>> From WXXI News.

This is Connections.

I'm Evan Dawson.

>> Our connection this hour was made last month when a series of letters went out to local residents who were on Medicare Advantage.

And here's an example of a letter from Excellus shared with WXXI News by a listener.

Quote.

Dear member, we want to share an important update about your Medicare Advantage plan.

As part of the impact of rising health care costs nationwide, we will no longer be offering select Medicare plans.

This means the plan you are currently enrolled in will not be available as of January 1st, 2026, and you will need to choose a new one.

We understand this may be unexpected and concerning.

Please know that while Medicare plans available next year will be different, our commitment to you remains the same as your local health plan.

We remain focused on your health and well-being.

Our team is ready to help you find the coverage that best suits your needs.

End quote.

Now, as you might imagine, members started calling Excellus immediately, but Excellus couldn't necessarily answer all their questions right away.

It turns out there was a reason for that.

and we're going to talk about that coming up.

But the result was some confusion, some fear.

We heard it from some of our listeners, and Excellus was not the only one in this situation.

We reached out to a number of companies to talk about these changes, to answer listener questions, to answer member questions, and to discuss what comes next.

We want to do so in a way that is straightforward, designed to make sure everyone has the best information about health care plans.

And I am glad to say that Excel has accepted our invitation to come on the program today.

And I want to be clear about that.

Excellus was the only company to say yes.

They did not have to come on today, but they are here and I'd like to welcome our guests from Excellus.

Andy Napierala is vice president of Medicare and individual market sales for Excellus Blue Cross Blue Shield.

Welcome.

Thanks for making time for us.

>> Thanks very much, Evan.

Great to be with you.

>> And Renee Pettenski is here, director of the Health Insurance Information Counseling Assistance Program at Lifespan.

Welcome to you as well.

Thank you.

So Renee, make sure you grab that microphone, get it real close to you here.

Great to have you here.

how much did Lifespan here in the last month about this issue?

>> Oh, we've heard a lot.

You heard a lot, a lot.

We've already talked to hundreds and hundreds of clients.

regarding the terminations.

>> What's the primary?

was it just kind of confusion about what's going on and what to do exactly?

>> probably a little of everything.

Confusion?

very scared, very concerned.

Not knowing, you know, what their options are because they're really not available until October 1st.

>> So here we are.

And I'm going to give Andy some time to describe a little bit of the background here.

First of all, the process these letters go out.

it turns out, as I found out yesterday, that you guys were limited in what you could say until October 1st, which is kind of strange to me, but you can talk about that.

But now that we are in October and you're trying to make sure people can work through it we've got plenty of space to talk about what is changing and why.

So take me through the process first and what's going on.

>> Yeah.

So the timing is is pretty challenging there.

As you point out, there are some required documents that need to be sent out by the end of September to notify people if their plan isn't going to be continued into the next year.

And then there's usually a gap of a couple days or a week where they're wondering, okay, well then then what's happening?

We're not allowed to talk about 2026 plans as an example until October 1st.

So then we're able to actually actually reach out to them and say, here's now, now we can talk to you about what we can do for you and what options are available.

>> But I want to I want to make sure I understand that point, though by law, you couldn't.

Yeah.

By law.

>> That's correct.

>> Even though these letters went out in September.

Right.

>> Yeah.

>> So the letters go out in September, and some of your members got these letters that their plans are going to change or be eliminated, and they're calling you and you're going by law.

I can't tell you anything more until October 1st.

>> Yeah, it's a little awkward for everybody.

I do think it's well intentioned.

On behalf of our regulators, they want to make sure that people have awareness before the season actually starts.

But it does create that awkward period.

I would.

>> Just note for the regulators, this is a good example in here in the Rochester market of how that even well-intentioned piece of regulation caused more confusion and more panic.

I think that's right.

Okay, so but now here we are and take us through what kind of a baseline, what you want people to know.

And then we'll get more specific.

>> Sure.

So what people are seeing this year in the Rochester market is something that's really happening around the country.

It's a general resetting of of the Medicare industry brought on by a number of factors.

So I do want people to recognize that Rochester is certainly not alone in this, but we're also not immune from what's happening around the industry.

It really and it's kind of a cliche term, but it's true.

It's been a bit of a perfect storm.

when it comes to the Medicare industry, a lot of it has to do with with rising costs.

Everyone's familiar with that.

one thing we do is we do try to work to keep our costs in line.

but there are certain things that that just continue to, to increase our costs.

prescription drug coverage hospital stays, things like that.

some of the emergent treatments, which are great for people, but then.

But but there's a certain cost associated with those things.

Also, funding has been a bit of a challenge.

for us that when it comes to things like the Medicare wage index, which I think maybe we'll get a chance to elaborate on in a little bit.

that really impacted our ability on the financial side as well and required us to make some difficult decisions.

So that's what you're seeing basically around the industry is all the Medicare plans facing some difficult decisions, then making changes in alignment with that?

>> This conversation this hour is not about systems.

I would say, again, listeners, if you've got questions or comments, you can make them and we'll welcome your phone calls.

We'll welcome your emails.

We'll do all of that stuff.

There's certainly a conversation to be had on a separate day about, you know, systems, but that's not an Andy Napierala conversation.

Andy and doing the nuts and bolts and, and and we will do that on a, on a different time coming up here.

