55,000 Maryland elderly scrambling for coverage

Quandary: The departure from Maryland of three Medicare HMOs has thrust many senior citizens into a period of anxiety.

September 03, 2000|By M. William Salganik | M. William Salganik,SUN STAFF

Frances Barczak, sitting in the front row at a meeting in a storefront Highlandtown health clinic, puzzled over a cost-comparison chart for Medigap policies.

"This only goes to age 70," she said. "I'm 90."

It is a small confusion in a universe of major quandaries.

For many senior citizens, this is a season not just of fretting over unfamiliar paperwork, but of making difficult choices. This year in Maryland, the options have narrowed and the complications have broadened.

The exit of three Medicare HMOs from the state, scheduled to take effect at the end of the year, has left about 55,000 elderly looking for alternative coverage. They are also looking for help - at sessions such as the one Barczak attended in Highlandtown and from county offices on aging and other sources of assistance.

"We were flooded with phone calls when those announcements came out," said Arnold J. Eppel, deputy director of the Baltimore County Department of Aging. His office recently sponsored a meeting on Medicare changes at a Towson senior center that brought out 300 people.

In addition to the big meetings, there's a lot of one-on-one counseling for perplexed seniors, such as the couple who, at the end of the Highlandtown meeting, sat down with insurance counselor Kisha Winston. From a plastic shopping bag they produced a rubber-banded packet of a dozen letters, all received in the past month from the federal government, their HMO and their doctor, and asked Winston to explain what's going on.

Medicare HMOs have left the market in Maryland and elsewhere each of the past two years, but this year's round is much worse, and the situation in Maryland is worse than that in most other states, said Joe Baker, associate director of the Medicare Rights Center, an advocacy group in New York.

Nationally, he said, nearly a million of the 6.5 million enrolled in Medicare HMOs are being dropped - more than in the past two years combined.

In Maryland three key factors have made the situation even more severe, according to Baker and local advocates and health insurance counselors:

Maryland seniors have just one option in signing up with another HMO. Only Kaiser Permanente will remain after Dec. 31, and it is raising premiums, will offer care only from staff doctors at its own centers and is seeking federal permission to cap its enrollment, meaning that those seniors wishing to do so may not be able to switch to Kaiser from one of the departing HMOs.

"There are a lot of people in urban and suburban areas that are really hurting," said Charles Culbertson, president of United Seniors of Maryland. "They can't really pay for prescription drugs, and that's the major benefit they were after when they joined the HMOs." The average senior spends $1,205 a year for prescriptions, more than double the $559 spent in 1992, according to the advocacy group Families USA.

In addition to the HMO pullouts, some large physician groups have been canceling contracts with the HMOs. Like the HMOs, the doctor groups have been saying they are losing money because federal Medicare rates haven't kept pace with medical inflation. This leads to situations such as that experienced by Alan Crumbaker, 56, of Armistead Gardens, who got a letter from UnitedHealthcare Aug. 14 telling him he had to select a new doctor by Aug. 21 in order to stay in the HMO for the rest of the year.

"It's one thing to be told my HMO is leaving at the end of the year. I can live with that," says Crumbaker, who is eligible for Medicare coverage because of a disability. "But to be told my doctor is leaving four months earlier, that just doesn't make sense." Patients such as Crumbaker can drop out of their HMO and keep their doctor - but then face out-of-pocket costs for seeing that doctor, as well as for prescriptions and other benefits covered by the HMO.

Some seniors, bouncing from plan to plan and doctor to doctor over the past few years, are suffering from a kind of Medicare fatigue.

Alma Barb, 69, also of Armistead Gardens, describes her Medicare experience as a "merry-go-round."

She had a doctor she was comfortable with, but when she retired five years ago after 37 years as a machine operator at PolySeal Corp., she lost her health coverage. She started going to a health center in Highlandtown where she could receive care at lower cost.

The health center, however, didn't offer hospitalization benefits beyond what is already covered by Medicare. She was treated at a hospital and got a $400 bill, which she paid off over time.

Then, she heard about Medicare HMOs, which covered those hospitalization costs. She called Prudential, "and they had a rep come to the house and all. She was real anxious to get me to sign up." Barb joined. "They gave me a big book and I picked a doctor" - she went back to the same one she had gone to when she had insurance through PolySeal.

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