Medicare Advantage plans expanded into dozens of new counties for the 2021 plan year. With the expansion in plans also came the news that the Centers for Medicare and Medicaid Services (CMS) increased the maximum out-of-pocket (MOOP) limit from $6,700 to $7,550 per year.
However, several companies, including Brand New Day, a Medicare Advantage prescription health plan available in 16 California counties, are bucking the trend by lowering their MOOP below $1,000. Conversely, industry-leading Kaiser Medicare Advantage has their MOOP set between $2,900 and $6,700 (rate varies by county and plan).
Want to compare Medicare Advantage Plans in California? Do so here.
Why is a Plan’s MOOP a Big Deal?
One of the most significant features built into Medicare Advantage is the Maximum Out-of-Pocket safeguard. It is basically the safety net designed into private plans to ensure Medicare beneficiaries avoid bankruptcy due to a serious illness or accident. But, let’s face it, the new $7,550 MOOP limit is a bitter pill to swallow for most people with Medicare benefits.
Brand New Day’s $999 MOOP is a welcome sign. In the past, MedicareWire has criticized the Medicare Advantage program for tricking seniors into HMO plans with zero-dollar premiums, only to later discover they can’t afford the health care services they need. However, Brand New Day, a 3.5-star Medicare Advantage plan, is showing their commitment to delivering care at an affordable cost.
A super low MOOP isn’t the only way Brand New Day is getting Kaiser Medicare Advantage plan members to reconsider their options. Many of their copays are lower, too, as shown in this sampling of plan costs in San Diego County.
| Services | Kaiser | Brand New Day |
|---|---|---|
| Primary Care Doctor: | $15 co-pay | $0 co-pay |
| Mental Health Specialist (individual): | $15 co-pay | $10 co-pay |
| Mental Health Specialist (group): | $7 co-pay | $10 co-pay |
| Occupational Therapy Specialist: | $30 co-pay | $30 co-pay |
| Emergency Room Care: | $90 co-pay | $100 co-pay |
| (waived if admitted within 24 days) | (waived if admitted within 24 days) | |
| Ambulance Services: | $200 co-pay | $125 co-pay |
| Hospital Inpatient Stay: | $285 per day for days 1 through 7 | $100 per day for days 1 through 4 |
| $0 per day for days 8 through 90 | $0 per day for days 5 through 90 | |
| $0 per day for days 91 and beyond | $0 per day for days 91 and beyond | |
| Sample: Kaiser H0524-037 vs. Brand New Day H0838-037. Rates vary by plan and county. | ||
What About Quality of Care?
Are Kaiser’s quality ratings from CMS worth the additional out-of-pocket costs? For 2021 Kaiser achieved 5 stars in all quality measures, save one, “Member Experience with Health Plan”, where Kaiser scored 4 stars.
Brand New Day was given a 1-star score on the same measure, showing the Achilles’ heel of the plan. MedicareWire encourages potential members to consider what a 1-star rating in member experience truly means. Clearly, many members were not satisfied with how the plan treated them when they required health services.
Here’s how CMS scored Brand New Day in all of the top rating categories:
Who Should Consider a Brand New Day Medicare Advantage Plan?
As soon as Brand New Day fixes their member experience issue, everyone should take a look at these plans based on their value. Until then, healthy seniors will do well on this plan. Likewise, it appears that members with certain chronic conditions do well with a Brand New Day plan.
Where Does Brand New Day Offer Medicare Advantage Plans?
Brand New Day Medicare Advantage Plans are available in the following counties:
- Fresno County, CA
- Imperial County, CA
- Kern County, CA
- Kings County, CA
- Los Angeles County, CA
- Madera County, CA
- Orange County, CA
- Riverside County, CA
- Sacramento County, CA
- San Bernardino County, CA
- San Diego County, CA
- San Francisco County, CA
- San Joaquin County, CA
- San Mateo County, CA
- Santa Clara County, CA
- Tulare County, CA
More About Brand New Day
Brand New Day offers a number of specialty plans in addition to its standard Medicare plan. In addition to its Medicare only, Medicare and Medi-Cal members, the plan offers specialized programs for those with ongoing medical conditions including Diabetes, Cardiovascular Disease, Dementia, and Mental Illness.
Brand New Day serves those who live in long-term care facilities. The HMO plan’s approach is designed to keep its members healthy and independent. For more information about Brand New Day, visit BNDHMO.com or call (866) 255-4795.