But if you want to weigh in on any of this or if you've got questions about your plan or maybe what is changing, what might still be available.

844295 talk.

It's toll free.

8442958255263 WXXI.

If you call from Rochester 2639994, email the program Connections at WXXI app.

or you can join the chat if you're watching on the WXXI News YouTube channel.

So before we kind of get into some of the other nuts and bolts there, Renee as you said, you've had hundreds of calls in the last month.

>> Hundreds, yes.

>> So what's your process of helping people see what is next here?

And what are you in general want people to know?

>> So Lifespan creates what's called a Medicare advantage comparison chart.

And that gives folks the opportunity to compare the Medicare Advantage plans that are going to be available for 2026.

And that chart is available on our website in our foyer by mail, by email.

>> Okay.

in general, for people who are saying, you know, my coverage is going to be gone, I'm not going to have any options.

You're telling them what?

>> Stay calm.

There's plenty of time and there's still plenty of options available for them to pick from.

>> There's time to pick a plan.

>> There's time to pick a plan.

>> And there will be options.

>> Lots of options.

>> Okay.

have you been able to kind of calm the waters with a lot of folks on this?

>> we have, yes.

because Lifespan does offer one on one consultations so they can come in and meet with a certified Medicare counselor to go over, you know, their options.

They can also speak with a counselor over the phone.

So at that point, we're helping them decide what's best for them.

You know, per their health.

>> Okay.

And are you overloaded with that?

>> We are overloaded, yes.

>> So if people do want to make a consultation with you, they should probably not.

Wait, maybe.

Try to get it lined up.

>> Well, right now, our in-person appointments are are getting booked up.

Okay.

but like I said, folks that are receiving termination letters, they have time.

They actually have until February 28th, although they don't want to wait till then.

Okay.

They really want to have a plan in place for January 1st.

but there is time.

There's plenty of time.

I would suggest that if they really need an appointment to definitely call or go and schedule it on our website.

>> Okay, what's the website?

>> Lifespan.

Dash rock.org.

>> Look at that.

You had to think.

>> For a second.

I did have to think for a second.

>> You got it.

Renee.

so, Andy tell me a little bit about deadlines here.

Renee is urging people to know that there is still time.

What do you want people to understand?

>> I would say that the same thing.

I think that when it comes to both, you know, working with Excellus or Lifespan or a broker in the community, whoever people choose to work with, there is time.

I would also recommend that they that they really take a look at things this year, even if your plan isn't being discontinued, you may have a significant increase in your out of pocket expenses.

Depending on your plan, you may have an increase in your deductible, or you might have one for the first time.

Depending on the plan.

So this is this is a year which we recommend people do this every year, but especially this year.

if you have any questions, reach out to a professional someone that that can really help you understand the coverage and make sure that you're signing up for the right thing.

>> the reasons for some of these changes, your letters have mentioned rising costs, Andy and in this is not unique to our market, our region.

Of course, this isn't across the country issue.

We've got rising health care costs.

drug costs, hospital costs.

so I know there is a lot of pressure.

and there's also questions about government reimbursement, which is tied to the Medicare wage index.

Right?

Yeah.

Okay.

So before we get to the Medicare wage index, how would you describe the environment in terms of that?

The rising cost pressure, the the upward pressure that you're facing?

>> It's it's very significant.

I think it's unlike anything that we've we've seen in the industry.

And I think it's all about for us that that balance of wanting to get people the best, the best care possible, while also trying to to manage costs with our provider partners and making sure that we're delivering care and encouraging people to do that in the most efficient fashion.

Because, you know, ultimately then, unfortunately, if things if things don't work the way that we anticipate to, we have to we have to make decisions like this where we're eliminating plans or increasing cost shares.

And this is not something that we want as a health plan either.

You know, the discontinuance is and the plan changes that are happening.

>> Andy I want to be really I want to be as fair and careful as I can because this is a charged environment right now across the country.

Everybody knows, you know, the story of literally an assassination earlier this year.

We don't need any more heat than is necessary.

I also don't begrudge people some of the emotions that they are feeling.

And one of the sentiments I've been hearing locally is, shouldn't they have known this earlier?

Should they have given us more time and some of the environment that you're describing with those upwards rising costs and government reimbursement, how would you describe for people who do feel like, hey, I was blindsided, I needed more time here.

What would you tell them?

>> Yeah, we do our best to do long term planning and to project what things are going to look like into the future when it comes to our, you know, our costs and our partnerships.

Unfortunately, there were some factors that that have led to some of the changes that happened relatively quickly, and there were some significant changes.

So the part D prescription drug changes for Medicare we knew that there were some coming, but we didn't exactly know how they were going to be rolled out.

And the ultimate impact there until we until we got into it, so to speak.

other things like the Medicare wage index, that happened pretty quickly.

And the challenge for us as a health plan was that it raised our how much we had to pay our provider partners without any funding to help offset that.

And that was a very sudden change, which it would have been hard for us to, to foresee that.

>> and I know that Lifespan kind of calls balls and strikes and just helps the community understand how do you feel like their communication has been with the community so far?

>> excellus.

I think it's been great.

>> Pretty simple.

>> Yep.

>> Okay.

To the phones, we go.

We're going to get to the wage index in a second.

Tom and Rochester with a question about this.

Go ahead.

Tom.

>> Yeah.

I'm just wondering if somebody could help clarify what is Medicare advantage.

