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Medicare HMO withdrawals: what happens to beneficiaries?

More than 400,000 Medicare beneficiaries had to seek other insurance arrangements when their health maintenance organization (HMO) withdrew from Medicare at the end of 1998. According to a new survey of 1,830 involuntarily disenrolled Medicare beneficiaries, two-thirds subsequently enrolled in another Medicare HMO; one-third experienced a decline in benefits, and 39 percent reported higher monthly premiums. One in seven lost prescription drug coverage; about one in five had to switch to a new primary care doctor or specialist. Those with traditional Medicare by itself or with Medigap, the disabled under age sixty-five, the oldest old, and the near-poor experienced the greatest hardship after their HMO withdrew.

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Health care financing among the elderly: who really pays the bills?

This paper investigates the issue of who pays the health care bills of the elderly by considering the types of subsidized health insurance protection enjoyed by the noninstitutionalized elderly and the way that increased Medicare cost-sharing efforts in the 1980s are affecting those without additional health insurance subsidies. In making this examination we estimate the out-of-pocket health care expenditures of the elderly either directly or as nonsubsidized medigap premiums by income level, taking into account four types of health insurance subsidies received by elderly persons: Medicare, Medicaid, Veterans Administration health care, and subsidized health insurance from either current or former employers. We find that increased cost sharing is likely to fall most heavily on those elderly least likely to afford it: the poor and near-poor elderly who have only Medicare as a health insurance subsidy, particularly those who are older and sicker and who use Medicare services more heavily. These persons are caught between well-intentioned federal cost-cutting efforts and the often confusing panoply of health insurance programs for the aged, and they will bear an inequitably large portion of any future Medicare cost-sharing initiatives.

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Medicare or 'medigap'? Dilemma for the elderly.

Many elderly people on Medicare turn to supplementary insurance to close the gaps in their health care coverage, only to find the bureaucratic demands of the Medicare system and insurance suppliers overwhelming. This report documents how older people often fail to obtain payments to which they are entitled and discusses the problems in paying for health care that volunteer counselors discovered among the elderly of northern California.

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Government and private insurance medical programs as well as MDVIP, an update.

On November 19,1945, President Truman outlined a Prepaid Medical Insurance Plan for all people through the Social Security System. Because of its comprehensive nature, it was coined "National Health Insurance." On July 30,1965, President Johnson signed the Medicare and Medicaid bill (Title XVII and Title XIX of the Social Security Act). Today, many groups of people are covered by Medicaid. However, there are strict requirements that may vary from state to state. Medicare offers the following types of medical heath care plans to include the original Medicare plan that is a "fee for service" plan. The individual may stay in the original plan unless he/she chooses to join a Medicare+ Choice Plan or a Medigap Plan. Most individuals will receive Medicare Part A when they are 65 without paying a premium because it has been deducted annually through their tax payments before the age of 65. Medicare Part A helps pay for the following: inpatient hospital care, skilled nursing facility, hospice care, and some home health care. Medicare Part B, however, must be paid by the individual through premiums to the Federal government. Medicare Part B medical insurance pays for doctors' services, outpatient services, and some other services that Medicare Part A doesn't cover. In an effort to supplement one's health care coverage, the individual may select either a Medicare+ Choice Plan or a Medigap Policy. The Medicare+ Choice Plan has four different types: Medicare Managed Care Plans, Medicare Private Fee for Service Plan, Medicare Preferred Provider Plans, and Medicare Specialty Plans. If one selects a Medigap policy, one may choose either a Medigap SELECT Policy or the standard Medigap policy. The front of a Medigap Policy must clearly identify it as a "Medicare Supplement Insurance." One must be carefully advised of the selection of the Medigap Policy. The Medicare Part B has a wide range of preventative services, including tests for breast cancer, cervical cancer, vaginal cancer, and colorectal cancer; bone mass measurements; diabetes monitoring and diabetes self-management; flu, pneumonia, Hepatitis B shots, and prostate cancer screening tests. It is important to emphasize that Medicare and Medicare supplemental insurance policies do not pay for home health care, such as durable medical equipment. Because of the enormous complexity of the wide variety of health insurance plans and their billing strategies, many physicians are electing to charge their patients an additional fee for being part of their practice. In return for their annual fee, their patients receive immediate cell phone access to their doctor 24 hours a day, 7 days a week. In addition, they receive same-day appointments and on-time appointments. They also spend as much time with their doctors as they wish. It is not surprising that there is growing evidence that the privately insured patient with a life-threatening illness will live longer than those individuals who have the same disease but have public insurance only. Legislatures are well aware of this crisis in medical care that must be corrected immediately.

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Helping Medicare beneficiaries choose health insurance: the illness episode approach.

Lacking objective, comprehensible information about health care coverage options, Medicare beneficiaries rarely understand the consequences of alternative purchasing decisions. We describe the Illness Episode Approach, a method providing information on Medicare itself, Medigap policies, and HMOs. The method presents calculations of seniors' out-of-pocket costs under different insurance options for 13 common illnesses.

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An economic assessment of health care coverage for the elderly.

The current array of public and private health care coverages for the elderly is so complex and confusing that consumers are unable to make effective choices. The recent "medigap market" still further confounds the operation of "economic efficiency" in competitive insurance markets; consumers are uninformed about the extent and value of their basic coverage and even more so about the vulnerabilities against which supplementary insurance is purchased. This structural impediment to effectiveness and efficiency is most critical for long-term nursing care. Future changes in public programs must recognize that comprehensive benefits must also be made comprehensible.

Acute Disease↗

Medicare HMOs: part of the solution or part of the problem in the struggle for cost containment?

The correct answer for salvage of the Medicare program while maintaining acceptable medical care is clearly not available today. Managed care programs for seniors have been an option in the last decade and plans are expanding rapidly into previously untapped areas. Some programs can indeed provide a multiplicity of services and thereby truly integrate and improve existing care plans. Others have less clear cut advantages. For any senior contemplating the options available for medical care under Medicare, HMOs and Medigap type instruments, the most salient advice is "buyer beware." A complete understanding of the options gained and lost by changing medical insurance coverage is essential.

Cost Control↗