Potential Members Should Ask Questions : Health care: Medicare recipients should check list of doctors, costs and emergency coverage before enrolling in an HMO’s seniors plan.
Carl and Miriam Greeneberg, as it turned out, were just browsing.
The Orange couple, both of whom receive Medicare benefits, were looking for a way to improve their health-care coverage while reducing the premiums they pay. When they got an invitation from PacifiCare Health Systems’ Secure Horizons program to attend a Valentine’s Day sales breakfast, they decided to go.
“We really are interested,” said Carl Greeneberg, 75, who retired from Parker Hannifin, the Irvine aerospace firm.
The couple listened, asked questions and pondered. They left the breakfast meeting with new information but without changing their health coverage.
“We’re just not sure,” said Miriam Greeneberg, 73. “We’ll have to think about it more.”
Joyce Dubow, an administrator at the American Assn. of Retired Persons in Washington, commends the Greenebergs for their caution and recommends that other Medicare recipients emulate them. As health maintenance organizations such as PacifiCare and FHP International Inc. scramble to sign up the elderly for their senior plans, the AARP advises that potential members take these steps before making any decisions:
* Find out if the doctor you prefer is affiliated with the HMO you are considering. If the doctor you see now is a confidante and friend, you may not want to change physicians. And Medicare will not pay the bills if you go to a doctor who is not a member of your HMO.
* Be absolutely sure you want the plan before you sign up, especially if you have the so-called Medicare supplemental coverage provided by many insurance companies. Dropping out of an HMO’s Medicare plan may be as easy as calling the company or the local Social Security office, Dubow said. But reinstating your supplemental coverage may be difficult.
* Though some plans have no premiums (apart from the $40 monthly Part B payment to the federal government), others charge extra for dental care, prescription drugs and eye exams. Make sure that the benefits are spelled out in brochures and fully explained to you by the HMO’s sales representative.
* Keep in mind that HMOs are not for everybody. Though most plans offer emergency care coverage anywhere in the world, not all do. If you travel often and far, Dubow said, keep in mind that virtually all plans have some geographic limitations. And if you are on an extended trip and need routine care, Medicare will not pay the bill, she said. Also, emergency care may be disputed if your plan does not consider your illness or injury to be a real emergency.
* Make sure that the plan you are considering has a toll-free hot line that you can call if you have questions and counselors who provide help free of charge. Though large HMOs like FHP and PacifiCare have those features, Dubow said, some smaller plans may not.
