BY TIM BONFIELD
The Cincinnati Enquirer
The federal government calls it the Medicare+Choice program. But when the latest stab at Medicare reform kicks in next year, senior citizens won't be getting many choices.
In November, elderly and disabled residents throughout Ohio and four other demonstration states received a 36-page booklet called "Medicare & You," issued by the federal Health Care Financing Administration. The booklet describes a variety of new and not-so-new health coverage options that were supposed to be available starting in 1999.
Early on, critics predicted the program would confuse seniors with a dizzying array of new coverage options. It turns out those fears don't matter.
In fact, the bugs in Medicare+Choice run so deep that private insurers, senior service agencies, even Medicare administrators are sending the same message to seniors: If you are happy with the way you get health care now, you don't have to do anything.
"The availability of choice is probably a good thing," said Joyce Dubow, a senior policy adviser for the American Association of Retired Persons. "There is no one plan that works best for everybody. But there's also such a thing as
too much choice. This program still has a long way to go."
Even though the "Medicare & You" booklet describes several new options, not a single company will offer seniors the "choice" of starting a medical savings account in 1999. Forget about the "choice" of joining private fee-for-service plans, too. There won't be any next year.
For Tristate seniors, the only "choice" other than staying in their traditional Medicare plan is to join a Medicare HMO, plans that offers financial savings in return for using a limited panel of hospitals and doctors.
Yet even for these plans, seniors nationwide will have less choice in 1999 than they had this year. That's because the rules and rate caps built into Medicare+Choice program prompted dozens of Medicare HMOs to abandon territories, raise fees, or cut benefits for next year -- and sometimes all of the above.
"The worries about confusion have turned into anxiety about the stability (of Medicare HMOs)," Ms. Dubow said. "I think the pullbacks send a message loud and clear about how important the traditional Medicare program is. When all else fails, that's what you can rely on."
Rather than getting hundreds of new or expanded plans as hoped, the Medicare+Choice program got 48 applications to start new HMOs while 43 existing Medicare HMOs dropped out of the program. Meanwhile, 25 HMOs sought to expand their service areas, but 52 HMOs reduced them.
In Greater Cincinnati, residents of Hamilton, Butler, Clermont, Warren, Boone, Kenton and Campbell counties still have at least four Medicare HMOs to choose from.
However, if you live in Ohio's Adams County, Kentucky's Gallatin, Grant or Pendleton counties or Indiana's Ohio or Dearborn counties, you might as well ignore Medicare+Choice.
Your only "choice" is regular old Medicare.
The Medicare+Choice program was created by the
federal Balanced Budget Act of 1997, with key parts taking effect Jan. 1, 1999.
The long-term goal was to help control Medicare's costs by encouraging people to switch out of traditional coverage into a variety of other types of plans.
It's not working out.
"Plans are looking at whether or not this is a business they can afford to be in long-term," said Julie Goss, a health care consultant who spoke at a recent media conference sponsored by Anthem Blue Cross & Blue Shield.
In the past three years, Tristate Medicare HMO enrollment swelled from 2,200 to more than 37,000 as seniors responded to an extensive marketing campaign touting HMOs over traditional Medicare.
Joining an HMO meant you didn't have to spend $800 to $2,000 a year to buy a supplemental plan to pay for Medicare deductibles and co-payments. Even better, many HMOs offered prescription drug coverage seniors can't get in regular Medicare.
These savings started evaporating this year when rate caps and tougher regulations changed the business outlook for Medicare HMOs.
Insurers are dumping or dodging the Medicare+Choice program for several reasons, Ms. Goss said.
The program includes a list of mandated benefits, such as routine cancer screenings and emergency care at non-network hospitals. It also sets new rules about appeals and monitoring quality of care. Even worse, the government is capping future HMO payment increases at 2 percent a year for the next five years.
Harold Puckett, an AARP representative who lives in Bethel, Ohio, said he joined a Medicare HMO and has been highly satisfied.
"But from the reports I get from other people, a lot of people aren't satisfied. They're afraid they'll get dropped after they sign up," Mr. Puckett said.
Stability has become a highly appreciated aspect of regular Medicare.
All Americans can get Medicare coverage once they turn
65. And once you're in Medicare, you can't be dropped.
