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HMOs to drop 215,000 Medicare beneficiaries in 2003
By Insure.com
It's official: Slightly more than 215,000 elderly and disabled Americans will be dropped from their Medicare+Choice plans on Dec. 31, 2002, according to the Centers for Medicare and Medicaid Services (CMS), the agency that oversees the Medicare HMO program.
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For more information on the Medicare+Choice program and to see if your Medicare HMO is shutting down on Dec. 31, 2002, visit Medicare's Web site.
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Although far fewer beneficiaries are losing their coverage in 2002 than in previous years, the number is still significant. Since 1999, approximately 2.2 million Medicare beneficiaries have been dropped from their health plans by insurers who say they were forced to withdraw from the Medicare+Choice program due to inadequate government funding.
The biggest problem facing beneficiaries who are dropped from their managed care Medicare plans is that they may not have and can't afford Medicare supplemental coverage that would help them pay for prescription drugs. Even though they may return to original fee-for-service Medicare, original Medicare does not pay for prescription drugs.
This creates a difficult decision for Medicare HMO enrollees. Should they take a chance on a new HMO only to be dropped yet again, or go back to traditional Medicare without a prescription drug benefit?
Your choices
If you are a Medicare HMO member who is losing coverage, you should know your available health insurance choices. You can:
- Do nothing and stay in your Medicare HMO plan until Dec. 31, 2002. You will automatically be enrolled in traditional Medicare, starting Jan. 1, 2003. You may also purchase a Medigap policy to help pay for some of the costs Medicare doesn't cover.
- Leave your Medicare HMO and change to the traditional Medicare plan anytime before Dec. 31, 2002. To leave your plan, you can send a disenrollment form or letter to your Medicare+Choice plan or call (800) 633-4227 and tell them that you want to disenroll from your plan. You can leave your Medicare+Choice plan any time on or after Oct. 1, 2002, and before the date you want the original Medicare plan coverage to start. You can choose for your original Medicare plan to start Nov. 1, 2002, Dec. 1, 2002, or Jan. 1, 2003. However, you must ask your Medicare+Choice plan to disenroll you before you want your original Medicare plan coverage to start. You may also want to buy a Medigap policy to help pay for some of the costs Medicare does not cover.
- Join another Medicare HMO health plan, if one is available in your area, any time before Dec. 31, 2002. You can join another plan by giving the new Medicare health plan a completed enrollment form before you want your new coverage to begin. You do not need to tell your old plan or send them anything — you will be disenrolled automatically from your old plan when your new plan coverage begins. You can select coverage in the new plan to begin on Nov. 1, 2002, Dec. 1, 2002, or Jan. 1, 2003, as long as the new Medicare health plan receives your enrollment form before the date you want your coverage to start. You should get a letter from your new plan telling you when your coverage starts.
PPO plans
In an effort to beef up the Medicare HMO program, Medicare is offering new preferred provider organization (PPO) health insurance plans as an alternative to traditional Medicare and Medicare HMOs. The PPO plans — that offer prescription drug coverage and greater access to out-of-network providers — are part of Medicare's demonstration project to determine whether Medicare HMOs will prove as popular as PPOs for consumers under age 65.
Medicare beneficiaries will be able to enroll in the new PPO option on Nov. 1, 2002. The PPO plans, which go into effect on Jan. 1, 2003, will be available to more than 11 million beneficiaries in parts or all of 23 states: Alabama, Arizona, California, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Missouri, North Carolina, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Virginia, West Virginia, and Washington.
Last updated Oct. 17, 2002
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