Perspective               

HMOs Leaving Medicare

The Centers for Medicare and Medicaid Services (CMS) reports that in 2002 about 536,000 people will lose their Medicare HMO coverage as a result of HMO pull-outs from the Medicare program. CMS requires HMOs who are leaving Medicare to send members a letter telling them about other Medicare options. And, CMS must mail comparative HMO information to people with Medicare by October 16.

If your HMO is ending its contract with Medicare, raising its premiums and copays substantially, or cutting benefits, you should keep in mind that you can switch to a new HMO or Original Medicare.

With an HMO you may spend less for your health care and get some extra benefits if you follow their rules, but you must use only the HMO doctors and hospitals in your area. To choose another HMO call 1-800-MEDICARE for HMOs in your county.

Be sure to compare HMO features such as doctors in your HMO's network and prescription drug coverage. Note that starting January 1 you can only leave a Medicare HMO and join another Medicare plan one time from January 1 through June 30. After you have made one change, including changing to Original Medicare, you must stay in that Medicare plan for the rest of the year, even if your doctor leaves the HMO.

If there are no other HMOs and your HMO is ending its contract with Medicare, you will be enrolled in Original Medicare automatically on January 1. With Original Medicare you can use almost any doctor or hospital anywhere in the country. Most people in Original Medicare get retiree or supplemental coverage to lower their health care costs. You can buy insurance from private companies like AARP or Blue Cross. Medicaid and other programs can also help cover your costs if your income is low.

If you need more information about your Medicare options for 2002, call your State Health Insurance Assistance Program, or SHIP. The number is listed in Medicare and You.

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