Sunday, July 16, 2000

HMOs: Learning your options




By Tim Bonfield
The Cincinnati Enquirer

        Medicare has produced a 12-page Question and Answer document for seniors who have been dropped by a Medicare HMO. It's available on the Internet at www.medicare.gov/choices/qa.asp.

        Questions also can be answered by calling a toll-free hotline, 1-800-MEDICARE. By Oct. 2, Medicare HMOs pulling out of local markets are required to send letters to enrollees explaining their rights and spelling out options.

        Several senior agencies and HMO executives urge affected seniors to wait at least until October before attempting to re-arrange coverage. Among options:

        Medicare: This government program is automatically offered to all people age 65 and up, as well as many people with disabilities. Basically, the plan covers 80 percent of hospital and doctor bills but no prescription drug costs. Enrollees must pay $45.50 a month for Medicare Part B coverage for doctor care, along with a variety of other deductibles and co-payments.

        For information, call the Ohio Department of Insurance, 800-686-1578, or the Ohio Department of Aging's Elder Rights Unit, 800-282-1206.

        Medicare supplemental plans: Most seniors have been buying these private insurance plans for years to pay expenses that Medicare doesn't cover.

        Med-sup plans are sold in 10 standard forms by many companies. Prices vary widely. Only the three most expensive plans offer prescription drug coverage.

        For phone numbers and rates on Med-sup plans, the Ohio Department of Insurance publishes a “Shopper's Guide to Medicare Supplement Insurance.” To get a copy, call 800-686-1578.

        Medicare HMOs: For monthly fees that ranged this year from $0 to $39, private health maintenance organizations provide all the benefits of Medicare plus some drug costs and other benefits. In return, seniors agree to seek care from a limited set of doctors and hospitals.

        With three HMOs leaving Greater Cincinnati at year's end, two will remain: Anthem's Senior Advantage and United's Medicare Complete. By law, the plans must offer open enrollment in October, November and December.

        Both say they can handle accepting many new members. However, United will not be available in Northern Kentucky, and neither has set rates and benefits for 2001.

        To reach Anthem, call its sales center at 800-467-8065. To reach United, call 800-504-4848.

        Medicaid: This government program covers health care for low-income Americans under age 65. But some Medicaid programs also help pay for some expenses not covered by Medicare for older Americans.

        Significant coverage is available for individuals earning less than $716 a month or couples earning less than $958 a month. Some Medicaid assistance is available for seniors earning up to $1,238 a month as individuals, or $1,661 as a couple.

        For information, call a Medicaid hotline at 1-800-324-8680 or your local county department of human services.

        Other sources for advice or services: The Council on Aging of Southwestern Ohio, 345-8643; Working in Neighborhoods Senior Action Coalition, 541-4109; Pro Seniors, 345-4160.

Dropped by HMOs, seniors left in the lurch
- HMOs: Learning your options



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