It's talked about and it would help to have some clarification as to really what it is.

>> Okay.

fair question.

Yeah.

you want to you want to take this one here?

Renee Pettenski.

>> Sure.

Medicare Advantage is a private insurer paid by Medicare to administer the plans.

Unlike a medigap that works in conjunction with Medicare, Medicare Advantage becomes your Medicare and takes over for your Medicare.

If if that makes sense.

Andy.

I don't know if you can explain it any easier than that.

>> Yeah, we're in the alphabet soup of Medicare here, but it's Medicare Part C, so it combines your hospital and your medical with traditional Medicare with with your part D prescription drug coverage.

The other reason that people like Medicare Advantage plan is it's coordinates the care for all of those things.

And then we can also offer supplemental benefits which they might not get through original Medicare.

That's how we can offer dental and hearing and vision and things like that.

>> All right.

Let's see if Tom, if that helps.

There.

Does that help Tom.

>> Very much.

Thanks.

>> Okay.

Yeah.

Fair question here.

And a good reminder for the host.

Always explain the terms here.

thank you.

Tom 844295 talk.

If you've got questions comments 8442958255263 WXXI.

If you're calling from Rochester, 2639994, email the program Connections at WXXI.

Dot Jean wants to know if this means drug costs are going up or drug.

if we're going to see certain benefits eliminated.

So Andy, what would you say to Jean?

>> So drug costs I think are going up around the industry.

what they what you might see are some increases to drug deductibles and cost shares is what I would anticipate you're going to see around around the industry.

and I'm sure Renee Renee would, would be able to to back me up on on that.

Yes.

Formularies do change.

they can change up to every month.

We try not to change them that often, but we work with our pharmacy benefit manager to make sure that we're we have as diverse of a formulary.

We're covering as many drugs as possible while still hopefully trying to find synergies there.

And and, and really make sure that we're doing the best that we can for everyone.

>> Okay.

Anything to add there?

Renee.

>> Drugs are changing tiers, you know, so that means co-pays are going to be different.

So there's going to be some cost changes there.

>> Okay.

And how do you know in advance especially for people on fixed budgets here.

>> Formularies the drug books and each of the insurers have them out on their website.

And I encourage everybody, especially this year, to make sure they're checking their drugs, make sure they're still covered and what tier they're going to be in so that they know what they're going to pay.

>> Jean, thank you for the email.

I hope that answers that.

Send me a note back.

If there's anything else you want clarified.

If you're on the phone, hang tight for one second.

We're going to get right back to your phone calls.

After we clear up a little bit more about what the Medicare wage index is and why this matters, and I'm going to give Andy Napierala a vice president of Medicare and individual market sales for Excellus BlueCross BlueShield some space to explain that.

Go ahead.

>> Well, thank you, Evan, for for the opportunity.

There to I think we'll try to explain it as best we can because as you mentioned, it is a complicated issue.

So our costs for, let's say, working with a hospital for an inpatient stay, we're contracted, thankfully, with, with all of the large facilities around, around Rochester which we're very thankful to have those relationships.

And when we contract with them, our contracts are actually based off of what Medicare Original A and B, the government, what they pay for certain services.

So we might pay 100% of Medicare, 101%, whatever.

Whatever the case might be.

So our costs are pegged to Medicare.

So what happened with with the wage index?

And this again, is something that was actually well intentioned.

it's well documented.

A lot of the hospital systems in upstate New York have really struggled financially for a number of years, and they cite not getting enough revenue.

So they've been lobbying justifiably different levels of government to have their reimbursement rates increased.

So the government decided that they that this was something that was very important for them to do, to make sure that people didn't lose access to care, which is very important.

and they ended up approving a large increase for a lot of inpatient Medicare reimbursements.

And since our contracts with these facilities are also based off of that, our costs increase significantly.

And basically overnight, it was something that that we didn't know this was coming.

>> And when did you find out?

>> it happened.

probably about a month before our, our bid, our Medicare bid was due for 2025. so it was for us.

It was really too late to make a lot of changes.

And we ended up suffering some financial losses because of that.

>> I mean, I, I'm seeing different numbers, but around $100 million.

Is that right?

Yeah, $100 million.

>> Yeah.

And access to that.

>> What do you want to see change.

Do you want to see anything change?

Do you want to see Congress do anything about that?

>> Yeah.

We would like to see.

And our New York delegation and local delegation have been great.

we've been been working with different levels of government to make them aware of the challenges that we have here.

Because, again, for us, as a nonprofit health plan, it's all about delivering affordable care to people and helping our hospital systems do that.

So their long term health is in viability is very important.

but the fact that the mandate came to us being unfunded and, and so and basically instant was really the challenge.

So what we would like to see is some, some reimbursement for us so that even if it's staged over time so we can we can basically be made whole for the significant outlay that we've had.

>> What are the chances that happens?

>> I'm not really sure.

I'd have to defer to our government affairs team on on that.

I do know that there are conversations ongoing.

And, you know, it's one of the many things that's probably being discussed at both the state and the federal level.

>> But I presume that you are preparing for that not to go your way.

>> Have to prepare for it for everything.

Yes.

>> Okay.

Yes.

to the phones we go.

and John in Greece and Frank in Greece.

We'll take John first.

Hi, John.

Go ahead.

>> Hi.

Oh, hi, Evan.

That's probably me.

It's Jack.

Oh.

