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HMO Withdrawals to Effect Thousands

On January 1, 2000 more than 327,000 elderly and disabled Americans will be forced out of HMO plans as more than 90 companies are dropping Medicare HMO coverage in selected areas. The Health Care Financing Administration (HCFA), the administrator of Medicare, are advising those who will be affected of the following:

5 THINGS TO REMEMBER

  1. You should know that no matter what happens, you are still covered by the Medicare program.

  2. If you are affected by a plan withdrawal, you will have to make a choice about who provides your health care. Make sure you have answers to all your questions before you make a decision.

  3. While you have decisions to make, your current managed care plan is required to cover you until December 31, 1999.

  4. Resources are available to help you make a new health care choice.

  5. You will receive additional information about your available Medicare choices, including the Original Medicare Plan and protections you have in choosing a Medigap insurance policy to supplement your Medicare benefits, in September 1999.

You may read or hear about managed care plans leaving the Medicare program in your area. If you are in the Original Medicare Plan, you are not affected. If you are in a Medicare managed care plan, you may be affected, but you are still covered by Medicare.

Medicare benefits will always be available to Medicare beneficiaries. Medicare benefits can be delivered either through the traditional fee-for-service arrangement, known as the Original Medicare Plan, or in some areas through managed care plans.

If you are affected by a withdrawal, you will have to make a new health care choice. But for most beneficiaries, you have time to make a choice. Since changing the way you receive your health care is an important decision, you may wish to ask those you trust such as family or friends for help. Special rules may apply when you disenroll from a Medicare health plan and return to the Original Medicare Plan with a supplemental insurance policy (Medigap). If you or your spouse have health care coverage through a former employer or union, contact a company representative before you make a new health plan choice. If you have Medicaid coverage, do not make a new health plan choice until you contact the State Medical Assistance Office or the State Medicaid Program.

Individuals affected by a plan withdrawal should receive a letter from their plan in July 1999. In addition to this letter, all beneficiaries affected by a plan withdrawal will receive another letter from their plan in September 1999. The September letter will provide you with more detailed information about your health care options, including information about Medigap insurance.

We understand that the withdrawal from Medicare of some managed care plans causes disruption for those enrolled in these plans. To ease this transition, HCFA is committed to ensuring that beneficiaries have useful information about Medicare and the rights and protections available to beneficiaries affected by these plan withdrawals.

To assist beneficiaries and their caregivers, HCFA established the Medicare Choices Helpline. The Medicare Choices Helpline can be reached by dialing 1-800-MEDICARE (1-800-633-4227). Hearing impaired individuals using a telephone device for the deaf can call 1-877-486-2048 for assistance. This toll-free number is staffed by English and Spanish-speaking customer service representatives from 8:00 a.m. to 4:30 p.m. local time. Customer service representatives at the Medicare Choices Helpline can:

  • answer your questions about plan withdrawal,

  • provide the names and phone numbers regarding your other health care options. Information about benefits and costs for the year 2000, beginning January 1, 2000, will be available in mid-September. NOTE: We expect that complete information about plan withdrawals for calendar year 1999 will be available in mid-July; and,

  • refer you to other organizations, such as the State Health Insurance Assistance Program, that can help you with your health care choices.

Source: Health Care Financing Administration

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