Medicare Plus Choice Still Offers Benefits

“Medicare Reform May Be a Tonic for HMOs” (James Flanigan, Nov. 30) ignores the positive experiences of many seniors in Medicare HMOs as they currently exist under the Medicare Plus Choice plan.

When Medicare Plus Choice was enacted, HMOs received 95% of the average amount that the government paid for the care of seniors in their area. In exchange for that payment, the programs charged seniors only a small copayment instead of a 20% charge and provided a prescription drug benefit and a pair of glasses annually.

Unfortunately, the government failed to keep HMO reimbursements in line with medical cost inflation. Payments fell to less than 90% of Medicare’s average expense per beneficiary. Squeezed by skyrocketing drug costs and rising hospital expenses, the plans cut benefits, producing an exodus from the program. Seniors blamed the HMOs for benefit reductions, while the role of the federal “man behind the curtain” escaped their notice.

Medicare HMOs still provide many seniors with their only option for a prescription drug benefit without purchasing costly supplemental insurance. Despite inadequate government support, the plans have served seniors very well and have probably saved many lives by improving access to medications and affordable care.

Daniel J. Stone, MD

Cedars-Sinai Medical Group

Beverly Hills