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HMOs to drop 1,000 senior citizens in county

November 06, 1998|By KERRY LYNN FRALEY

Sharpsburg resident Eva Knight hasn't been officially notified yet that the managed health care plan that replaces her Medicare benefits won't be renewed at the end of the year.

Knight, 67, said she heard from a friend that her HMO - Optimum Choice - is one of two that will no longer be available as an alternative to Medicare in Washington County after this year.

Since verifying the news with the insurance company and her doctor's office, she has been concerned, she said.

On Friday morning, Knight attended a seminar sponsored by the Washington County Commission on Aging to find out what her options are.

More than 1,000 Washington County senior citizens will be dropped from two managed health care plans at the end of the year, according to Katrina Eversole, coordinator of the commission's Senior Health Insurance Counseling and Advocacy Program.

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"I'm not here to tell you what is the best choice. I'm here to tell you what the choices are," said Eversole, who said her office has been flooded with telephone calls since one of the companies sent out a notification letter two weeks ago.

Knight was one of about 200 people who filled an auditorium-style classroom at Hagerstown Community College for Eversole's short, information-packed presentation.

"We're older and we just wonder what's going to happen next," said Knight, who said the seminar helped allay her concerns.

Only one of the three HMOs now covering Medicare clients in Washington County will remain after Dec. 31, Eversole said.

Those senior citizens left out in the cold by Optimum Choice and United Health Care Mid-Atlantic's departure will revert back to Medicare as their primary coverage unless they switch to the one remaining HMO in the county, Blue Cross/Blue Shield's Medi-Care First, she said.

HMOs have their advantages and disadvantages, Eversole said.

The advantages include no deductibles and comprehensive services, like vision, dental, hearing and prescription medicine coverage, that Medicare doesn't cover, she said.

HMOs will accept clients with pre-existing conditions except for end-stage renal disease or kidney failure, Eversole said.

Disadvantages include requirements to choose a primary care physician from within the plan's network, to get that doctor's referral to go to a specialist and to live in the service area, she said.

You have to find a network doctor who is accepting new patients, Eversole said.

Doctors can leave the network at any time, she said. She gave the names of six doctors leaving Medi-Care First's network at the end of the year.

If you choose to go back to Medicare, you should consider buying one of 10 standardized "Medigap" insurance plans, which cover gaps in Medicare coverage, deductibles and co-payments, Eversole said.

They offer a wide range of supplemental coverage, ranging from Plan A, offering very limited benefits not including Medicare's $764 hospital stay deductible, to the comprehensive Plan J, including extended prescription drug benefits and preventive care, she said.

Since the plans are standardized by law in coverage, Eversole suggested first figuring out which of the 10 plans is right for you, then comparing different companies to find out the variables.

Variables include price, whether there's a local agent to deal with and whether you'll have to file the Medicare paperwork, she said.

It's important that anyone being dropped from an HMO keep their cancellation notice letter, which guarantees their right to purchase Medigap insurance plans A, B, C or F, Eversole said.

While they have 63 days after the Dec. 31 cutoff to do that, it's preferable to make a decision before then to ensure continuous insurance coverage, she said.

Based on what she heard at the seminar, Knight said she thinks she's going to switch to Medi-Care First.

Hagerstown resident Melissa Earley said she came to the seminar to "kill two birds with one stone" by gathering information for both her mother and the doctor's office where she works.

Earley said her mother, who is now covered by Optimum Choice, doesn't have the choice to switch to the other HMO because she has end-stage renal disease.

She said it's heart-wrenching because her mother is going to end up paying about twice the $45 a month she now pays for the HMO to buy Medigap insurance.

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