MEDICARE+CHOICE: Advocates Say Bulletin Confuses Seniors
As mailings describing the new Medicare+Choice options land in the mailboxes of seniors across the country, Wisconsin legislators and senior citizen advocates are cautioning that the literature may be confusing and misleading. Among their primary gripes: the letter describes plans that are not available in many Wisconsin counties, and doesn't clearly state that seniors who choose the new options must give up their current Medicare coverage -- and may not be able to get it back. Medicare HMOs are currently available in only eight Wisconsin counties. The Milwaukee Journal Sentinel reports that the advice of many state officials and senior advocates is, "If in doubt, throw it out." U.S. Rep. Tom Barrett (D-WI), who plans to introduce legislation banning cold calls from HMOs to seniors, said, "I'm concerned that older people will feel pressured to change plans. My strong message remains the same, 'If you don't want to change, don't.'" Guenther Ruch of the state insurance commissioner's office said, "The last thing we want is for our senior citizens to panic and say, 'Medicare is making us do this or do that.' If people are happy with the Medicare coverage they have, they should keep it. They should make any decision to change very carefully." At a meeting at a Wisconsin senior center, Legal Action of Wisconsin's Laura Neuman, "wav[ing] the bulletin in the air," said, "If you get this letter, feel free to burn it or to bury it or to use it to train your puppy dog -- and not a darn thing will happen to you." The percentage of Wisconsin Medicare beneficiaries enrolled in HMOs has grown from 4% last December to 5.3% last month (Huston, 11/8).
Picking Up The Slack
Aggressive marketing and a decrease in competition have led to an "unprecedented" number of seniors in the Chicago area enrolling in Humana Inc.'s and Aetna US Healthcare Corp.'s Medicare HMO plans. The Chicago Tribune reported Saturday that the two companies "are seeing major suburban pickups where United HealthCare Corp. is departing." Humana reports that an "average sales month in the Chicago area is about 1,800 (Medicare customers) a month, and this month it's 3,000 and we're anticipating the same or more next month," according to spokesperson Valerie Kennedy. The demand for Medicare HMOs is perceived as so large that two other Chicago-area plans, Accord Health Plan and American Health Care Providers, are entering the Medicare market this year. Vector Securities International's Dave Shove warned that companies that recruit aggressively in areas like suburban Chicago where reimbursements are relatively low may pay the price later on. He said, "If the government doesn't fix [the reimbursement rate schedule], these other companies will be going through what United did at this time last year. Either Humana and Aetna are making a mistake, or they have better contracts with providers (of medical care). If reimbursement isn't enough, they still have to make it work" (Japsen, 11/7).
The Orlando Sentinel reports that it is no mystery why Florida's Polk County will become the only county in the state without at least one Medicare HMO plan: Polk's reimbursement rate of $398 per month is by far the lowest in Florida, nearly half the amount paid to plans in Miami-Dade County (Pack, 11/7).
An editorial in the Hartford Courant charges that Connecticut's largest HMO, Physicians Health Services, isn't helping its credibility -- damaged by its pullout from the Medicare HMO market in two counties -- by "requir[ing] doctors to justify prescriptions for certain drugs over the 30-day supply the HMO deems therapeutic." The editorial argues, "requiring all physicians to justify dosages routinely adds yet another onerous layer of bureaucracy and costs to an unwieldy system. ... Careful monitoring is needed to prevent HMOs from luring consumers with promises they can't keep and then compromising care to prevent red ink" (11/9).