14 November 2004
Medicare HMOs try to lure new members
They're not exactly giving away toasters to new members, but Medicare HMOs in South Florida are offering lots of new goodies to get senior citizens to join up.
Fitness programs. Pilates and tai chi classes. Dentures and hearing aids. And, most importantly, more money for prescription drugs, including coverage that rolls over from month to month like cell phone minutes.
With Monday the first day to enroll in Medicare HMOs for 2005, seniors can expect good news from health plans for the first time in a long time.
After years of cutting benefits and raising co-payments due to flat reimbursements from Medicare, HMOs received a 10.6 percent boost from the government, thanks to the Dec. 2003 vote in Congress that creates a Medicare drug program in 2006.
As a result, many health plans have lowered co-pays, lowered or ended monthly premiums, and expanded the services they cover -- although it's not like in the good old days of the early 1990s when HMOs provided medicines free of charge to members. Seniors also will have more choices. HMOs are offering 61 plans in the three counties of South Florida in 2005, vs. 45 last year.
The good news, however, has complicated the decision about which plan -- or regular Medicare -- is best for a senior.
"It's a big job to shop. It takes us a long time," said Tamarac retiree Marie Wells. She and her husband, Herbert, switched to CarePlus last year after Health Options began charging a monthly premium and cut back on medication coverage, forcing them to pay $4,000 out of pocket. She said they would jump to another HMO if the deal were better.
"You go for the prescriptions and your hospital co-payment and your [doctor] co-payments. That's what I'm looking for," Wells said.
Sheldon Glickman, a Boynton Beach retiree who will be shopping among the HMOs this month, added: "It's very hard for a lot of people. I feel sorry for the older seniors who get confused about the paperwork and all the requirements. It's not crystal clear at all."
Choose carefully, consumer advocates warn. Each person should look at the specific benefits of a plan before signing up, to make sure that it covers what they need.
Take a lot of medicine? Look for generous coverage and make sure the plan covers your drugs. Bad teeth? Look for plans that cover dental and dentures. Love your doctors? Make sure they are in the plan.
On prescription drugs, a few plans are now offering "rollover" benefits, in which unused coverage carries over month-to-month. CarePlus was first in the area to offer the option earlier this year. Humana Health Care Plans and Vista Healthplan are adding it in some 2005 plans.
"We looked at doing fitness programs and items like that. We have taken all these dollars for these other things and put them toward our pharmacy," said Mike Fernandez, president of CarePlus.
Humana, South Florida's leading Medicare HMO with about 130,000 members, is trying to boost interest with "Silver Sneakers," a free low-impact exercise program for seniors.
Vista is starting exercise programs with Pilates, yoga and tai chi, and giving discounts on alternative health care and non-prescription medicine. The plan has boosted coverage such as transportation, chiropractor care and hearing aids.
Palm Beach County is benefiting more from the new largesse than are Broward or Miami-Dade counties. Palm Beach County for years has received less generous benefits, because Medicare pays less to HMOs there under a complex formula accounting for local medical costs.
With this year's extra funding, CarePlus is expanding into the area, and other plans are vying for seniors in Palm Beach County who have ignored HMOs so far.
"It has been a county with untapped potential," said Vista spokeswoman Pam Gadinsky.
By Bob LaMendola
Health Writer
Ft. Lauderdale Sun-Sentinel
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