Health options left for elderly

Rural residents have other plans available after drop by HMOs

Decisions effective Dec. 31

July 04, 1999|By Brenda J. Buote | Brenda J. Buote,SUN STAFF

CareFirst BlueCross BlueShield's decision to drop the rural elderly from its Medicare HMO will affect 1,562 Carroll County residents, but county and other officials said the cut should not cause panic.

CareFirst BlueCross BlueShield is the latest company to drop the rural elderly from its Medicare HMO, effective Dec. 31.

Members of CareFirst's Medicare HMO, called MediCareFirst, may select another HMO, elect to return to their traditional Medicare coverage, or sign up with one of the four Medigap plans offered in Maryland, which will cover services Medicare doesn't.

MediCareFirst members should receive a letter in about a week notifying them of the change. A second, more detailed letter will follow in September, CareFirst officials said.

Carroll County officials and Washington-based American Association of Retired Persons representatives said other resources are available to seniors.

"We have a very active Senior Health Insurance Program. They will work with seniors to understand the issue and their options," said Janet B. Flora, bureau chief for the county Bureau of Aging. "What people need to do is to look at their options."

When evaluating their choices, CareFirst members should consider several factors, according to Steve Hahn, an AARP spokesman who tracks health and consumer issues.

"People need to look at the out-of-pocket costs of the plans they're considering -- the premiums and co-payments," he said. "They also need to find out what's covered and what's not, and make sure they'll have access to their [doctors]. And, of course, they should consider whether the location of the services provided by the plan are convenient."

Statewide, about 14,000 CareFirst members will be forced to return to traditional Medicare coverage, while 31,000 others will have to pay premiums or join a different health maintenance organization.

Finding another HMO could prove difficult.

Across the nation, a number of large national companies have dropped their Medicare HMO businesses. The cuts have been especially deep in rural areas like Carroll County, where federal reimbursement payments are lower.

Last fall, four companies -- Aetna U.S. Healthcare, NYLCare, Prudential HealthCare and Optimum Choice -- fled the Maryland Medicare market, and United HealthCare cut back its service areas, leaving lots of confused and angry seniors demanding a legislative solution.

"It's still too early to say what that solution might be," Hahn said. "There's not enough information available yet."

Early studies indicated the HMOs were being overpaid because they were attracting younger, healthier seniors who required less care. Seeing the potential for profit, many HMOs sent recruiters to senior centers and homes. In Maryland, the market surged from 1,000 members in 1994 to about 90,000 last year.

But the increasing number of members meant the HMOs were providing coverage for seniors who required more care. As a result, HMOs in Maryland and nationwide have seen their Medicare books go from black to red.

CareFirst BlueCross BlueShield announced Thursday that it expects a loss of $5 million this year in its Medicare HMO. The company attributed the decline in revenue -- and its decision to slash benefits in sparsely populated areas -- to "the federal government's failure to provide adequate reimbursement" in rural communities.

Anyone with questions may contact Susan Cronin in the Senior Health Insurance Program at 410-848-4049 or the Health Care Financing Administration at 1-800-Medicare. The agency operates under the U.S. Department of Health and Human Services and oversees Medicare.

Seniors may also receive a free publication, "Making Medicare Choices," by writing to AARP at 601 E St., N.W., Washington, D.C. 20049. Requests should be sent to the attention of "Fulfillment" and should include the publication's document number, D16747.

Pub Date: 7/04/99

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