CT Senior Citizens Face HMO Uncertainty

[NRSKarenRN, BSN, RN]

Senior Citizens Face HMO Uncertainty

By DIANE LEVICK

The Hartford Courant

June 30, 2001

http://www.ctnow.com/scripts/editorial.dll?eetype=Article&eeid=4830866&render=y&Table=&ck=&ver=3.0

It's nail-biting time for Roberta Doyle.

The only adequate insurance the West Haven senior citizen can afford is her Medicare HMO, and she won't know for at least 2½ months whether she'll be allowed to keep it - or be dumped Dec. 31 as millions were over the past few years.

Normally, Medicare HMOs had to disclose by July 1 their intentions for the coming year, including any rate increases and benefit cuts. But a federal agency has given them until Sept. 17 this year to make final decisions, extending the uncertainty for an already shell-shocked population.

Advocates and professionals who work with the elderly say the delay won't give seniors enough time to shop around, and will pressure them into potentially harmful decisions.

The crunch comes as choices for seniors are shrinking further, with some sellers of traditional Medicare supplement insurance now pulling back along with the HMOs.

HMOs, however, say the extension was granted so they'd have more months of data to use in making their weighty decisions.

"It gives us a better opportunity to figure out how we can stay in these markets,'' says Ira L. Morrison, communications manager for Shelton-based Health Net, formerly PHS Health Plans'.

But Doyle, 65, is worried because her sole income is $600 a month from Social Security, and she's irked that the Medicare HMOs have more breathing room while seniors have less.

"I don't like them putting it off an additional three months this year,'' Doyle said. "I don't think it's fair to the consumer, to force us into making snap decisions.''

The decisions will be more important than ever because starting in 2002, seniors in Medicare HMOs will be permitted to make only one switch in insurance that year, whether it's to another HMO or traditional Medicare. Currently seniors can change plans as often as they want.

It's unlikely many of the 74,126 Medicare HMO members in Connecticut know about the decision-making extension given to the health plans, but consumer advocates are suing over it.

The nonprofit Center for Medicare Advocacy in Mansfield filed a U.S. District Court lawsuit in Washington, D.C., on June 23, claiming that the extension violates federal statute. The defendant is Tommy G. Thompson, U.S. secretary of health and human services, and the plaintiffs include the Medicare Rights Center in New York and the Gray Panthers Project Fund.

The delay "puts older and disabled Americans at risk of making poor health coverage decisions, thus jeopardizing their health and finances,'' said Judith A. Stein, the Mansfield center's executive director.

Seniors' advocates say they'll have less time to gather information on plans still available, benefits, and prices and to prepare comparative materials. They're also concerned that if there are further HMO withdrawals, the remaining insurers will have even less time than last year to handle the flood of applications from seniors looking for alternative coverage.

"Last year it was an absolute nightmare,'' recalls Beverly Kidder, director of the Aging Resource Center at the South Central Agency on Aging in West Haven. Insurers couldn't process applications fast enough, so some seniors had no insurance for a short time, she said.

Meanwhile, two of the lowest-priced Medicare supplement insurers - Monumental Life Insurance Co. in Baltimore and Iowa-based Life Investors Insurance Co. of America - will stop selling new policies in Connecticut Aug. 15.

Monumental is seeking regulators' approval for a 33 percent rate increase this fall for existing Connecticut customers.

Companies that don't sell new supplements must renew existing customers who want to continue, but the consumers may be vulnerable to steeper rate jumps.

Thirteen other companies are still selling Medicare supplements to new customers in Connecticut.

United American Insurance Co., which stopped selling supplement Plan D and Plan G in Connecticut as of May 10, plans to discontinue Plan B on July 26, according to the state insurance department.

Senior citizens who have questions about Medicare and insurance can call the CHOICES program at 800-994-9422.

ATTENTION HOME HEALTH NURSES: "The decisions will be more important than ever because starting in 2002, seniors in Medicare HMOs will be permitted to make only one switch in insurance that year, whether it's to another HMO or traditional Medicare. Currently seniors can change plans as often as they want." This is extremely important for you to be aware.

In Philadelphia are, there are only TWO MC + Choice HMO's, both basic programs WITHOUT RX drug coverage, they yanked that Jan 1, 2001.