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
You should know that no matter what happens, you are still covered by
the Medicare program.
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.
While you have decisions to make, your current managed care plan is
required to cover you until December 31, 1999.
Resources are available to help you make a new health care choice.
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