Hey, Jack.

Sorry.

Evan a couple.

Let me try and keep this as tight as I can.

There's so much involved in this.

It's.

I've been on Medicare.

My wife and I for Medicare Advantage for a number of years now.

And the first thing is we switched plans this year because those became so expensive.

I was getting it through my employer, which originally was Kodak and outsourced.

But any any event the insurance company we were with this past year has terminated our plan.

We'll be selecting something new, probably Excellus most likely excellus, I should say.

But the company that we were with was interesting.

Once you sign up with them, all their customer service is outsourced to the Philippines.

So you speak with someone that has no clue on what the U.S.

health care system is.

They read from a script.

So finally, I've asked to speak to someone from the U.S., and that's a whole nother story.

But what?

So customer service is poor with many of these companies.

they the companies themselves.

I have surgery, my, my and my daughter's son had surgery this past year.

Both cases after the surgery was completed, the insurance company decided they didn't want to pay for it.

And they have all sorts of reasons, but they it seems like they make up excuses.

Again, you're talking with somebody that doesn't understand the U.S.

health care system.

and, you know, the thing is that the impact is so serious and so threatening from a financial standpoint.

I'm not even certain at this point how much I may be liable for my surgery.

My daughter paid for their son's surgery out of pocket.

and the final point, maybe this is someone someone can help with, is my wife takes a tier five injectable.

at home, and you know, they're so expensive.

We hit the max, which was okay.

Thank God the max is put in for the tier five drugs for this year.

For 2000, for $2,000.

But the difficulty is when you.

Now we have to manage another transition.

The drug is not on the formulary.

We have to come up with another equivalent, which we think we have.

And then you have a short supply of that drug.

So hopefully when we work with Excellus on January the 1st, we get our new cards, we can get a supply for my wife because it's not like she's taking a drug because she wants to.

It's life threatening.

like I said, I will keep this short.

There's so much involved here.

It's just crazy.

>> But can I ask you a quick question, Jack?

>> Sure.

>> Because I'm trying to be fair here, and I have occasionally been cynical about insurance in the past, and I'm really trying to be careful just because, number one, everyone needs good information.

Number two, nobody needs more heat at a time when there's plenty of heat.

We just need to be straightforward, right?

So my job as a journalist is to be straightforward and try not to be cynical.

I can't I don't want to be, naive, but I don't know of a whole lot of cases.

I'm sure this has happened where you've got an approved surgery and then afterwards it's unapproved.

You're telling me that insurance said we're going to cover your surgery?

You had the surgery, and then they said, we changed our minds.

That seems wild to me and probably not legal.

And I feel like I'm missing part of the story.

>> Well, let me tell you what happened.

I had my surgery in, in in July, August.

I get the 24 page report of all the gory details that were done in that surgery.

8 or 10 line items per page.

So there's 150 steps involved in my surgery as this is the way they bill it for my shoulder surgery.

So what happened is the insurance company said, oh, well, rejecting and it's all happy talk from people offshore.

Oh you know you're not liable.

Don't worry that we're rejecting it because of a coding error.

Well, and then I read through these hundred and 40, 150 line items, and I see a couple of one liners under there that say, oh, well, they have a question about something else.

So it's like it was approved.

I mean, we're talking about Strong Memorial Hospital.

They work with this.

This is a major insurance company.

They do their big one.

And so I got my what.

And after numerous phone calls with the insurance company and strongest billing organization, we're left with, you know, I think they do this all hands off.

It's all paper, electronic paperwork back and forth.

The answer I got from the billing department, as strong as this happens all the time, and it may take up to two years to be resolved.

And in the meantime, I'm waiting for a bill to show up from strong.

And then what do I do with it?

>> Well.

>> That's the truth.

>> Yeah.

No, no, I hear you, Jack.

And I want to thank you for the phone call.

So there's a number of things there.

Let me work backwards again.

this is not necessarily Andy Napierala bailiwick.

As vice president of Medicare and individual market sales for Excellus.

But in general, one of the the concerns about the complexity of American health care that journalist Annie Lowry has written a lot about is sometimes it is so opaque or so hard for the lay public to understand a decision on coverage or claims, et cetera., that it almost forces people not to be covered.

Are you?

Do you feel like Excellus is doing your best to simplify for your members?

>> We're doing everything that we can, so I'll just give you a couple examples.

There was the required documentation that we had to send out in September, and we then follow that up as soon as we're able to with a much more explanatory, customer friendly explanation of what's happening and what their options are, I take a look at things like our, our resource centers that we have.

We have two in Rochester, one in Greece and another one that we we just opened recently in perinton.

And that's an opportunity for people to come see us.

They can sit down, they can review plan options, they can get help with customer service issues.

we know that this is that this is confusing.

And we're trying to keep we're trying to simplify things wherever we can.

We know that it's confusing and it's very important, and it can feel very expensive.

So I do empathize with with with Jack on, on the phone.

I think as an industry, we're, we're, we're hopefully taking some steps in the right direction there to make things more transparent.

and to help educate people on what's happening and why.

>> No matter where they are employed or working from.

Right?

Yeah.

So so that's a that's a fair complaint of his.

You think.

>> I can't say specifically.

I mean, I'm proud that we're in upstate New York company and all of our staff are here are here.

and, you know, we we live, work and play here.

These are our communities.

You know, we're in New York state based nonprofit.

