Fewer Top-Value HMO Plans for Seniors, Disabled
California seniors and disabled people who are looking for good value in Medicare HMO plans have a diminishing range of choices, according to a guide released Wednesday by Consumers Union and the California Health Care Foundation.
The 2003 Guide to California Medicare HMOs, which calculates consumer value by weighing benefits such as prescription drug coverage against costs, gave top ratings to only 11% of Medicare health-maintenance organizations this year, contrasted with 44% two years ago. Nearly all of the top-rated Medicare HMOs are in the greater Los Angeles area.
Over the past three years, the plans, which expand upon basic Medicare coverage, have been trimming benefits such as prescription drug coverage as they have been raising premiums and other out-of-pocket costs, said Ann Monroe, director of the Quality Initiative for the California HealthCare Foundation, an Oakland-based health-care philanthropy and research group.
“People can’t assume the plan that they’ve had for a number of years is still the right plan for them because there have been so many changes,” Monroe said. She recommended that Medicare HMO participants consider their individual needs for prescription drug coverage and doctors’ visits when choosing a plan.
Medicare HMOs all over the country are asking beneficiaries for more money and cutting benefits, said Karen Davis, president of the Commonwealth Fund, which sponsors health-care research.
Nationwide, Medicare beneficiaries are paying $37 a month in premiums this year, up from $14 in 2000. In that same time period, the percentage of Medicare plans with prescription drug coverage has dropped from 78% to 69%.
HMO industry representatives blame coverage cutbacks and price increases on low federal reimbursements that haven’t kept pace with the costs of medical care. Medicare HMOs are “a powerful example of how private health plans can bring affordability, flexibility and new choices to the Medicare program,” Karen Ignagni, president of the American Assn. of Health Plans, said in a statement last week. But, she added, “insufficient funding continues to limit beneficiaries’ ability to receive these coverage options on a wider scale.”
The highest rating among the state’s plans in the Guide to California HMOs -- marked with five stars -- went to two plans that operate only in Los Angeles and Orange counties. Both of the plans, Blue Shield 65 Plus Value Plan and CareMore California Medical Advantage, are in their first year of operation.
Southern California has managed to maintain high-value Medicare HMO plans because the competition for Medicare dollars is so fierce, said Sandy Risdon, program manager for the Health Insurance Counseling and Advocacy Program in Los Angeles County.
“Los Angeles County has the densest Medicare population in the country -- 1 million,” Risdon said. With the federal government reimbursing health-care plans in L.A. County at $707.96 monthly per Medicare beneficiary, the highest rate in the country outside of south Florida, “you can see there’s a great incentive to concentrate where there are numbers,” Risdon said.
But Medicare managed-care plans all over are getting less generous and harder to understand, the health-care researchers said. For instance, Monroe said, some plans have added an annual $2,200 deductible for services that used to be fully covered, such as hospital outpatient surgery, producing an unexpected cost for beneficiaries.
Joe Turner, a 68-year-old resident of South Los Angeles who is looking to join a Medicare HMO, said he feels bewildered by the choices. He hopes to find a plan that allows him to visit his doctors at Harbor-UCLA Medical Center without a co-payment and to have long-term care for a lung condition. “I’ve looked around but haven’t found anything yet,” he said. “Seriously, these prices make a whole lot of people think about buying [medications] on the Net or in Mexico or Canada.”
Consumers can obtain a copy of the guide on the Internet at www.calmedicare hmos.org or request a free printed copy at (888) 430-2423.
