19,000 elderly must find other coverage 3 choices in wake of Aetna's decision

Health care

September 03, 1998|By M. William Salganik | M. William Salganik,SUN STAFF

An article in Thursday's business section about HMOs that offer a Medicare plan in Maryland should have included the Kaiser Permanente health plan.

The Sun regrets the error.

A decision by Aetna U.S. Healthcare to leave the Medicare HMO market in Maryland -- taking with it the NYLCare plan that Aetna acquired about a month ago -- will leave about 19,000 Marylanders over 65 seeking alternative coverage.

Aetna and NYLCare Medicare members will have three choices, Walt Cherniak, an Aetna spokesman, said yesterday:

Enroll in another Medicare HMO. There are four other Medicare HMOs in Maryland.

Return to the traditional Medicare coverage of fee for services rendered.

Buy a Medicare supplemental plan, sometimes called "Medigap" insurance, that covers some deductibles and other expenses not paid by fee-for-service Medicare.


Other Medicare HMOs cannot turn away Aetna and NYLCare members who want to switch, and, at least in the Baltimore and Washington metropolitan areas, most offer similar benefits.

A possible problem, however, is that "once you've developed a relationship with a plan's physicians, there can be disruption" in switching to another HMO with a different list of participating doctors, said Martin Corry, director of federal affairs for the American Association of Retired Persons.

Pamela Causey, a spokeswoman for the state Office on Aging, said the state's Senior Health Insurance Counseling and Advocacy Program has insurance counselors throughout the state who can assist seniors with questions about their options.

Aetna U.S. Healthcare has 11,442 members in Maryland, while NYLCare has 7,568, according to the Health Care Financing Administration, the federal agency that administers Medicare. Cherniak said Aetna's largest Medicare HMO enrollment is in Anne Arundel, Carroll and Baltimore counties, while the largest concentration of NYLCare members is in Montgomery and Prince George's counties.

The largest Medicare HMO plans in the state are MediCareFirst, offered by Blue Cross and Blue Shield of Maryland, with 27,709 members, and United HealthCare with 20,905. Prudential and Optimum Choice also offer Medicare HMO coverage in the state. Altogether, 83,352 Marylanders, of the 580,689 eligible for Medicare, have chosen HMO plans.

Aetna said this week that it would be dropping coverage in the District of Columbia, Maryland and five other states. Medicare reimbursement levels to HMOs varies by county, and Aetna said it could not offer affordable programs in those states and still remain profitable.

Optimum Choice, run by Mid Atlantic Medical Services Inc. of Rockville, pulled out of the Medicare HMO market in nine Maryland counties last year.

MediCareFirst now charges an additional premium in 16 rural counties, after saying it lost more than $5 million last year on its Medicare HMOs. This year, Blue Cross has said, the plans are breaking even.

Other HMOs nationally have cut back on benefits or reported losses from Medicare HMOs.

Corry said 1997 federal legislation, designed to cuts payments in some areas and boost them in others, was causing some shifts. "There's a certain amount of shake-out in the industry," he said, "but we're not seeing a huge wave of this."

Pub Date: 9/03/98

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