Perspective               

What To Do if Your Medicare HMO is Leaving the Market

On July 1, 1999, 41 Medicare HMOs announced that they will terminate their Medicare contracts at the end of the year, on December 31^st, and another 58 plans announced that they will reduce their service areas. As a result, 327,000 people on Medicare will be dropped from their HMOs.

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 be automatically enrolled in Original Medicare when your HMO service ends. You do not need to take any action. Original Medicare is the government-run program that 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, when you are dropped by your HMO you have the right to buy Medigap plans A, B, C, and F, even if you have a pre-existing condition. In order to be protected by this rule, you must stay in the HMO through the end of the year. If you leave the HMO before the termination date, depending on where you live you may lose this right. Also, 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 back the same Medigap policy. 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 2000 from what they are today.

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.

Unfortunately, many people on Medicare may still be hurt by Medicare HMO withdrawals. For example, while seniors who are dropped have guaranteed access to Medigap plans A, B, C, and F, people with disabilities do not have this protection if the Medigap companies in their region did not already sell policies to people with disabilities.

If you are on Medicare and want more information about your insurance options, call your State Health Insurance and Assistance Program, or SHIP. The number is listed in the back of the Medicare & You which was sent to people on Medicare. You can also get a copy by calling 1-800-MEDICARE. Or call your Senator or Congressperson. They should have staff who can help you.

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