MEDICARE HMOS: Clinton Plan No Boon for CA Enrollees
Californians enrolled in Medicare HMOs already have more substantial prescription drug benefits than those touted by President Clinton in his Medicare reform proposal, the Los Angeles Times reports. Nearly 40% of all Medicare beneficiaries in the state are enrolled in HMOs, and a new study by the California Medicare Project, a new arm of the California HealthCare Foundation, found that "the Clinton plan would do nothing to help 98% of them." Most Medicare HMOs in California offer more generous benefits and charge lower co-pays than would Clinton's plan. For example, PacifiCare's Secure Horizons HMO offers members unlimited spending on drugs, with a $5 to $10 co-pay. By contrast, Clinton's proposal would offset 50% of the cost of seniors' drugs, with maximum outlays of $2,000 a year in 2002, climbing to $5,000 by 2008. Members would pay $24 each month in 2002, increasing to $44 monthly by 2008. Although PacifiCare officials say that consumers will see their co-pays increase as drug prices skyrocket, customers "will still be far better off" than they would under Clinton's plan. At the same time, however, California HMOs echo the complaints of HMOs nationwide that say low federal reimbursements are threatening their ability to offer enriched benefits. Next week, the Times reports, HMOs are expected to announce they are raising their co-pays and limiting drug spending for Medicare subscribers. "Everybody is profoundly worried about the rise in the price of prescription drugs," said Dr. Mark Smith, president of the California HealthCare Foundation. "Health plans and doctors and purchasers are all worried. They don't know where this is going, and they don't have any confidence (that) they know how to control these costs" (Rosenblatt, 9/8).
Filling in the Gaps
California Medicare Project, unveiled today, will educate seniors, policymakers, health professionals and the media about changes and proposals regarding Medicare. The Project today released the first in a series of "Medicare Snapshots," which will provide county-by-county statistics that look at how Medicare changes affect consumers. According to the survey, conducted by the Field Institute for the California HealthCare Foundation, 60% of Medicare enrollees in the state said they "feel confused" about changes in the health care system; 39% reported being "overwhelmed" and 26% reported understanding "none or little of what they need to know" about Medicare. Forty-three percent of the 755 respondents were unable to provide the correct answer to four of seven questions about Medicare. Many of the respondents were unsure where to find quality information on Medicare, as only 15% said they were aware that Medicare offers information comparing competing Medicare HMOs; 57% said they were aware of the toll-free 800 number for such information. Even when seniors get their hands on some form of Medicare information, 33% say the information is "helpful," 41% say it is "somewhat helpful," and 14% say it is not helpful. Only 26% of respondents were aware of recent changes to Medicare. "With so many changes being made and proposed for the Medicare program, it is difficult for seniors and others to stay informed about it," said Jack Christy, director of the California Medicare Project.
In its "snapshot," the Medicare Project reports that about 13,000 Californians -- fewer than 1% of the 1.5 million California Medicare beneficiaries enrolled in HMOs -- are affected by HMOs that will drop their Medicare plans this January. Seven HMOs have withdrawn entirely or have scaled back in 12 counties, but the moves only leave about 1,524 enrollees who live in Calaveras and Tuolumne counties with no other managed care plan in their county. "Although media reports on Medicare sometimes give the impression that the 'sky is falling,' our 'snapshots' show that it isn't falling in California," Christy said (California HealthCare Foundation release, 9/8).