So I'm really proud of that fact.

I can't speak for other companies, but I know that for for our team, we're focused on on trying to help people understand what's happening and how we can help every day.

>> The last issue that Jack's talking about is, you know, facing a $2,000 max for tier five drugs, but wondering what drugs are on there, not seeing it on the formulary, what would you what would you tell him there?

>> Renee well, whenever a drug is not on a formulary, you always got to go back and work with your prescribing doctor and see if there is something else that they can use that would work as well.

>> Okay.

Jack, good luck to you.

I definitely appreciate that.

And I want to say, I mean, like, I'm not questioning at all your experience there, man.

I'm with you there.

I just sometimes it's tough to not knowing all the details, but I wish you, well, good health to you.

Hopefully good coverage to you.

After we take our break, we're going right back to your phone call.

So if you're on the line, hang there and we'll just work through your questions and comments.

You just heard Renee Pettenski, who's director of the health Insurance Information Counseling Assistance Program at Lifespan, who is with us?

Andy Napierala is here from Excellus.

They're the only company of its type that said yes to come on today.

That matters to me, that matters to this community, and I want to thank them for that.

And again, if you think I'm just running cover for Excellus, that's not the case.

They have to answer your questions.

They have to answer ours.

And they know there are some people who are upset, but they're here.

That does matter.

Let's come right back.

We'll take more of your calls next.

>> Coming up in our second hour, Rochester is about to become home of the only film music festival in North America.

And it's pretty cool to go behind the scenes of major Hollywood productions and find out how the music comes together.

Maybe you've got a favorite movie score or song for me growing up, stripes, Police Academy I know I'm a nerd, but there's a lot of cool stuff to talk about and we'll do it with the team next.

Our.

>> Support for your public radio station comes from our members and from Mary Cariola center.

Supporting residents to become active members of the community, from developing life skills to gaining independence.

Mary Cariola center Transforming lives of people with disabilities.

More online at.

Mary Cariola.

Org.

>> This is Connections.

I'm Evan Dawson got a number of emails from people saying, what about MVP MVP's?

Not here.

When we're bummed about that, that's their choice.

But this is from Sue, who says I currently have MVP coverage.

I have not yet received a letter from them about my plan not being offered.

However, the Lifespan chart does not list my current plan.

Are the three listed by Lifespan, the only ones they will be offering?

And why have I not heard from MVP?

That's from Sue.

Do your best on that one.

Renee Pettenski.

>> Okay, so you know the letters, the termination letters go out in the U.S.

You know, postal mail, snail mail.

So anything can happen to the letters between the time they're dropped till they, you know, either get to the members or not.

I would just maybe call your insurance company and say, you know, is my plan terming verify that I think that's important.

there's lots of termination letters that went out.

some people in other companies did not get any.

>> Okay.

So it literally may be a U.S.

mail issue.

Could be.

But but Sue, hopefully that helps.

And send us a note there.

if you need more information.

Charlie says on dental care.

I'm starting my second year on Medicare Advantage.

I have not received any letter from the Rochester City School District about rising costs.

Should I be expecting a letter?

Also, I don't have dental care right now.

Where would I go to find that on my advantage plan?

Thank you for this important show.

That is from Charlie, a retired teacher.

>> Okay, so usually employer groups start their notifications somewhere in November.

Mid to to late November.

So I would.

Don't give up.

It'll be coming.

Okay.

The information will be coming.

>> Okay.

again, Charlie, hope that answers that question there.

and let's see here.

Just working down the line here David.

Listening in Vancouver, Canada says shows like this one remind me how lucky I was to find work in Canada nearly 30 years ago, moving from the Finger Lakes.

He says it's beyond sad that so many Americans have to go through so much just to get or not get the health care they need.

Maddie writes in to say, Evan, this is perhaps an unpopular opinion, but I feel like people forget that having health insurance does not mean everything is covered.

People need to budget and save for health expenses.

Health insurance doesn't cover everything.

That's from Maddie.

What would you say to that?

Renee?

>> Well, you know, every insurer gets to pick and choose what they're going to cover.

so, you know, not every plan is going to have everything that you need.

There's they're just not always going to have it like some plans have transportation, some don't.

>> I think Maddie's point is, on its face, obviously correct.

I mean, not every health insurance plan covers every possible outcome of your health, right?

I think the balance is, is it transparent enough?

Do you feel like you understand what's covered?

Do you feel like there's follow through?

That's.

What do you think?

>> Andy I think that's that's exactly right.

And that's where when people evaluate their coverage, they do need to consider a wide range of things.

It's it's the total out-of-pocket costs, including premiums, deductibles, cost shares, making sure their preferred facilities are going to participate with the plan, that their drugs are going to be covered.

And at what tier if they travel to make sure that their coverage is going to be able to travel with them.

We have a lot of snowbirds in upstate New York, so that's something that's important to a lot of people.

And the other thing that.

>> Does coverage, travel with them.

By the way.

>> It can it depends on the plan.

Excuse me.

Okay.

yeah, PPO plans have become very popular in recent years, and people can enroll in one of those, which gives them a lot more out of area coverage or those Medicare supplement plans that Renee mentioned earlier.

The other thing that I think we we should we should discuss here, Renee would be some of the the financial assistance plans that are available for folks as they as we're all feeling, this rising cost environment, there are things like the low income subsidy and New York State's Epic plan that actually help limit out-of-pocket costs.

