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New Medicare handbook updates benefit information

Medicare has begun to mail 34 million copies of its new handbook to beneficiaries and the physicians who treat them. Called Medicare & You 2001, the guide was produced by the Centers for Medicare & Medicaid Services (CMS), formerly the Health Care Financing Administration (HCFA), the federal agency that administers Medicare.

The mass mailing started Sept. 15 and is part of Medicare's effort to help beneficiaries and their doctors understand health care options, whether through original Medicare or Medicare+Choice plans.

Didn't get a handbook?

If you don't receive a new handbook by Oct. 31, you can call the Medicare Choices Helpline at (800) 633-4227 and ask for one. Hearing-impaired individuals using a telephone device for the deaf can call (877) 486-2048. This toll-free number is staffed by English- and Spanish-speaking customer service representatives from 8 a.m. to 4:30 p.m.

Also available at Medicare's Web site, the handbook provides updated benefit information, including new services covered under both plans. Medicare now covers annual screenings for breast, colon, and prostrate cancer, and diabetes self-management training. The handbook is valid from Jan. 1, 2001 to Dec. 31, 2001.

PFFS plan explained

The new 73-page guide also details Medicare's first private fee-for-service plan (PFFS). A PFFS plan is a Medicare plan offered by a private health insurer, in contrast to the original Medicare plan, which is offered by the federal government. PFFS plans are a hybrid between Medicare HMOs and traditional Medicare fee-for-service plans. (For more information on the Medicare PFFS plan, see Sterling Life offers Medicare "hybrid".)

While the PFFS plan does not cover prescriptions — a benefit typically provided by Medicare HMOs — it has no network restrictions, and allows you to visit any Medicare-approved doctor or hospital of your choice.

This no-network option could be particularly important to beneficiaries who live in rural areas that historically have lacked private Medicare insurance options or are losing their Medicare+Choice HMO, according to CMS. Nearly one million beneficiaries nationwide must find new coverage beginning Jan. 1, 2001, when more than 100 health insurers drop their Medicare HMO plans. (See Medicare HMO withdrawals in 2000: A state-by-state list of pullouts.)

Although it is too early to predict the difficulty Medicare beneficiaries will have finding new coverage, a report published in 1999 by the Kaiser Family Foundation, a California philanthropy, shows that more than two-thirds of the 1999 "disenrollees" were able to join other Medicare HMOs. However, the study — called How Medicare Withdrawals Affect Beneficiary Benefits, Costs, and Continuity of Care— also revealed many of the beneficiaries who joined other Medicare HMOs experienced a decline in their supplemental benefits, an increase in premiums, and disruption of their medical care arrangements.

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