Hassle-Free Health Coverage: Medicare HMO's

Due to the increasing costs of Medicare Supplement policies, many seniors are switching to managed care plans. In 1998, the federal government estimated that some 70,000 Medicare recipients a month were switching to some form of managed care. At that point, of the 38 million seniors and disabled eligible for Medicare, almost 6 million were enrolled in a Medicare HMO.

Medicare HMOs combine the benefits of Medicare and Medigap policies all in one. However, some participants have complained about the non-responsiveness that the plans share with other managed care programs.

The federal government funds most of the revenue for each participating HMO, which makes the cost to you about the same as the premium you would normally pay for Medicare Part B ($43.80/ month for 1997), depending on the HMO. (However, that may be changing soon, with rising costs and increased claims, companies are beginning to charge premiums in addition to the government's funding.)

Items such as eyeglasses and prescription drugs are covered under most HMOs. As long as you have Medicare Part B, continue to make the payments and live in a service plan's area, you are eligible for enrollment without health screening.

You can find the names of HMO plans in your area by calling your state's insurance office. Remember, however, the same criticisms previously discussed in terms of HMOs still apply.

Once you enroll in a Medicare HMO, you can switch back to Medicare anytime. However, you may not

switch back to a Medicare Supplement policy you previously had without the company's permission. You can be sure it will review your health record -- and possibly turn you down. That's why some seniors hang on to their Medicare Supplement policy while in an HMO. This assures continuous coverage under the supplement if they change their minds and go back to traditional Medicare service.

The other managed care option you have is through a program called Medicare Select. Basically, this is another form of Medicare supplement insurance sponsored by the federal government, that may or may not be continued. In 1998, Medicare Select came up for review and -- by the end of 1998 -- the Medicare system still was having trouble replacing it as a Medicare option.

Congress proposed Medicare Select in 1990 as a pilot program for those seniors who wanted some level of choice in where and with whom they could secure health services. Service delivery is in the form of a Preferred Provider Organization (PPO) and provides standard Medicare supplement benefits, depending on which policy you buy.

If you buy a Medicare Select policy, you are buying one of the standard Medicare Supplement policies. You can purchase a policy through an insurance company or HMO -- but be sure to inquire which policy you are buying. When you enroll in a Medicare Select policy (should such policies continue to be available), you choose a physician or medical provider from a list provided by the company of "preferred providers." To receive full benefits, you must go to a doctor or provider from the list.

If you choose to go elsewhere, Medicare Select policies are not required to pay any benefits for non-emergency services. So, it pays to go to your doctor of choice. And, if you decide you don't like the policy, you can always return to an individual Medicare policy. You will, however, have to reapply for a Medicare Supplement -- just as with HMOs.