I know you, you and your staff probably help people with that all the time.

>> Yes.

So there are a lot of assistance programs available for folks that are on Medicare.

obviously based on income.

So there's a Medicare savings program also called MSP.

if folks qualify for that that would eliminate paying the part B premium that comes out of Social Security checks each month.

There's also the extra help called low income subsidy.

Alice for short.

That helps folks with lowering their drug costs.

So at Lifespan we can help them apply for these for this help.

And there's also hospital assistance programs that both Rochester Regional and U of R have financial aid.

>> How often are you helping people with in this way?

>> actually quite, quite often.

>> Are there people who don't know that they're eligible for this?

>> Yes.

Yeah.

Yes.

>> Okay.

So again, this is just about being as as well educated as you can be about what you qualify for.

>> Correct?

>> Okay.

back to your phone calls, Greg in San Diego, California.

Hey, Greg, go ahead.

>> Hey.

Yeah, it really seems that the ability of choice is becoming less and less each year.

I had long have and am still a member of Humana.

I don't think that's in the Rochester area, but Humana.

Medicare advantage.

So I am in an advantage plan right now.

Up until December 31st, after the 31st.

I don't know what's going to happen.

the the advantage plans are just going away here in San Diego County.

I may be my only choice.

May be to go back to our original Medicare A and B and try and get into a supplemental plan, which makes it even more expensive just to have that, you know, coverage.

I've been happy with Humana, but they cut off.

I've been seen by doctors at the University of California at San Diego, great care, wonderful.

But earlier this year UCSD told Humana, we're, you know, we don't we don't want you anymore.

And I found out back in July that I was going to have to some someone snitched and gave me a heads up that Humana was going to not be serving UCSD.

So it appears that my only choice is to go back to the original A and B. and get a supplemental plan, which is really expensive.

>> Is it your sense that there's going to be fewer choices everywhere?

Greg, is that your is that kind of where you're going here?

>> Yeah.

For, for from the experience out here, there's one hospital group called Scripps.

It's a corporation.

They run four hospitals and the CEO of that hospital last year announced that one of their hospitals would accept any advantage plan.

And I know that because I went into Scripps, I was treated, you know, for in immediate emergency procedures.

Then after I was there for one day, I had to be transported to a UCSD hospital because Scripps.

No, no longer took Humana.

They didn't don't take any advantage plan.

So I had to get moved out of one hospital to another just because of my Humana health coverage.

And it's crazy.

It really is confusing.

And yeah, it's.

But I, I think I'll just go back to the original A and B and look at the Supplementals.

But that's going to be a lot more expensive come January 1st.

>> Well, Greg, good luck to you.

Thank you for the phone call from San Diego.

Now, Mark had emailed to ask, is the problem that you're describing on the show today?

A Rochester problem, or is this happening across the country?

So Greg's story is not exactly a Rochester story.

He's in San Diego, but Mark's asking, is this unique to Rochester?

What's going on?

What's the answer here?

>> No, it's happening everywhere.

It it's happening across the country.

>> In relation to rising costs.

>> Yes.

Yeah.

It's not at all a Rochester or upstate New York specific thing.

And, you know, being Excellus BlueCross BlueShield, we're part of the Blue Cross Blue Shield Association and numerous, numerous groups that that represent the industry.

And it's happening everywhere.

It's a general resetting of of of, of the industry that we're all we're all working together to get through.

>> Maureen wants to kind of nitpick the statement about what is local.

So here we here we are.

Andy.

So Maureen says, if I heard the Excellus representative correctly says there are two centers, centers where customers could come to discuss things face to face.

Is that right?

Yeah.

And she says, if I heard correctly, those are in Greece and in Perinton.

Yeah.

Okay.

So Maureen says, I realize Greece has a Rochester address, but those two locales are not really in the city.

Neither of those areas would be convenient or up close for Rochester customers.

So what would you say to Maureen there?

Are you on a bus line?

>> We are.

So when we pick our our resource center locations, we use a number of factors.

So we take a look at the demographics in the area and make sure that they're close to, to highways and public transportation.

And in this case now we have one on either side of town that kind of brackets.

The city which was something that we've had in mind for a while.

So hopefully this will make it a little bit more convenient for everybody.

>> Okay, Maureen, I hope that answers your question there.

Paul.

And Webster says there's been more reduction across all insurance providers in available plans for 2026.

And the Rochester area than is the case in central New York or western New York, Syracuse or Buffalo.

What is the dynamic going on in the Rochester area that is causing more stress on the insurance providers compared to other parts of New York?

Is that an accurate statement?

First of all, from Paul in Webster, Andy?

>> I think generally speaking it is accurate, yes.

>> Okay.

So what's going on here compared to Syracuse and Buffalo?

>> It's a it's a pretty detailed explanation, but I guess, you know, just generally speaking there's counties but we're our reimbursements in the way our plans perform are very county specific.

That's true for any any health insurance carrier in the industry.

and Monroe County and Rochester happens to be a challenging county compared to other locations like Central New York.

As an example.

>> What would make it unchallenging?

What would make what would make it better?

>> It's that combination of costs.

And then also reimbursements.

the math in Rochester.

>> Who's responsible for that?

Who could who has the key to that castle to make it different?

>> Well, on the cost, it's a number of things.

You know, as we mentioned, it's it's providers.

