Shrinking Medicare Pinches Seniors
Seniors will be hard pressed to find any good news or easy choices in a just-released report on the quality of Medicare HMOs in California.
The 2002 Guide to California Medicare HMOs provides a report-card-like rating of every health plan on various measures, including the quality of prescription drug benefits, out-of-pocket costs and what members think about the plans.
The study found a significant drop in the number of Medicare HMOs operating in the state, as well as an overall decline in the ratings of many of the remaining plans.
“For a lot of seniors, Medicare HMOs remain the place to be, but it’s harder to make the right choice,” said Ann Monroe, director of medical quality programs for the California HealthCare Foundation, an Oakland-based health care philanthropy and research group that co-authored the study.
During the past year, the number of Medicare HMOs in California dropped nearly half, from 196 to 100.
“We were surprised by the dramatic reduction. Some plans, like Maxicare, are gone. Others have dropped certain counties,” Monroe said.
Most plans have reduced their drug benefits, sometimes by increasing what members must pay for prescriptions or requiring wider use of generic drugs, she said.
The landscape has changed dramatically, Monroe added, noting that the HMOs in Los Angeles County that received the highest ratings last year included Maxicare, UHP and SCAN Health plan, all of which have encountered financial difficulties.
Maxicare Health Plans, a long-troubled HMO, filed for Chapter 11 bankruptcy protection in May 2001.
“Generally, what we are finding is that the plans that offered the best coverage have not been able to sustain that over time,” Monroe said.
The situation in Southern California is better than some other parts of the state, where HMOs have quit the Medicare business, limiting consumers’ choice of plans, or slashed benefits.
Medicare recipients in Los Angeles and Orange counties have nine HMOs to choose among, and all but one Orange County plan offers a prescription drug benefit.
The comparative information about Medicare HMOs comes at a time when a new federal “lock-in” policy will make it more difficult for seniors to switch between traditional Medicare and the HMO option. The new rules permit Medicare beneficiaries to change plans only once between January and June 2002 and not at all between July 1 and Dec. 31.
Previously, seniors could change plans each month.
The loss of that flexibility makes for a dicier decision for seniors. “Now that seniors will be locked in, do they bet that their HMO plan, even though it is losing money, will turn around?” Monroe said.
In some cases, a senior on multiple prescription drugs might opt to join a financially weaker plan because it offers more generous drug coverage, while a financially healthier plan might have fewer drug benefits. “It’s a terrible place for seniors to be,” she said.
Monroe suggests that seniors bear several factors in mind when reviewing the quality report: Be certain the HMO’s network includes the doctors and hospitals you want; check the drug benefits to see if brand-name or generic drugs are preferred; compare the plans’ ratings on managing chronic conditions, preventive care and financial health.
The guide can be accessed on the Internet at www.calmedicare.org. A free copy, in English or Spanish, is available by calling (888) 430-2423.
More than 4 million California seniors are covered by Medicare, about 1.5 million of whom currently belong to HMOs. The study was released last week by Consumers Union, publisher of Consumer Reports magazine, and the California Healthcare Foundation.
