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Results from search: http://www.medicarewatch.org/2001Basic/Expanding_Coverage.html

Medicare Reform: Expanding Medicare Coverage Medicare Reform A Century Foundation Guide to the Issues revised for 2001 Copyright Information Introduction Medicare Nuts and Bolts What Is Right with Medicare? What is Wrong with Medicare? What Is New in Medicare? Evaluating Reform Proposals Expanding Medicare Coverage A Prescription Drug Benefit A Buy-In for the Fifty-five-Plus Uninsured Reform the Entire Health Care System Expanding Medicare Coverage Given the current economic prosperity and changes in modern medicine, many believe it is time to think about augmenting the benefits Medicare provides. The most frequently mentioned proposals involve the provision of an outpatient prescription drug benefit, an option for Americans approaching retirement to buy into the program, and the addition of coverage for long-term care. The chief disadvantage of these proposed changes is their expected cost. However, the scope of the current Medicare benefit package is restricted in such a way that it lags behind that of most private sector insurance plans for the under-sixty-five population. Enhancing Medicare's coverage would improve seniors' quality of life, and it might make restructuring the program or raising taxes and premiums more palatable. *   A Prescription Drug Benefit The lack of outpatient prescription drug coverage in fee-for-service Medicare is the program's most glaring inadequacy. Most private insurance plans, and the universal public health plans in other developed nations, cover prescription drugs. Drug therapies can reduce the need for hospitalization and treat chronic health problems like heart disease, arthritis, and depression effectively.  Up to 69 percent of Medicare beneficiaries do obtain drug coverage of some kind through supplemental insurance, such as HMOs, employer-sponsored plans, and Medigap plans. (See Figure 9, page 50.) However, the out-of-pocket spending of older Americans on drugs amounts to about 50 percent of their costs, compared with just 34 percent for those under sixty-five. 97 The price of prescription drugs used most often by the elderly has been rising in recent years, and expensive, new brand-name drugs, some of them more effective than the older drugs they are superseding, are being brought to market at an increasingly rapid pace. 98 Figure 9. Percentage of Medicare Enrollees with Supplemental Coverage for Prescription Drugs (a Benefit Not Covered by Fee-for-Service Medicare) Source : John A. Poisal and George S. Chulis, "Medicare Beneficiaries and Drug Coverage," Health Affairs 19 (March/April 2000): 250. Since Medicare constitutes a large share of the market for any medical services it pays for, pharmaceutical companies fear that a new Medicare drug benefit might lead to government regulation of drug prices and crimp the development of new drugs. Whether innovation would actually be hindered is a hotly debated question. An outpatient drug benefit for Medicare beneficiaries could take many forms. The most important distinction between the three major plans currently under consideration in Washington is how they would fit into the current structure of the American health insurance system. 99 A Benefit through the Existing Medicare Program This approach would make the coverage of prescriptions an optional part of the standard Medicare benefit package. Beneficiaries would have a single opportunity to opt into the new benefit and would pay an additional annual premium, much as they do for the Medicare Part B (physicians' services) benefit. Employers who already provide substantial drug coverage to their retirees would receive a subsidy to encourage the continuation of that coverage. If adequately subsidized, a benefit of this sort would make it possible to give sick people the care they need without dramatically affecting the cost of each person covered. It also would maintain the Medicare program's tradition of offering a single package of benefits to all elderly and disabled people, a feature that contributes to the program's broad-based popular support. On the other hand, a drug benefit might encourage some companies to drop their existing drug coverage for retirees, despite the subsidy they would receive. About a quarter of today's Medicare enrollees enjoy this kind of employer-provided coverage, which is a major, if dwindling, source of private dollars spent on drugs for older Americans. Also, by subsidizing costs from the first dollar spent on prescription drugs, this design might lead to an increase in drug use and drive up program costs.  A Benefit in a Restructured Medicare Program This reform would divide up Medicare into competing health plans, including both managed care plans and the traditional fee-for-service program. Beneficiaries' plan premiums would be partly subsidized by the government. Each participating plan would be required to offer a "high-option" package of benefits that included prescription drugs. In theory, beneficiaries in this remodeled Medicare program would choose superior plans on the basis of price and quality, pushing health plans to provide better care at a lower cost over time. In order for competition among health care plans to work, beneficiaries would be allowed to switch plans and plan options on a regular basis. As a result, however, healthier beneficiaries would likely stay away from the expensive high-option packages with drug coverage until they fell sick and needed more generous coverage. This separation of beneficiaries into sicker and healthier groups could drive up the premiums of the high-option plans. The government would try to prevent this split by paying more to plans that cover sicker beneficiaries. However, such "risk adjustment" efforts have proved difficult to design and implement. Furthermore, genuine market competition between health plans likely would force some of them out of business, which could prove disruptive to beneficiaries. A Benefit Via the Supplemental Insurance Market Another strategy is to subsidize the purchase of private supplemental insurance policies that cover outpatient prescriptions, leaving Medicare itself basically unchanged. Adopting such a plan would cause minimum disruption to the current system of supplemental insurance and might lead to less displacement of private spending on drugs than the other two approaches. By leaving the status quo largely intact, this approach also might garner the political support of pharmaceutical companies. The flaws of the existing supplemental insurance market could reproduce themselves under this approach, however. Sicker beneficiaries might disproportionately buy into individually purchased drug coverage plans, thereby forcing up insurance premiums, while healthier beneficiaries avoided the insurance market until they became ill.  ...Previous Next... 97. Margaret Davis et al., "Prescription Drug Coverage, Utilization, and Spending among Medicare Beneficiaries," Health Affairs 18 (January/February 1999): 236. Some of those beneficiaries counted as covered may have drug coverage for only part of a calendar year. 98. See "Factors Affecting the Growth of Prescription Drug Expenditures," National Institute for Health Care Management Research and Education Foundation, July 9, 1999, available at http://www.nihcm.org . 99. For a comprehensive, point-by-point comparison of several major proposals for prescription drug coverage, see "Prescription Drug Coverage for Medicare Beneficiaries: A Side-by-Side Comparison of Selected Proposals," Kaiser Family Foundation, Washington, D.C., March 2000. For more information and sources on this subject, see "An Outpatient Drug Benefit for Medicare," Idea Brief no. 10, The Century Foundation, New York, June 2000, available at http://www.ideas2000.org/Issues/Health/Drug_Benefit.pdf .   