It's it's regulators, it's mandates.

It's things like that.

and then on the revenue side, reimbursements for us, I mentioned the wage index.

Now things are based off of Medicare.

Our reimbursement rates from CMS, which is the center for Medicare and Medicaid Services, our governing body.

They differ at the county level.

>> All right.

Paul and Webster, I hope that answers some of that question as well.

let me get back to your phone calls.

This is Frank in Greece.

Hey, Frank.

Go ahead.

>> Hello.

I just wanted to say, I realize this is a Medicare conversation, but I received Lifespan services, and I just want to attest to their professionalism and their depth of knowledge and their compassion and their generosity of spirit.

So keep it up, Lifespan.

>> Thank you very much.

>> It's a really lovely phone call.

>> Yes.

Like it?

Thank you.

>> Didn't even come from your cell phone address.

>> No it didn't.

>> That was not a plan.

>> To call.

>> I know Frank's a semi-regular.

And I'm glad.

Frank, I'm glad to hear you had a good experience.

Lifespan has to serve a lot of people.

And this is a high pressure time right now, as we talk about what's going on with Medicare Advantage, the concern which is for some, a euphemism that people have had for the last few weeks, that's what we're talking about this hour.

If you've got if you've got a letter talking about the changes to your Medicare Advantage plan that is coming starting January, January 1st.

Yep.

Right.

that's what we're talking about, why that's happening, what that means for you, what you can do about it.

So if you missed earlier this hour, Renee Pettenski from Lifespan has been well, Renee and the team at Lifespan have been counseling people who have been calling to understand that there is still time.

>> Plenty.

>> Plenty of time, and that there will be options.

I think for some listeners who are feeling a little cynical about it, they might their rejoinder to that might be, there's options.

Are they worse options than they they used to be?

Are they more expensive options?

>> I say yes to all of the above.

Okay.

Yes.

>> But but there's not zero options.

and and and excels is being upfront about this the reason I mean they're acknowledging costs are going up.

Plans are getting more expensive.

And we're talking a little bit about why that is happening to but if we got about ten minutes left, if you want to jump on the phone, it's 844295 talk.

It's toll free.

8442958255263 WXXI.

If you call from Rochester 2639994, email the program Connections at wxxi.org or jump on the chat on the YouTube channel.

And here's a comment from YouTube.

Who has the time and availability to do all of this for their needed services?

How are laypeople supposed to understand these complicated plans?

Okay, so understanding plans, that's one thing that Lifespan tries to help people with.

>> That's exactly what we do.

>> How do you help people understand the complicated plans?

>> Well, we have that beautiful chart again, you know, that compares the Medicare Advantage plans.

Folks can come in, they can sit down with a certified counselor.

They can speak with one over the phone and we can go through the plans and explain, you know, the differences.

And then help them decide what's best for them, for their needs.

>> And you do this all the.

>> Time, all day long.

>> Okay.

Is it I know you're not designing the system, Renee.

You guys are helping people navigate the system.

Correct?

Is the system pretty opaque, or is it gotten a little easier to navigate over time?

>> no, it has not gotten easier.

>> Okay.

All right.

well, so a little solidarity for the listener or the viewer on YouTube, but again, Lifespan can help you with that.

They are loaded up.

Don't probably just make a phone call and think that you're getting right through right now.

That's right.

but there is time, so hopefully you can find that time.

Dallas writes to say a coding error when they say that and you hear that a lot.

How many codes are there?

Like 10,000.

What does that mean?

What is a coding error?

Andy.

>> Well, I think there's at least that many.

Not that I'm not that I'm the expert on that.

I would defer to our, you know, our, our folks that that work with provider partners.

But basically what ends up happening is when you have a service or a procedure done the provider will then list what, what they did.

And there are different codes that basically stand for different things.

So if you have one operation, it may be there may be multiple codes depending on what they had to do.

And that determines how much they're going to be reimbursed based on the coding.

So in this case they're they're saying that they you know, they didn't cover it because there was a coding error.

and that the insurance company in question, which thankfully wasn't us.

was refusing to pay on that account.

>> Yeah.

And again, every case is going to be different there.

Dallas.

I mean, why a coding error would happen is it sounds like a paperwork error.

It's probably not just a paperwork error.

It's probably a question of what the procedure entailed and why and what was, you know, supposed to be covered and why.

>> That's what it sounds like.

Yeah.

>> Okay.

and I understand, Dallas, if you or others are sort of cynical about that because it feels like there's so many codes that's designed to create loopholes.

But again, that is not related to the current discussion.

You want to talk the the depth of coding error on another show.

That might be wonky, but maybe we'll do it.

Maybe.

Maybe that's a separate conversation, a different day.

Mike in Penfield is next on the phone.

I see the phone keeps ringing here.

Hey, Mike, go ahead.

>> yeah.

Evan, I just the person that called in was wondering about the two excellus.

sites for getting questions answered.

I haven't gone there, but I did go on the Excellus website.

and I was able to get to their online messaging chat function, and I found that they were very quick to get somebody on there, and they were very knowledgeable.

I was on there 4 or 5 times with different questions.

So that's another option for people who need answers to their questions about Excellus.

>> Okay I'm glad it worked well for you.

That's good.

That's a good endorsement.

Again, that is not a planted phone call.

That's someone who and probably glad to hear it Andy Napierala that it worked well for Mike.

