MEDICARE+CHOICE: Seniors Are In The Dark, AARP Says
Nearly a year after the Medicare+Choice program was passed by Congress as part of the Balanced Budget Act, the Department of Health and Human Services yesterday released the regulations detailing the standards health plans must meet to be part of the program (HHS release, 6/18). But an American Association of Retired Persons survey also released yesterday found that an astounding 89% of seniors "lack adequate knowledge to make an informed decision" about the myriad choices they will face regarding their health care coverage. The Washington Post reports that the study found that nearly one-third of Medicare beneficiaries knew "almost nothing" about HMOs, and half of those respondents were enrolled in such plans. In addition, just over half of all seniors "didn't understand the fundamental concepts behind HMOs or other managed care options." Just over half could identify the gatekeeper role of a primary care provider and 55% of beneficiaries understood the concept of a network. "We are in favor of greater choice," said AARP senior lobbyist Tricia Smith. "But it only works if you have informed consumers exercising leverage in the marketplace, and we are not there by a long shot," she said (Havemann, 6/19). CongressDaily/A.M. reports that 30% of the respondents in the AARP study "did not know enough to even complete the questionnaire" (Rovner, 6/19).
Knowledge Is Power
The AARP study comes at a time when federal officials are trying to find ways to inform consumers about their new choices under Medicare. The Medicare+Choice program, slated to begin in January 1999, will expand the Medicare program to include preferred provider organizations, provider-sponsored organizations, private fee-for-service plans and a medical savings account demonstration project. The Health Care Financing Administration is developing a national information campaign including a toll-free hotline, a patient handbook and a Website (HHS release, 6/18). Providing information to beneficiaries has been a concern of patient advocates since the Medicare+Choice program was introduced. Senate Special Committee on Aging Chair Chuck Grassley (R-IA) sent a "strongly worded letter" to HHS Secretary Donna Shalala yesterday detailing his concern that beneficiaries would not have adequate information to make decisions when the program starts next winter. "It's great that we've increased health care choices for seniors, but we have to give them the tools to choose," Grassley said. "Seniors need good, objective information about their health care options. They need to know about their rights and responsibilities. Glossy sales pamphlets from managed care plans just won't do the job" (Grassley release, 6/18). The Wall Street Journal reports that Grassley is concerned about a new HCFA plan to distribute detailed "information comparing plans" only in "specific markets," rather than to all beneficiaries as expected. The plan comparisons will be distributed to 5.5 million beneficiaries in Ohio, Florida, Arizona, Oregon and Washington. Beneficiaries in other areas will receive general information about their options. A Clinton administration spokesperson "said providing the detailed information to all beneficiaries this year had been an option but never an absolute plan." AARP's Smith said "the modest approach would allow the agency 'to go more slowly and to do it right, rather than to push ahead and add confusion'" (6/19).
The rule set yesterday by HHS -- dubbed by some as the "mega-reg" -- lays out financial and operational requirements for health plans that participate in Medicare+Choice and details consumer protection provisions set out in the balanced budget legislation, CongressDaily/A.M. reports. Included is a requirement "that health plans allow women direct access to [OB/GYNs] for routine and preventive care without having to get permission from 'gatekeeper' physicians." The regulation also requires plans to turn around appeals in 14 days, down from 60 days (6/19).