Dumped by Medicare -- now what?

Medicare Plan A? What about Plan B? And what does M+

By RANDOLPH FILLMORE
© St. Petersburg Times
published March 25, 2003

If you were one of the thousands in Florida who lost some medical coverage when your Medicare HMOs ducked out of the government's Medicare+

Choice (M+C) program as of Jan. 1, you are not alone.

According to Deane Beebe of the Medicare Rights Center, 25,000 more people were dropped by their Medicare HMOs at the beginning of the year.

"Florida has proven particularly unprofitable for Medicare HMOs," Beebe says. "The HMOs got into the Medicare market, but were surprised when old people started getting sick."

The federal government's Centers for Medicare and Medicaid Services (previously the Health Care Finance Administration, or HCFA) says Florida ranks fourth in the nation for the highest number of Medicare beneficiaries dumped by their HMOs in 2003.

This seems to be a trend. According to a December 2002 report from Weiss Rating Inc., national Medicare HMO enrollment has declined from 6-million to 5-million since 1998. And in Florida, the number of HMOs participating in the Medicare+ Choice program in Florida has been cut in half since 1997.

The 1997 Balanced Budget Act laid the groundwork for the Medicare+

Choice program, which gave those on Medicare the right to augment their coverage by signing up with an HMO.

M+C was confusing in 1997, and it remains full of pitfalls. For example, if a senior was dropped by his or her HMO as of Jan. 1 and did not select another HMO during the 63-day open enrollment period that ended March 4 but did sign up later, the new HMO does not have to cover pre-existing conditions. By law, a new HMO selected during the open enrollment period must cover those same pre-existing conditions. Not so if you missed the enrollment period. Thus, an uninformed senior easily could miss significant coverage.

Unfortunately, the Medicare HMO quagmire is not likely to clear up soon, and, with President Bush proposing changes, it may become more difficult for seniors to keep track of shifts in policies.

With that in mind, here are some basics about Medicare HMOs.

How do you go about finding another Medicare HMO?

Charles Inlander, president of The People's Medical Society, a nonprofit advocacy group, suggests first finding out which plans service your geographical area.

"You can go to Medicare's Web site, www.medicare.gov, and find out which plans are available in your county," says Inlander. (Another Web site to consider is www.medicarerights.org.) But let the buyer beware. Being dumped by an HMO is not the only cause for concern. Cutbacks in selected services, such as vision care, are frequent and unannounced. By law, plans must announce in September if they are going to drop subscribers as of Jan. 1 of the next year, but they do not have to announce cutbacks in services ahead of time.

"Plans may have a certain benefit aimed at luring subscribers, but they may drop some aspects -- such as drug benefit plans or vision plans -- with no notice," Inlander warns.

Inlander, who says he likes the Medicare HMOs, also offers a special caution for snowbirds: The Medicare HMO coverage you bought from a company in another state may not cover you while you are in Florida.

When can you sign up for a Medicare HMO and how do you pay?

You can sign up for a Medicare HMO three months before you turn 65 until three months after your 65th birthday. All Medicare+

Choice programs have open enrollment from Nov. 1 to Nov. 30. HMO plans must agree to stay in Medicare from Jan. 1 to Dec. 31. But they can announce Sept. 1 if they are going to drop out of the government program as of the next Jan. 1. If you have been dumped by your HMO, the enrollment period for a new one varies from state to state. Know that all HMOs take a standard fee of $58.70 from your Social Security check to pay for your coverage, but some may require an additional fee.

Do you need a Medicare HMO?

Maybe not.

With HMOs dropping out of Medicare, many seniors have washed their hands of them. According to retired nurse Mickey Lentz, seniors now may opt to sign up for Medicare Part B. While Medicare Part A (often called "original Medicare") covers hospitalization, Part B pays doctor bills, outpatient tests and some outpatient treatments.

"If you opt to join a Medicare HMO, you sign over a standard amount -- $58.70 a month -- from your Social Security to the HMO," Lentz says. "And you allow the HMO to decide when you should see a specialist and what treatment you should receive. I signed up for Part B and let them keep the $58.70 because I prefer to continue going to my own doctor, not the HMO's."

Medicare Part B covers some pretty important and expensive tests and preventive services, including colo-rectal cancer screening, mammograms, bone mass measurements, glaucoma screening, prostate cancer screening and flu and Hepatitis B shots.

Which Medicare HMOs are best?

A list of Medicare HMOs in Florida is available from the National Medicare Hotline (call toll-free 1-800-633-4227) or online at www.medicare.gov. You should also consider Choosing a Quality Healthplan; Florida HMO Report 2002, published by The State of Florida's Agency for Health Care Administration (AHCA). It's available several ways, including online at www.myflorida.com and www.floridahealthstat.com.

The report, compiled by the University of Florida's Bureau of Economic and Business Research, includes an HMO member satisfaction survey, quality of care indicators (particularly for cancer and diabetes screening) and a summary of member complaints.

According to the survey, almost 5-million Florida Medicare recipients are also covered by an HMO. The plans in Florida with the most members are Health Options Inc., Humana Medical Plan and United Healthcare of Florida.

Capital Group Health Services of Florida Inc., Florida Healthcare Plan Inc., Neighborhood Health Partnership Inc., United Healthcare of Florida,and Preferred Medical Plan Inc. rated highest in overall satisfaction on the 2002 survey.

But note that each of these plans has some shortcomings, according to members surveyed. Some mentioned difficulty in getting referrals, dissatisfaction about how the plan communicates with subscribers and lack of screening and diagnostic services.

Beebe, of the Medicare Rights Center, cautions that many HMOs may have steep co-pays for some services, such as therapies, and not all HMOs provide prescription drug benefits. Further more, Medicare HMO plans are not available in all Florida counties, especially rural areas.

When retired Tampa businessman Henry Sung moved from Hillsborough County to Marion County, he lost his HMO coverage. When he sought coverage with another company, he was denied. Sung didn't know he had to officially stop coverage by his former HMO before seeking other coverage.

"It's been very disappointing," says Sung, who also lost his Medicare coverage during his move. He has since been reinstated on Medicare, but he is about to file a complaint in Tallahassee.

"It's very unfair to seniors moving from one place to another. So let my experience serve as a warning to others. Fortunately, I didn't get sick during this time." As Sung's fiasco shows, those covered by Medicare would do well to keep tabs on every proposed change.

-- Randolph Fillmore is a freelance writer who lives in Tampa.

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