[MOL] Making sense of medicare's new choices..... [00286] Medicine On Line

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[MOL] Making sense of medicare's new choices.....

October 22, 1999
Making Sense of Medicare’s New Choices
About Jan Greene | Patients' Rights Archive

Q: I just got a booklet in the mail from Medicare that talks about changes in the program. Does this mean I have to change health plans or re-enroll?

A: Not to worry. The new materials you’re getting (along with 32 million other elderly or disabled Americans) are meant to make the system less confusing. The booklet itself shouldn’t prompt you to make any changes, unless you read it and realize you’d rather be in a different type of health plan.

      The people who run Medicare, a federal agency known as the Health Care Financing Administration (HCFA), have found to their dismay that despite years of indoctrination, Medicare recipients still don't have a firm grasp on what managed care really means, or how to decide whether to join an HMO. So they've put out this booklet (Medicare & You 2000), beefed up their Web site and set up a toll-free phone number (800-633-4227) to help everyone get up to speed. The booklets were supposed to be mailed in September and October. If you didn't get one, call the toll-free number or download the booklet in PDF form from the Web site (it's about 60 pages long).
      One reason for all the hullabaloo is that a recent law allowed Medicare to offer a lot more different types of health plans to the public, with the idea that the elderly who depend on the program for their medical care should have all the same options that working people or others in the open marketplace have. So, for instance, instead of simply choosing between original Medicare (fee-for-service) and Medicare managed care (HMO), you could pick a preferred-provider organization (PPO) that falls somewhere in the middle. The new plan is called Medicare+Choice. Or you could go completely on your own and set up a medical savings account (MSA).
      For those of you whose eyes are already glazing over at the this bounty of bureaucracy, relax. Reality does not always follow where legislators try to lead it. Your choices are still essentially the same: regular Medicare or an HMO. No insurance companies have yet stepped forward to offer an MSA under Medicare, and the other new options have been similarly ignored by the marketplace.
      That's not to say there hasn't been change over the past year or two in Medicare HMOs. In fact, managed care companies have been busily shutting down plans in unprofitable areas, forcing 320,000 beneficiaries to change plans this year; about 80,000 of them, though, will have no other HMO option and must return to original Medicare. If you're one of those unlucky folks, be sure to maintain your coverage through the end of the year to keep an important guarantee that you can sign up for Medigap coverage, if you choose.
      For the rest of you — 39 million Medicare beneficiaries, six million of whom are in HMOs — keep in mind one other change that the new booklet will explain. For the first time this year, there will be a guaranteed open-enrollment period for Medicare HMOs during November. Many health plans allow you to join at any time of the year, but some don't. For those that limit sign-up periods, the law now requires that there be a November open-enrollment period. Here's what this boils down to:

  • If you're happy with your health plan, don't do anything.
  • If you've been thinking about changing HMOs or joining one for the first time, here's your chance.
      How to make this decision? Fortunately, Medicare is a public program that requires some disclosure by plans that participate. A useful resource is the Medicare Compare feature on the organization's Web site. It allows you to choose a location and compare the attributes of different HMOs. Keep in mind that it mostly lists the basics, so if you have some particular ongoing need, such as a brand-name medication or supply, try calling the health plans directly and asking whether they cover it. And while you can compare health plans by cost and basic coverage, it's hard to know how they'll act when push comes to shove and you're in the hospital for a hernia operation and wondering how long you'll get to stay. Try talking to friends who have real-life experience with Medicare HMOs in your area. Recommendations can be quite valuable.
      If you tend to scoff at all this talk of being an informed consumer, consider the results of a recent study sponsored by the Kaiser Family Foundation that found big differences among Medicare HMOs, the kind of differences you'd know about only if you did your homework. In Cook County, Ill., for instance, you could pay a premium of $63 per month or no premium at all, depending on which plan you chose. Prescription drug coverage also varies widely: Some basic plans don't cover medications at all, some place a yearly limit of $1,000 or $2,000 on them, and others will pay unlimited drug benefits.
      The moral of the story: It pays to shop around. And read the Medicare & You 2000 handbook when it comes in the mail. At least you'll be caught up on your homework before the next round of changes hits the health care system.

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