WEISS RATINGSAdvice for 300,000 Medicare Beneficiaries
Being Dropped from their HMOs on January 1
PALM BEACH GARDENS, Fla., November 8, 1999 -- On January 1, 2000, more than 300,000 Medicare patients will be dropped from their HMOs, with many required to pay higher premiums, forced to accept reductions in service, or unable to find any alternative managed care in their area. These industry announcements come on the heels of the 407,000 that were dropped under similar circumstances at the beginning of 1999 as well.
"This is often a serious blow to the elderly," commented Martin D. Weiss, Ph.D., chairman of Weiss Ratings, Inc., the only provider of safety ratings for most HMOs and Blue Cross Blue Shield plans. "They are left in a quandary and have scant access to reasoned advice, relying primarily on sales people for guidance.
For Medicare beneficiaries who will be losing their coverage at the start of the new year, Dr. Weiss offers the following step-by-step advice:
Step 1. Don't move until the end of the year. Stick with your existing HMO until December 31. If you drop out sooner, your withdrawal will be considered "voluntary," and you will immediately forfeit certain kinds of guaranteed coverage for next year.
Step 2. Start checking into alternatives immediately. To avoid any coverage gaps, you will want to enroll before December 31 in a new policy that will take effect as of January 1. Get a list of HMOs in your area, but make sure it is up to date, including new plans that have recently been approved by Medicare. (Contact the Medicare Choices Helpline at 1-800-MEDICARE.)
Step 3. Approach HMOs with caution. Over 160 of the nation's HMOs are losing money, 14 have already failed and 10 more are at a high risk of failure. So don't be surprised if many more decide to duck out of this business next year. To check the safety of your HMO, call Weiss Ratings at 1-800-289-9222 ($15 per company) or look for the Weiss Ratings Guide to HMOs and Health Insurers at your local public library.
Step 4. Don't wait until the last minute to sign up. Assuming you can find an HMO in your area that is stable and offers reasonably priced benefits, be sure to sign up as soon as possible. Reason: Some HMOs have set a limit on the number of Medicare patients they will accept. The sooner you enroll the better the chances of getting in.
Step 5. Don't be afraid to leave HMOs entirely and shift to traditional Medicare plus a supplemental policy. Provided you don't withdraw until December 31, you are guaranteed eligibility in Medicare supplement insurance ("Medigap") regardless of your health status. Under this guarantee, you can choose among four different Medigap plans -- called Plans A, B, C and F. Depending on your health, you may also be eligible for six other Medigap plans available. With Medicare and Medigap, it's far less likely you will get dropped again. Plus, you will have more freedom to choose your provider or hospital and will benefit from better access to specialists.
Warning: Your last day to take advantage of this guarantee is March 3 -- 63 days after your HMO coverage ends.
Step 6. Shop around for the least expensive Medigap policy that meets your needs. &mbsp;The cost of Medigap insurance can vary drastically by insurance provider -- even for identical plans offering the same benefits in the same location. For example, a 70-year-old female in Columbus, Ohio could pay $2,020 for Plan F from United American Insurance Company, but only $1,007 if she signed up with American Family Mutual Insurance Company. Other examples of premium differences, for a 70-year-old female, between identical Medigap policies include:
|Location||Company with Higher Premium||Company with Lower Premium|
|A||Phoenix, AZ||Mutual of Omaha||$1,209||USAA Life Insurance Co||$602|
|C||Columbus, OH||Guarantee Trust Life Ins Co||$1,413||Unicare Life & Health Ins Co||$1,068|
|F||Los Angeles, CA||Central States Health & Life
Co of Omaha
|$2,668||Blue Cross of California||$1,260|
|J||Miami, FL||Monumental Life Ins Co||$5,776||Physicians Mutual Ins Co||$3,371|
If the policy that your agent quotes for you is too expensive, don't give up. There could be much cheaper policies available with the same benefits.
Step 7. Beware of future Medigap premium increases. Before you sign on the bottom line, find out if your insurance company will automatically raise your Medigap premiums as you get older. If it does, that may help explain why it's cheaper up-front. For example, USAA Life Insurance Company charges $1,240 per year for a Plan F for a 70-year-old female living in Los Angeles, California while Physicians Mutual Insurance Company charges $1,584 for the same coverage. However, USAA will probably raise rates as you grow older, while any rate increases at Physicians Mutual will be limited to standard increases that apply to everyone across the board.
To help you shop for the least expensive and most financially stable Medigap policies, Weiss offers the Health Insurance Report for Seniors. Weiss will ask you to provide your age, gender, zip code, and county of residence. The Weiss report then provides you a customized listing of the actual premium rates that are available to you for each of the 10 Medigap plans, by insurers in your area. It also gives you a guide to nearly all Medicare HMOs in the country. The report is available for $49 by calling 1-800-289-9222.
Largest and Strongest Medicare HMOs
(Based on total Medicare premiums as of 12/31/98
and a Weiss Safety Rating of B+ or above)
|Blue Shield of California||373,726,000||A|
|Health Alliance Plan of Michigan||148,626,303||A-|
|Blue Cross of California||71,539,000||A-|
|Partners National Health
Plans of NC
|Dean Health Plan, Inc.||16,424,000||B+|
Largest and Strongest Medigap Insurers
(Based on total Medigap premiums as of 12/31/98
and a Weiss Safety Rating of B+ or above)
|United American Insurance Company||471,751,000||A-|
|Health Care Service Corp
a Mutual Legal Reserve
|Physicians Mutual Insurance Company||251,214,000||A|
|Mutual of Omaha Insurance Company||240,448,000||A-|
|Hartford Life Insurance Company||127,510,000||B+|
|Principal Life Insurance Company||118,514,000||A-|
|State Farm Mutual Automobile Ins Co||105,714,000||A+|
|Capital Blue Cross of Pennsylvania||97,921,384||B+|
|Blue Cross & Blue Shield of SC, Inc.||57,983,000||B+|
|USAA Life Insurance Company||53,348,000||A|
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