Five Questions With: Melissa Cummings

Melissa Cummings is the executive vice president and chief customer officer at Blue Cross & Blue Shield of Rhode Island. She discusses Blue Cross’ Medicare enrollment period, the details of Medicare plans and its 5-star rating.

PBN: What is the Medicare annual enrollment period?

CUMMINGS: It’s a great time of year. Choosing a Medicare plan is an important decision that affects both your physical health and your financial health, and it’s one that people often make with the help of their family and friends.

So even if you’re not one of the 200,000-plus Rhode Islanders who are eligible for Medicare, it’s helpful to know that the Medicare annual election period runs from Oct. 15 to Dec. 7. During that time, you can choose to stay with your current plan or switch to another Medicare plan.

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If your needs have changed or if you’re not in a top-rated plan – one that’s rated 5 stars by the Centers for Medicare & Medicaid Services – it’s a good idea to shop around. Thanksgiving is in a few days, so this is a perfect time to talk with your loved ones to make sure they have the best plan for them.

PBN: What’s the difference between Original Medicare and Medicare Advantage plans?

CUMMINGS: With Original Medicare, your benefits are managed by the federal government and you can see any provider that accepts Medicare. Medicare Advantage plans offer benefits through private insurers, such as Blue Cross & Blue Shield of Rhode Island, and use provider networks. That means you generally have lower costs if you use doctors and hospitals within the plan’s network.

Medicare Advantage plans offer the same benefits as Original Medicare and often much more, including benefits that help older adults stay healthy and independent. For example, all BCBSRI Medicare Advantage plans offer $0 benefits for help with household chores, a national fitness membership and rides to the doctor. But what really sets Medicare Advantage plans apart is they simplify your coverage, with one benefit plan and one membership card. Many Medicare Advantage plans, including most of the options BCBSRI offers, have dental, vision and prescription drugs all in one plan.

PBN: Blue Cross & Blue Shield of Rhode Island recently received a 5-star rating for all its Medicare Advantage plans. What is the significance of the 5-star rating system?

CUMMINGS: A star rating system is so helpful when we’re looking for a great restaurant or shopping for a reliable appliance. And that’s true of choosing a Medicare plan too. The Centers for Medicare & Medicaid Services created a 5-star rating system that measures member satisfaction, quality and plan performance.

Members enrolled in 5-star plans generally experience lower out-of-pocket costs, higher member satisfaction, better health outcomes and a best-in-class provider network. You can enroll in a 5-star plan at any time of the year, not just during the annual election period, which is great for people who aren’t satisfied with their plan.

At BCBSRI, we’re so grateful to our members for rating our Medicare plans 5 out of 5 stars in 2022 and 2023. We’re once again the only health insurer in the state to earn 5 stars for all of our plans.

PBN: How did BCBSRI retain its top rating?

CUMMINGS: Being local matters. We have relationships with doctors and hospitals, which helps us connect members to the care they need when they need it. We can also talk with Rhode Islanders in person about their challenges, such as wanting to stay in their homes without relying on family and friends. That led to a new benefit where trained helpers assist you with household chores like vacuuming, yardwork or even setting up your WiFi. People have loved it.

We’re the only insurer in Rhode Island to have stores and that has strengthened our ties in the community. Our employees know our members – not just their names but their stories. Some members come in, take a free fitness class then go to lunch together. Our 5-star rating matters so much to us because it means our friends and neighbors are happy with their plans. That’s what we live for.

PBN: What advice do you have for consumers looking to choose a Medicare plan?

CUMMINGS: You really want a plan that works for your life. I often suggest making a list of the health care services and prescriptions you expect to need next year and then compare benefits based on that list. Once you find a few plans you like, check their star ratings on medicare.gov.

If you might qualify for Medicaid as well as Medicare, a Dual Special Needs Plan often offers extra benefits. Our $0 BlueRI for Duals plan offers $17,000 a year in benefits, and we can help people figure out if they are eligible for it.

I know Medicare can be complicated, and it’s our job at BCBSRI to make it easier. So bring us your questions and bring a loved one too. For me, our members are also family – I helped my mom and dad choose their BCBSRI Medicare Advantage plan.

Claudia Chiappa is a PBN staff writer. You may contact her at Chiappa@PBN.com.

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