Feature Archive

Making the Right Medicare Decision

Older Americans are facing a Medicare health care system featuring more options -- and more uncertainty....

By John Cutter
WebMD Feature Older Americans are facing a Medicare health care system featuring more options -- and more uncertainty -- than at any time since Congress enacted the program in 1965, say advocates for seniors.

Where there used to be only one choice in Medicare, seniors now face a myriad of alternatives, from the original fee-for-service plan to a variety of managed health care options. The U.S. Health Care Financing Administration (HCFA) recently completed a mass mailing of "Medicare and You 2000," a handbook intended to outline the various choices.

Senior advocates say it is important that seniors select the right Medicare option -- especially older, more infirm seniors, who have the most health care needs. A wrong choice could mean higher out-of-pocket expenses and more difficulty gaining access to specialists within managed care plans.

A Reason to Be Cautious

Is the new "Medicare and You 2000" handbook enough to help seniors make the right choice?

No, says Diane Archer, president of the Medicare Rights Center in New York, an organization that provides free health care counseling to seniors. Although she praises many things about the handbook, she advises seniors to be cautious, because the Medicare landscape is shifting dramatically.

For example, Archer says, health maintenance organizations (HMOs) have pulled out of many communities and started charging higher co-payments and deductibles. Also, specialists on the plans may not be accepting new patients.

The cost of private supplemental insurance plans, which cover items such as deductibles in the original Medicare coverage, has also increased, Archer says. Many of the newest managed-care options, like medical savings accounts, are no longer available.

"The first thing people need to know is that they do not have to make any changes if they are happy with their health care plan today," says Archer, referring to the new Medicare options that Congress created in 1997 under the name Medicare + Choice. Archer is echoing a theme of the Medicare handbook, which was mailed to more than 32 million households in September and October.

Yet many people have found the book difficult to understand. "We're hearing from a lot of people who can't get through the handbook," Archer says. "They say they can't find out what they need to know. It's a little dense."

An HCFA spokesman, however, says beneficiaries have mailed more than 13,000 response cards back to HCFA, most with positive comments about the handbook.

Help Beyond HCFA

Archer recommends that people who are considering changing their health care option under Medicare seek advice. Every state has a SHIP, or State Health Insurance Program, which provides free health insurance counseling on Medicare.

Advocates also recommend that seniors ask their friends about their experiences. Archer suggests asking those who have had the most health problems, because they will know best how a plan functions.

The American Association of Retired Persons (AARP), the nation's largest membership organization for older Americans, also offers a variety of booklets that can help, from "9 Ways to Get the Most From Your Managed Health Care Plan" to "Medicare Basics," says an AARP spokesman. HCFA provides other booklets besides the "Medicare and You 2000" handbook, including a "Worksheet for Comparing Medicare Health Plans."

For now, if people are unhappy with their choice, they can leave one Medicare plan and enroll in another within 30 days. That policy, however, will change in 2002, when only one change will be allowed in the first six months of the year. In 2003, only one change will be allowed in the first three.

Rising Costs

Even with Medicare and the new managed care options, older Americans are finding health care expenses rising.

"The biggest problem for most people is affording the health care they need, even with Medicare," says Archer. "People are telling us they can't afford to get the care they need, because Medicare supplemental policies are too expensive, medications are too expensive, and they are having trouble with special needs if they are in HMOs."

The average Medicare beneficiary pays 18 percent of his or her annual income, or about $2,370, for out-of-pocket health care costs -- over $200 more than in 1997, says an AARP official. These costs include buying supplemental insurance, known as Medigap, to pay for deductibles and co-payments not covered under the original Medicare plan, as well as prescription drugs and services not usually covered under Medicare, such as dental, hearing and vision care.

©1996-2005 WebMD Inc. All rights reserved.
Last Editorial Review: 1/30/2005 10:45:10 PM