Perspective               

Don't Rely on The HMO's Salespitch

If you are on Medicare and are thinking about joining an HMO, you should first get some key information about the HMOs in your area. Remember, Medicare HMOs get a set amount of money from the government for every person they enroll. People with costly health care needs usually cost the HMO more money than the government gives the HMO. But, HMOs can make a lot of money if they enroll people who are relatively healthy because they don’t cost the HMO much to treat. So, it is in the Medicare HMOs’ best interest to enroll as many relatively healthy people as possible.

To encourage people on Medicare to join, Medicare HMOs spend a lot of money aggressively marketing, and selling, their plans. Often, HMO sales people go to places where there are a lot of people on Medicare, like senior centers and retirement communities, or invite people to a nice restaurant and try to convince everyone there to join. These HMO salespeople are usually not people who provide health care. Of course, salespeople tend to give information that makes their HMO look good. They probably can’t tell you important health care information that you should know before joining, such as specific drugs and treatments the HMO provides for particular health conditions.

Joining a Medicare HMO is a serious decision, and one that you should not make hastily. Remember, people on Medicare can stay in traditional Medicare as long as they want and get the care they need from any doctor they want. If you do decide you want to join an HMO because you think you can save money and get some extra care, do some research and get information from a source you can trust. If an HMO salesperson wants you to join, take home the marketing material and think about the decision. Don’t sign anything in the presence of an HMO salesperson. And don’t rely on the HMO’s salespitch.

Call the National Medicare Hotline at 1-800-638-6833 to get the number of the Health Insurance Information, Counseling and Assistance program (or ICA) in your area. The ICA program is an objective source of information, and ICA counselors can tell you what to look for and what questions to ask when you want to choose an HMO.

For More Information, Contact: Beth Demel, (212) 869-3850, ext. 18.

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