Perspective               

Impending HMO Pullouts

Aetna, the nation's largest health insurer, and Cigna HealthCare have announced plans to close their Medicare HMOs in some areas next year. Aetna has yet to disclose which areas the closings will affect, and Cigna has announced shutdowns in a dozen cities affecting 104,000 enrollees. More announcements are expected in July when health insurance companies are required to tell the Health Care Financing Administration which markets they intend to serve in the next year. Some experts predict that up to 1,000,000 people could be affected by HMO pullouts next year.

If you or someone you know is being dropped from an HMO, you need to know what to do. The Medicare Rights Center makes the following recommendations:

First, keep in mind that you still have Medicare even if your Medicare HMO announces that it is ending services by the end of the year. You will automatically be enrolled in Original Medicare when your HMO service ends. You do not need to take any action. Original Medicare lets you see almost any doctor anywhere in the country.

Two - if you are over 65 and want to get supplemental insurance, or Medigap, to fill gaps in Original Medicare, you have the right to buy Medigap plans A, B, C, and F, even if you have a pre-existing condition. Call your local State Health Insurance Assistance Program for more information about your rights to buy a Medigap policy in your state. You can find the number in your Medicare Handbook or by calling 1-800-MEDICARE. If you have been in the HMO for less than a year and previously had Original Medicare with a Medigap policy, you have the right to leave the HMO and get the same Medigap policy back. For more information, call your state insurance department or 1-800-MEDICARE.

Three - if you decide to join another Medicare HMO, you can do so by enrolling directly with the HMO. Be sure to thoroughly research the rights and benefits you will have in this new HMO and get information from as many sources as possible before enrolling. Remember that the benefits and premiums may be very different in 2001 from what they are today. Benefits can be cut and premiums can go up significantly.

Four - if your HMO is terminating and you are worried about covering your out-of-pocket costs, contact your local Social Security office to find out eligibility guidelines for Medicaid and for QMB, SLMB, QI-1 and QI-2. These programs may help pay your Medicare deductibles, premiums, and coinsurance, depending on your income level.

For more information, call your local State Health Insurance Assistance Program. You can get the number from 1-800-MEDICARE.

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