MEDICARE+CHOICE: Seniors Caught In Confusion
Many seniors who are losing coverage because their Medicare HMO is pulling out of their area are finding costs for equivalent Medigap coverage prohibitively high and the rules about what kinds of coverage they may be eligible for confusing. In addition, the New York Times reports that "the Clinton administration and the health insurance industry disagree over the rights and protections available to such Medicare beneficiaries," with federal officials acknowledging "that their interpretation of the Medicare law would not necessarily be accepted by all the companies that sell ... Medigap insurance." Not only are many of these companies unfamiliar with new federal laws regarding the sale of such insurance, but "some ... contend that they do not have to comply with the federal insurance standards until states adopt laws and regulations to carry them out." In addition, many seniors who have lost HMO coverage haven't received any word from the government about their predicament. Elyse Politi, the Medicare managed care ombudsman for northern Virginia, said, "The biggest concern for consumers here is that they haven't received any official notices from the Health Care Financing Administration or from the HMOs about what their options will be."
Fill The Gap
The Clinton administration is telling Medicare beneficiaries that certain designated Medigap policies -- specifically A, B, C and F -- must be made available to all those losing their coverage "in the first 63 days of 1999." However, none of these policies provide prescription drug coverage, a highly desirable benefit that lured many seniors into HMOs. Bonnie Burns of California's insurance counseling program, "said Medicare beneficiaries faced a grim paradox: If you have a health condition that causes you to use prescription drugs, it's unlikely that a Medigap insurance company will sell you a new policy covering prescription drugs."
Just Who's Eligible
In addition, the Clinton administration contends that sellers of Medigap insurance may not discriminate against seniors or disabled enrollees "because of ... health status, claims experience, receipt of health care or medical condition." But Chip Kahn, COO of the Health Insurance Association of America, "strenuously disagreed," contending that those conditions apply to the elderly, but not to the disabled. Kahn said, "The Clinton administration is trying to set health policy by administrative fiat. ... Disabled people who choose to buy Medigap policies are likely to have higher health costs than the average senior covered by Medicare and Medigap. Requiring insurance companies to sell Medigap policies to the disabled, at standard rates regardless of their claims experience, will lead inevitably to higher Medigap premiums for the elderly" (Pear, 10/19).
The Arizona Daily Star reports that the changing Medicare HMO landscape is hitting the state's rural beneficiaries particularly hard, with some plans withdrawing in rural areas and those that remain charging more to compensate for lower federal reimbursements. Intergroup's Senior Care has decided to persevere in several rural Arizona counties, but it has instituted new costs that will mean rural members will pay more than their urban counterparts -- $750 more in hospital deductibles, $5 more for physician visit copays and $7 more for prescription drug copays. Some seniors charge the federal government with discriminating against rural residents. Rose Marie Jones, 70, of San Manuel said, "Why should I be worth less, just because I want to live in the country where it's quiet?" Local officials are "urging seniors to contact their state and federal legislators," but Stewart Grable of the Pima Council on Aging warns it may not do much good. He said, "[U]nder the system we've set up, health care is a business. The fact that it pushes people from rural to urban areas, the fact that it means poor people go without their medication, it's a no-brainer. If you set up the health care system on a profit motive, where there is no profit, the system fails" (Erikson, 10/18).