>> Absolutely.

I'll just tell you quickly, when we realized that we were going to have to make some of these difficult decisions and discontinue some plans, my mind immediately went to, how are we going to be there for people and help them through this, this experience?

So it was an organizational effort to to say, what are we going to do?

So we really we dedicated more staff in our call centers for customer service all of those things like, like chats.

We developed another resource center for people to come see us.

we're supporting our broker partners and our community partners like Lifespan and just souped up our website, made a great landing page, filmed some videos to put on there so that we can help educate people and help get as much information out there as possible.

As as we kind of go through this, this annual enrollment period.

>> have you had to use their website, Renee.

Do you agree with Mike?

>> Yes.

>> And.

>> You can answer that if you want.

>> No, no.

Nope.

>> Can't do.

>> That one.

No, but Excellus has been very proactive in you know, reaching out and to get their, their clients who have received the termination letters, they're holding lots of meetings out there for them.

So I think that's very helpful.

>> People want transparency and they want to be able to get answers quickly.

They don't want to feel like they're in an endless maze.

Exactly.

Mike, thanks for the phone call.

And, gates, this is Deirdre.

Next.

Deirdre.

Go ahead.

>> Hi.

I'm calling about the change for my son, who has a dual Medicaid, Medicare plan.

through Medicare Advantage.

And for the last three years, we've had a $211 health benefit.

for food.

And it can also be used for other things, but we used it for food.

and it's going to zero next year, depending on how they interpret his particular disability.

he's a person living with autism.

And therefore gets local Medicaid in addition to Medicare.

>> Okay, hang on there for a second there, Deirdre.

Andy Renee, can you offer some ideas on what this means for them?

>> Well, I would suggest contacting Lifespan because we also have a chart with all the dual eligible plans on there for 2026.

You can, you know, schedule an appointment and sit down with a counselor.

And you know, go over the plans and see if any of them fit for your son for the upcoming year.

>> Okay.

Deirdre, is that something you feel like you can do?

>> Do work with a broker currently, and we she and I will sit down and do that.

however, it's it looks like for people like my son.

who do have the dual enrollment.

>> Oh, we lost you.

The call dropped.

Deirdre.

I'm sorry.

That literally the call dropped.

so I apologize for that, Deirdre.

But I guess I will just say I wish you the best.

I mean, I'm not trying to be trite.

I know that this is a nervy time.

and it's a challenging time.

in general, Andy are should or Renee are there concerns for families with, with family members with disabilities that they'll have less coverage, fewer coverage options here?

>> I don't know about that, honestly.

Okay.

again, I would refer back to the 2026 dual eligible plans that are available again.

Lifespan has that chart.

I think that would be helpful.

And I would also suggest that you know, her broker, if they don't have that chart, maybe get the chart and look it over with her.

>> Okay.

And then you want to add their Andy.

>> I would agree with that.

I think that when it comes to dual plans, they're actually they're growing pretty rapidly around the industry.

>> Okay.

so before we close here, another question from a listener about whether the government shut down is going to impact some of this.

Well, the negotiations involving the government shutdown affect the options available.

Andy.

>> Thankfully not.

No, Medicare is considered mandatory.

And and essential spending so that continues regardless of, you know, through the government shutdown.

>> Okay.

so as we wrap up here in our last 90s, I want to give you the floor Renee what do you want to leave with listeners as they try to navigate some of this?

>> again, just be calm.

there's plenty of options, plenty of time.

Feel free to contact Lifespan.

You can sit with a counselor.

You can speak with a counselor.

we can help you the best that we can.

We're also holding lots of meetings to just go over the Medicare Advantage plans.

so give us a call.

be patient, because we do have a lot of callers coming in, and it might take us a day, maybe two, to get back to you.

But again, plenty of time to get this done.

>> Okay.

Andy Napierala final thoughts from you.

>> Yeah.

Just appreciate the opportunity here.

Hopefully we're able to help provide some more information around what's happening in the industry.

It's a tumultuous time, very dynamic change happening.

and we're here to help people through it.

We're in this together.

This is something that, you know, whether you work with someone from our team or a Lifespan or your broker.

there are options available.

You've got some time to figure things out.

and looking forward to helping as many people as we can.

>> I'll close with one email from Doug and Renee.

What would you advise, Doug?

He says, why not just refuse to pay these new unreasonable Medicare Advantage bills?

What would be the consequences, especially if a multitude of people refuse?

You're not going to advise people to refuse?

>> I would never advise that.

No, I would not advise it.

>> You know, you don't want medical bankruptcies to increase.

>> Increase?

No.

Definitely not.

>> Yeah.

And I would say this, Doug if you are frustrated, I would not begrudge your frustration.

Right.

I understand your frustration.

I don't think anybody on this program can authorize nonpayment intentionally, but I will say that if you're frustrated, I get it.

I want to thank our guests for being here.

Renee Pettenski, director of the health Insurance Information Counseling Assistance Program at Lifespan.

They're very busy right now.

Give them some time, but they're helping a lot of people.

Thank you for being here.

>> Thank you so much for the opportunity.

>> Andy Napierala vice president of Medicare and Individual Market Sales for Excellus BlueCross BlueShield, the only company in its field that agreed to come on this program today.

It means a lot to our listeners.

Thanks for being here.

>> Thanks for the opportunity.

>> Appreciate it.

More Connections coming up.

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