Nearly 1.7 million elderly and disabled
Americans have lost their Medicare+Choice plans in the last three years
and the trend is likely to continue as health insurers dump their most
unprofitable Medicare HMO plans. 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?
A Medicare lock-in provision took effect Jan. 1, 2002. Previously, the
Medicare program has allowed people to switch HMOs as often as once a
month, throughout the entire year. However, between Jan. 1, 2002, and
June 30, 2002, you can switch just once to another Medicare HMO or
return to traditional Medicare. After that, you are stuck with your
choice for the remainder of the year.
"We don't tell people what to do because each person has a different
situation," says Joyce Dubow, a senior public policy adviser with AARP.
"Seniors need to be well informed before they make a decision —
particularly now."
The regulations will become even tougher in 2003. Beginning in 2003,
you will only have the first three months of the year to make a change.
After March 31, 2003, you will have to stick with your choice for the
following nine months.
"The lock-in is certainly causing a lot of concern," says Dubow.
"People are very anxious about the instability in the [Medicare+Choice]
program."
So if you are still a Medicare HMO member, but you are concerned with your future health insurance options, you should know your available choices. Up until June 30, 2002, you can either:
- Return to original Medicare: This choice, often called
"traditional" or "fee-for-service" Medicare, helps pay for doctor and
hospital care. Original Medicare is always available.
If you choose this option, you can also buy Medicare supplemental insurance,
or Medigap. These are private insurance policies that you buy to
supplement traditional Medicare. Medigap offers expanded benefits and
coverage for out-of-pocket health expenses, depending on the kind of
policy chosen. However, the cost varies widely, as do the benefits. See
Medigap insurance: Filling in Medicare's gaps.
- Select another Medicare+Choice plan: These HMO
options offer a health care package that may include some benefits not
covered in traditional Medicare, such as a prescription drug benefit.
If there is another plan that is being offered in your area and it is
accepting new enrollees, you can choose to enroll.
Make sure you know what you are getting when you sign up for a plan. Do
a side-by-side comparison of the costs and benefits of each plan. Does
the plan provide prescription drug coverage? If it does, are there
limitations placed on them? Many insurers are raising their premiums
and/or cutting back on their prescription drug coverage. Some will only
pay for the generic versions of brand-name drugs. For help, use
Insure.com's Health plan comparison worksheet.
