MEDICARE HMOs: HCFA Moves To Assist Seniors

      The federal government moved Friday "to clarify the rights of hundreds of thousands of elderly Medicare beneficiaries being dropped from" HMOs, the New York Times reports. The action comes in response to announcements by HMOs in 30 states that they plan to drop coverage for Medicare enrollees on Jan. 1, leaving their customers to find another HMO that will cover them or "enroll in the original Medicare program." Federal officials originally planned to take no action, but after being "deluged with complaints, President Clinton said Medicare officials must help 'seniors who have been so shaken' by the withdrawal of HMOs from the program." Nancy-Ann Min DeParle, head of the Health Care Financing Administration, said Medicare enrollees who are dropped from their HMO must be offered coverage through at least four of the 10 standard Medigap policies. The policies provide basic medical care, but do not cover prescription drugs. Companies that ignore this requirement will be fined $5,000 for each instance.

Only Half The Story
      The Clinton administration also announced that, contrary to an earlier announcement, insurers will not be required to extend the same coverage requirements "to people under 65 who qualify for Medicare because of disabilities," unless the enrolles had qualified for such coverage in the past. Last month, HCFA said disabled Medicare recipients would be guaranteed access to Medigap plans labeled A, B, C or F. Bonnie Burns, director of communications at California's statewide insurance counseling program, called the decision to exempt the disabled a "tragic error." Diane Archer, executive director of the Medicare Rights Center, voiced a similar criticism: "The Balanced Budget Act of 1997 protects people with disabilities whose HMOs are pulling out of Medicare. It guarantees them the right to buy Medigap insurance. But the government's narrow reading of the law undermines this right and may leave people with disabilities without adequate health care coverage." Chip Kahn, COO of the Health Insurance Association of America, argued that Congress "never intended" to ensure Medigap coverage for the disabled. He said, "We are glad the administration reconsidered its position and now has the same interpretation of the law that we do." The Times notes that insurers "had threatened to sue the government if it pressed this reading of the law." DeParle opted to put the disabled coverage burden on the states, saying, "We encourage states to find ways to help these beneficiaries." About 18 states currently mandate access for the disabled (Pear, 10/24).

Chicago Fire Sale
      The Chicago Sun-Times reports that the state's Senior Health Insurance Program hotline has been inundated by telephone calls from angry seniors. Most callers belong to United HealthCare's Medicare Complete HMO, which is pulling out of five suburban Chicago counties. Kathy Claunch, director of the Illinois Insurance Department's insurance program for seniors, said, "It's frustrating to them. They do not know all the (Medicare) rules" (Ritter, 10/26).