Medicare decided NOT to send consumers info on MC Plus HMO plans!

Home Health Columnist / Guide · Sep 10, 2001

No Mail From Medicare, but Lots of Headaches

By Jane Bryant Quinn

Sunday, September 9, 2001; Page H02

http://www.washingtonpost.com/wp-dyn/articles/A60220-2001Sep7.html

A judge just told the administrators of Medicare that they're in "blatant violation" of the law.

Every October, they're required to send to beneficiaries, by mail, some basic consumer information about Medicare managed care in their area, to help them choose.

This year, they decided not to. The new administrators argued that consumers could get the same or better information by telephone and the Web.

Judge Henry Kennedy Jr. of the U.S. District Court in Washington wasn't buying. Mail it, he said. Older people and the disabled are supposed to have comparative price and benefit information in their hands.

This year, that's more important than ever. You'll be locked into any managed-care plan you choose for the first six months of 2002. Previously, you could switch at any time if the plan was taking new members.

Here's what's going on.

Once a year, the government mails Medicare beneficiaries a booklet called "Medicare & You." It explains the general program and tells you about your choices.

Most older people belong to traditional Medicare, which allows you to go to any doctor who'll accept you.

Alternatively, you can choose to belong to a Medicare managed-care plan. Such plans give you extra benefits, such as limited prescription-drug coverage, but you see only the doctors in the plan.

Medicare beneficiaries are supposed to receive all this information by Oct. 16. Every November, you're allowed to switch to any managed-care plan you want.

If your managed-care plan closes -- and closings will affect hundreds of thousands of the elderly this year -- you'll need to find a substitute.

Last year's Medicare booklet listed all the managed-care plans in your area, their monthly premiums, whether they offered drug coverage, their consumer-satisfaction ratings, what percentage of older female patients got mammograms and what percentage chose to leave the plan.

There was also a seven-page section on your Medicare patient's rights.

This year's booklet offers no such detail. You're directed to the Web or a toll-free number, 800-633-4227.

At Medicare, they seem to think that having less written information is good for you. "The idea here is to turn consumers into more active consumers" who "know how to call the 800 number and find out," Peter Ashkenav, a spokesman for the federal Centers for Medicare and Medicaid Services (CMS), told my associate, Dori Perrucci.

Aren't you glad to know that Medicare wants to keep you dialing the phone?

Several consumer groups weren't, including the Gray Panthers Project Fund in Washington and the Center for Medicare Advocacy in Willimantic, Conn. They took the government to court.

Judge Kennedy issued a strongly worded preliminary injunction, ordering the government to provide older people with the information required by law.

Medicare argued that it was too late and too expensive to do such a mailing now.

"The court looks dimly on such excuses," the judge wrote. "Any timing or budgetary problems" are of the government's "own making."

This mess occurred in the first place because Medicare bowed to the managed-care industry.

The plans were supposed to file their premiums for 2002 by July 1. But they wanted to wait until September (premiums are going up), and CMS head Thomas Scully agreed. That made it impossible to print the costs in the Medicare booklet mailed to consumers in October.

It also delayed the announcement (now coming this week) of which plans are leaving Medicare. Several hundred thousand older people will have to find new coverage by Jan. 1.

The consumer groups that brought the lawsuit met with CMS two weeks ago to discuss its compliance plans.

It appears that government will have to pay for a second mailing containing the information you need. But it may not reach everyone on time, says Vicki Gottlich of the Center for Medicare Advocacy. To give you more time to choose, the government plans to extend the open enrollment period through December.

Ultimately, you'll have three ways of comparing managed-care plans this year:

1. The government's mailing, whenever it comes.

2. The 800-633-4227 phone number. You can ask questions about a specific managed plan. The operator is supposed to be able to check the answer on the Web.

You can also ask for a printout of some minimal information about your local managed-care plans. It should arrive within two weeks.

The printout will not include information about the percentage of people leaving the plan or how satisfied its customers are unless you specifically ask, says CMS spokeswoman Joyce Winslow.

3. Check the Web http://www.medicare.gov