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Medicare Choice Changes May Affect Your City's Recipients.

Municipal officials may be faced with questions from constituents currently participating in Medicare+Choice programs in their communities in the coming weeks.

Approximately 43 Health Maintenance Organizations (HMOs) participating as providers in Medicare, Choice will have dropped out of the program effective December 31, 1998.

This change will have broad effects for Medicare beneficiaries, since they will have to select another HMO in the Medicare+Choice program before November 30, 1998, or choose a different type of Medicare insurance before December 31, 1998 to prevent a lapse in coverage.

Approximately 420,000 beneficiaries of Medicare+Choice will lose their HMO on January 1, 1999, because their plan did not renew as a Medicare+Choice carrier. All beneficiaries who are affected by this change should have been notified in writing by the Health Care Financing Administration by November 20, 1998.

Beneficiaries have three choices to face in the coming weeks. They may:

* select another participating HMO in their service area;

* elect to return to fee-for-service Medicare; and/or

* elect to obtain a Medigap Insurance Policy.

The Health Care Financing Administration has reported that a number of factors may have influenced the decisions of HMOs to withdraw from the Medicare+Choice program--small participant enrollment within the market, the merger of Aetna and NYLCare and other mergers, new payment rates enacted by the Balanced Budget Act of 1997 and an increased regulatory burden.

An extensive public outreach campaign has been launched in all 50 states to address the transition of health plans for Medicare+Choice beneficiaries.

Elected officials may refer constituents with questions to a toll-free line (1-800-MEDICARE) and the beneficiary-oriented website, If a constituent did not receive a notice in writing of the change in coverage, direct the constituent to the 1-800 number for more information and confirmation that they are not affected.

Additionally, local officials may refer constituents with questions and concerns to their State Health Insurance Assistance Program for help with Medicare+Choice questions, Medicare bills, Medicare Supplemental Insurance Policies or long-term care insurance, payment denials or appeals, Medicare rights and protections, complaints about care or treatment, or for more information on Medicare health plan choices.
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Title Annotation:health care provider services
Author:Cormier, Kristin E.
Publication:Nation's Cities Weekly
Date:Nov 30, 1998
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