Byline: Judith Graham
CHICAGO _ Some 200,000 senior citizens across the United States will experience disruptions in their health-care coverage next year, as HMOs limit their participation in Medicare or withdraw from the giant government health program altogether, according to a major survey released Monday.
A much larger number of seniors will be hit with the double whammy of reduced benefits and higher costs, reported the American Association of Health Plans, the survey's author.
In particular, seniors can expect less coverage for prescription drugs from Medicare HMOs, as well as sharp increases in monthly premium payments or co-payments due when services are delivered, said Karen Ignani, president of the health plan association.
These trends are not new: HMOs have been beating a significant retreat from Medicare since 1999, and benefit reductions were especially sharp last year, as financially stressed HMOs tried to regain a stronger economic footing.
Still, the trend's persistence for another year spells considerable problems for large numbers of elderly men and women who will be forced to switch health plans or convert to traditional Medicare, and who might need to buy expensive Medicare supplemental policies or sign up with new doctors.
Furthermore, the planned HMO pullbacks from Medicare underscore the Bush administration's failure to stabilize Medicare's troubled managed-care program and reverse declining participation, despite vows to do so last year.
"We're disappointed," admitted Tom Scully, administrator of the Centers for Medicare and Medicaid Services at the U.S. Department of Health and Human Services. But "we'll lose less people than we did last year or the year before," he noted.
In 2001, 934,000 seniors had to scramble for new Medicare coverage when their HMOs left the program or limited coverage. This year, 536,000 seniors found themselves in a similar predicament.
HMOs were to tell the government Monday whether they plan to stay in the Medicare program or limit participation, although the association's survey gave early indications of intended pullbacks. Health plans will begin making public announcements of their decisions in the next several weeks.
Scully and Ignani blamed inadequate funding for the problems of Medicare HMOs. For the past several years, annual funding increases for Medicare HMOs in most urban areas have been limited to 2 percent to 3 percent, while expenses covered by the health plans have been rising by 15 percent or more.
"We hope Congress will step forward to help save this program," Ignani said.
The House of Representatives has approved $3.2 billion in additional payments over the next 10 years for Medicare managed-care plans; the Senate has not acted on a similar measure. The Bush administration has proposed a one-time 6.5 percent rate increase next year to stem the growing tide of Medicare HMO defections.
But some lawmakers may balk when they realize that HMOs have turned out to be more expensive than traditional Medicare and not the money savers they were originally made out to be.
According to a March report of the Medicare Payment Advisory Commission, spending for beneficiaries in Medicare HMOs averaged 4 percent higher last year than spending for demographically similar beneficiaries in the traditional Medicare program.
Meanwhile, advocacy groups suggest that other health-care priorities should take precedence over bolstering Medicare managed care.
"A prescription drug benefit for everyone on Medicare has to come first, before any (extra payments) to HMOs, doctors, hospitals or other providers," said Joyce Dubow, senior policy adviser to AARP's Public Policy Institute.
Judy Stein, executive director of the Center for Medicare Advocacy in Mansfield, Conn., said: "It would be one thing if beneficiaries were crying out for more choice of insurance plans, like HMOs, but they're not. What they want is freer choice of doctors, hospitals, home health-care providers and medical-supply companies."
Nationally, nearly 5 million of the 38 million Americans covered under the Medicare program belong to HMOs. In Illinois, about 71,500 senior citizens participate in the managed-care option.
___
(c) 2002, Chicago Tribune.
Visit the Chicago Tribune on the Internet at http://www.chicago.tribune.com/
Distributed by Knight Ridder/Tribune Information Services.
No comments:
Post a Comment