the dates for making changes or enrolling for 2012 coverage have changed.

But a local company long associated with the health care industry wants to make it easier.

MercyCare Health Plans is now offering Medicare Advantage for coverage staring Jan. 1.

"It's an extension of Mercy Health System's efforts to provide complete care in our area," said Joseph Nemeth, vice president and chief operating officer for MercyCare. "We provide so much of the care in this area that we thought this was the next logical step."

Medicare is health insurance for people 65 or older, people under 65 with certain disabilities and people of any age with end-stage renal disease.

It has three components that are most well known:

-- Part A, commonly referred to as hospital insurance, covers inpatient care in hospitals, skilled nursing facilities, hospice and home health care.

-- Part B, also known as medical insurance, helps cover doctor services, outpatient care, home health care and some preventative services.

-- Part D is a prescription drug coverage option run by Medicare-approved private insurance companies.

Medicare Advantage plans such as MercyCare's also are referred to as Medicare Part C. They cover both Part A and Part B and often include Part D.

Medicare-approved private companies run Advantage plans. Medicare pays the companies a fixed amount every month for the care, and the consumer pays the balance as well as their Part B premium.

Still, Medicare Advantage plans are considered more economical and stress-free for coverage that meets or exceeds the standards set by the original Medicare program.

"Advantage plans simplify the insurance process," Nemeth said. "With Medicare Advantage, you get coverage for doctors, hospital and drugs, and it's much simpler to deal with one company."

This year, open enrollment for Medicare Advantage plans started earlier—Oct. 15—and ends earlier—Dec. 7—than previous years.

MercyCare started planning its Medicare Advantage earlier this year. After completing mountains of paperwork and entertaining government officials for site visits, MercyCare signed a contract to offer four Advantage plans.

Nemeth said MercyCare covers 30,000 people in Rock and Walworth counties, where its Advantage plan will compete with those offered by Humana, United and Anthem.

"We are a local company that puts a human face on the process," he said. "What do you do now if you've got a Medicare question? Call someone in Washington, D.C., or Milwaukee.

"With our plan, we're right here in Janesville. You can call us with claims questions or pharmacy issues. It ties in with our overall guiding principle of making health care local."

MercyCare employs about 55 people—many of them health care professionals, not bureaucrats—tasked with coordinating care, he said.

Nemeth said he expects growth in the plan will mean the hiring of an additional 25 employees at MercyCare.

Between now and December, Mercy is conducting a multitude of seminars on Medicare and Advantage plans.

"We would certainly encourage people to go to one of these seminars," Nemeth said. "Even if they don't sign up for the product, they're still going to learn an awful lot about Medicare."