The Insurance Buying Guide: Medicare HMO's
Due to the increasing costs of Medicare Supplement policies, more and more seniors are switching to managed care. The federal government estimates approximately 70,000 Medicare recipients a month are switching to some form of managed care. Currently, of the 38 million seniors and disabled eligible for Medicare, almost 6 million are enrolled in a Medicare HMO.
Medicare HMO's basically combine the benefits of Medicare and Medigap policies all in one. What makes them so attractive?
The federal government funds most of the revenue for each participating HMO, which makes the cost to you only 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.) And, items such as eyeglasses and prescription drugs are covered under most HMO's. 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.
Please note: 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. And, you can be sure they will review your health record if you do and possibly turn you down. That's why some seniors hang on to their Medicare Supplement policy while enrolled in an HMO, just to make sure they are happy with it. This guarantees continuous coverage under the supplement if they change their mind 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 and if it meets your needs. 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 insurance company of preferred providers. To receive full benefits you must go to the doctor or medical provider selected.
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.
In short, there is a plan to meet your needs as you move through your golden years. Remember to review the cost, check the benefits and the service issues that are important to you, before you make a choice. And, don't be afraid to ask questions. It's your health, you deserve the best!
