Guest Column

Senior consumers need to do their homework

senior consumers by the American Association of Retired Persons
Free educational forums held earlier this month on the topic of Medicare managed-care plans drew more than 700 seniors statewide.
   Attendance at the forums, sponsored by the American Association of Retired Persons (AARP) and the Washington State Medical Association (WSMA), may be a testament to how confusing the task of selecting medical coverage has become for Medicare recipients.
   Seniors who are weighing the options of continuing to use fee-for-service, traditional Medicare coverage, or switching to a Medicare managed-care plan need to do their homework before making a decision that may change the way they receive medical care.
   "For some patients, Medicare managed care is the right answer to their health insurance needs. For others, it may not be," says Gil Thurston, State Coordinator for the AARP Health Advocacy Services program.
   Nearly 700,000 Washington state seniors are eligible to join managed Medicare plans. Currently 14 percent of those are on the plans in Washington, compared to 24 percent in Oregon.
   With so many choices for insurance coverage in the market today, each person must take the responsibility of understanding those options and making decisions that are appropriate to their individual situation. Unfortunately, finding the information is not always easy.
   "Seniors must take on the responsibility to understand and take charge of their own situation before making a decision," says WSMA President George Rice. "The bottom line is: know your own health care needs and ask questions before you sign up with a Medicare managed-care plan."
   WSMA and AARP suggests seniors ask the following 10 important questions of an insurance company offering a Medicare managed-care plan before making a decision:
    1. Does your physician(s) participate in the plan? If not, how much will it cost you to continue receiving care from him/her? Can you easily change physicians within the plan?
   2. Do you require ongoing specialized medical care (such as seeing a rheumatologist for arthritis), and are those services covered by the plan? Do you need to obtain a referral before you can see medical specialists or obtain specialty care services?
   3. What services are covered and or not covered? Does the plan include coverage for any conditions you may have now ("pre-existing" conditions), such as diabetes, heart, or pulmonary disease?
   4. Where do you go for care? To a central location(s) where all services are provided, or to individual doctor's offices? Is the location convenient?
   5. How do you appeal treatment decisions made by the plan?
   6. Are you covered by the plan if you become sick or injured while out of town? If so, how?
   7. Can you cancel your enrollment anytime and without penalty? Can the plan cancel your enrollment? If so, for what reason(s)?
   8. Do you have friends or relatives who belong to a Medicare managed-care plan? Ask them about their experience with the plan.
   9. Is the plan "federally qualified?" Plans that are federally qualified or that have Medicare contracts must meet specific "quality" guidelines.
   10. How much does the plan cost, including premium and copayments?
   To further help seniors through the Medicare managed-care maze, the Senior Health Insurance Benefits Advisors (SHIBA) program of the State Insurance Commissioners office offers one-on-one counseling for seniors on health insurance issues. The service is free and available to anyone by calling 1-800-39-SHIBA (ext. 102).
   For a package of information on how to research and make a decision around Medicare managed-care plans, contact either the WSMA at (206) 441-9762 or AARP at (206) 526-7918.