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HMOs Drop Coverage for SeniorsBy Del Williams More than 536,000 US senior citizens are scrambling to find new doctors or new coverage because their health plans terminated their Medicare managed-care services, according to a Nonrenewal Report issued by the Centers for Medicare & Medicaid Services for the year 2002. Among the hardest hit are seniors in California (84,000), Florida (59,000), Pennsylvania (55,000), New Jersey (53,000), Texas (46,000), and Michigan (31,000), who will be losing coverage in the coming year. Even those with continuing coverage face substantial premium hikes and dwindling drug benefits. Particularly hard hit will be those with chronic illnesses such as respiratory disease. These patients will bear the brunt of high medication and healthcare costs. Though all seniors 65 and older are covered by Medicare, those enrolled in managed-care programs agree to see doctors within a limited network and receive additional benefits, such as preventive care and prescription-drug coverage. The current coverage crisis stems from rising delivery costs and limited government reimbursement. Doctors and hospitals increasingly balk at seeing Medicare HMO patients since they aren't sufficiently reimbursed for their services. Without enough doctors and hospitals providing care, an HMO can't serve its members. The problem is worst in large urban markets, where more than half of Medicare+ Choice beneficiaries live, but where reimbursement rate increases have trailed rising costs since 1997. To compensate for the funding shortfall, premiums for seniors retaining Medicare HMO coverage are expected to spike while benefits dwindle in the coming year. In the Sacramento area, for example, monthly premiums for Kaiser Permanente's Senior Advantage Medicare Plan doubled from $40 to $80 Jan. 1. Healthnet, following suit, is raising premiums 50%, from $40 to $60 per month for its Seniority Plus members in the area. Pacificare and Western Health Advantage, while holding monthly premiums at $50 in their Sacramento-area Medicare plans, will eliminate brand-name drug coverage next year. Nationally, seniors caught between rising premiums and shrinking coverage will find themselves in a similar bind. Even those with Medigap policies will feel the squeeze. Medigap policies A through J, for instance, have minimum standard benefit packages, and the H, I, and J plans covering prescriptions have annual drug caps ranging from $1,250 to $2,000. For the 30 million Americans with a Chronic Obstruction Pulmonary Disease (COPD) such as asthma, emphysema, or cystic fibrosis--collectively the fourth leading cause of death in the US, however, help is available. Geriatric Services of America (GSA), a national community service organization based in Tempe, Ariz., provides direct help and support to older Americans suffering from chronic respiratory disease. Through its Respiratory Disease Control Program, GSA provides access to a comprehensive range of special medication benefits, as well as support and homecare services, which eliminates out-of-pocket expenses for patients with primary or supplemental insurance coverage. Through GSA's patient support center, nebulizers and respiratory medication are provided and paid for with free home delivery, conveniently packaged and ready to use. GSA handles all paperwork, and clinical patient care coordinators work with doctors and insurance companies once a patient has enrolled in the program. Patients can enroll themselves, there is nothing to buy, and there are no enrollment or membership fees. Currently, Medicare, AARP, Blue Cross, Blue Shield, and more than 180 other insurers have special benefits for patients with respiratory disease. GSA provides access to these benefits, and coordinates all elements of care to help patients, doctors, and insurance companies combat respiratory disease. For more information about GSA, email: grheault@geriatricservices.com. Del Williams is a technical writer based in Torrance, Calif. For daily news concerning senior health, log onto: www.alsuccess.com
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