|Making Sense of Medicare’s New Choices|
Greene | Patients'
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
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).
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.
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
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:
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
- 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.
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
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.