Groups plan talk on HMO worries

Health maintenance organizations are pulling out of the county, leaving many elderly residents worried about coverage.

By SAUNDRA AMRHEIN

© St. Petersburg Times, published July 12, 2000

The phone calls are steady and desperate. The callers are tearful.

To calm the panic they are hearing on the other end of the phone, two agencies for the elderly have scheduled a town hall meeting to address the issues surrounding the withdrawal of Medicare HMOs from Hernando County.

Mid-Florida Area Agency on Aging is joining the state's Department of Elder Affairs' SHINE Program to hold the meeting at 2 p.m. Friday at the Enrichment Center in Spring Hill after a week of anxiety-ridden phone calls to their offices from area seniors.

A representative from SHINE, or Serving Health Insurance Needs of Elders, will discuss options and answer questions at the meeting, at 1244 Mariner Blvd., said Jennifer Glymph, coordinator of outreach and wellness programs for Mid-Florida.

Several counselors also will be available for individual consultations for customers who will lose their Medicare HMO coverage at the end of the year.

"We're going to be there basically to try to deter the panic we're seeing," Glymph said. "The phone has been ringing off the hook. Most of the people are crying."

Both AvMed Health Plan and Humana announced within the past month that they will pull their Medicare HMOs out of Hernando County by the end of the year in the face of declining federal reimbursement rates for their services and a lack of competition from doctors and hospitals in securing better prices.

Medicare HMOs offer a laundry list of benefits not covered by traditional Medicare, the most important one for seniors being prescription drugs. Without any companies left to offer such plans, retired residents are facing a tower of medical bills.

"I'm on a lot of medication for high blood pressure," said Mary Elizabeth Koogler of Spring Hill on Tuesday afternoon after speaking before the County Commission earlier in the day about the dilemma facing many seniors like herself. She had been enrolled with AvMed, and then Humana.

"I'm sure they've spent billions on me," she said.

But Koogler says she has no idea how she's going to afford her monthly doctor bills and prescription drugs without a Medicare HMO.

After Koogler's comments, the County Commission agreed to send a request to the Hernando County Health Care Advisory Board to investigate alternatives to Medicare HMOs. The commission also agreed to send a letter to doctors in the county urging them to participate in the state's Indigent Drug Program.

The Florida Department of Elder Affairs is urging seniors to sit tight and not take action right now, because the HMOs are required to continue their services until Dec. 31. However, the department is urging seniors to explore their options on Medicare supplemental policies, known as Medigap.

Customers who do not choose a Medigap plan by Jan. 1 will be rolled over into traditional Medicare. Medigap insurers cannot exclude customers of withdrawing HMOs because of pre-existing conditions during two crucial periods: the first is 63 days after the final notification letter from the HMO, which should be dated Oct. 2; the second is 63 days from the date the HMO coverage ends, which is Dec. 31.

But like traditional Medicare, Medigap plans do not cover prescription drugs.

All those affected by a Medicare HMO withdrawal will get an information package mailed to them Oct. 2 from their plan, explaining rights and options. The Department of Elder Affairs says seniors should delay action on Medigap programs until they receive their final notification Oct. 2.

To contact SHINE, call the Elder Helpline at (800) 963-5337.

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