The Graying of HMOs : Before You Sign Up

As health maintenance organizations scramble to sign up the elderly for their senior plans, the American Assn. of Retired Persons offers this advice to consumers.

* 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. But reinstating your supplemental coverage may prove difficult.

* Though some plans have no premiums (apart from the $40 monthly Medicare Part B payment to the federal government), others charge extra for dental care, prescription drugs and eye exams. Make sure the benefits are spelled out in brochures and are fully explained to you by the HMO’s sales representative.


* Though most plans offer emergency care coverage anywhere in the world, not all do. If you travel often, 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.

* Emergency care may be disputed if your plan does not consider your illness or injury to be a real emergency.

* Make sure the plan you are considering has a toll-free hot line you can call if you have questions, with counselors who provide help free of charge.