Results from search: http://www.medicarerights.org/testimony12.html

Medicare Rights Center-Testimony 8            Testimony                Statement of Jennifer Weiss Director of Policy , Medicare Rights Center Before the US House of Representatives Committee on Ways and Means, Subcommittee on Health Medicare Supplemental Insurance March 14, 2002 View Her Testimony A webcast and transcript of the entire hearing can be found at kaisernetwork.org , a free service of the Kaiser Family Foundation. My name is Jennifer Weiss and I am the director of policy at the Medicare Rights Center. The Medicare Rights Center is a national consumer service organization, based in New York, working to ensure that older and disabled Americans get good, affordable health care. Under a contract with the New York State Office for the Aging, with funding from the Centers for Medicare and Medicaid Services, we operate New York State's Health Insurance Assistance Program hotline. Every year we hear from more than 60,000 people with Medicare, who have questions about their Medicare benefits, rights and options. We also operate a National Medicare HMO Hotline that assists elderly and disabled Americans who are struggling to get needed care and coverage from their HMOs. I thank the Ways and Means Subcommittee on Health for this opportunity to testify on Medicare Supplemental Insurance policies. For the older and disabled men and women we serve, there are three critical Medigap issues: they want meaningful and understandable Medigap choices, a good Medigap benefit package, and affordable Medigap coverage. To the extent Medigap reform proposals affect these key issues, on behalf of our clients, we ask that you tread carefully. As you well know, changes often have unintended consequences. Adding new Medigap plans that are not affordable, or that lead to increases in the premiums charged for other Medigap plans, or that discourage access to needed care, will jeopardize the health of older and disabled Americans. At the same time, changes designed to save money by discouraging access to needed care may end up costing Medicare more in future hospitalizations and other complex health services. Any new Medigap option must be designed so that people can easily understand its risks and benefits. For example, there is incontrovertible evidence that Medigap standardization has been successful in allowing consumers a meaningful basis to comparison shop - a good thing for consumers and for the market. Medigap first dollar coverage In an ideal world there would be a simple answer to the question of how to design cost-sharing in Medigap that strikes the right balance between ensuring that people who need care get care and discouraging people from seeking unnecessary care. Finding that delicate balance requires a fair and objective review of our learning on health care usage. Based on our experience, we have two serious concerns that we raise here: One, plans that do not provide first dollar coverage might deter people who elect these plans from getting needed care. Two, plans that do not provide first dollar coverage might draw a healthier pool of policyholders, which could lead Medigap insurers to raise rates on the less healthy pool of policyholders who elected first dollar coverage plans. Moreover, plans that do not provide first dollar coverage are not likely to attract subscribers. As you know, the two high deductible plans currently available have few subscribers. Today, many more people sign up for plans that cover their high deductibles and high cost sharing than for less expensive plans that do not. Regardless of ideology, none of us wants a health care system that deters people from getting needed care. At the same time, limited public resources should not be diverted to pay for unnecessary care. We need to understand clearly where the dividing line is. The tragedy we hear at the Medicare Rights Center, day after day, is from our elderly clients who report that they go without needed care because they cannot afford it. As you well know, prescription drugs are the prime example of what we consider to be an inhumane and uncivilized deprivation in modern day America. Remember, the Medicare population is a group of Americans who have a median income below $24,000 a year. Indeed, members of the Committee, our neighbors are going without needed health care as we meet today. Our client experiences also tell us that Medigap policies are the mechanism through which our clients budget for their health care each month, enabling them to predict many of the costs they will face. Human beings, of course, are not clairvoyant and are hard-pressed to self-insure for unexpected high cost health care needs. While a high-deductible Medigap plan may mean a beneficial lower monthly Medigap premium, it may also mean a gamble about future health care needs and out-of-pocket costs that keep people from getting necessary care. Reducing first dollar costs As this Committee considers ways to offer people with Medicare meaningful health care choices, encourage access to needed care and discourage unnecessary care, we would urge you to look at offering supplemental coverage options directly through Medicare with a co-pay and a premium. Adding supplemental coverage options to Medicare would allow the millions of people with disabilities under 65 the right to purchase coverage, promoting their access to needed care. It could also spread risk more broadly and help stabilize supplemental insurance premiums. We wonder whether the Congressional Budget Office has ever scored this proposal to expand Medicare and strongly recommend that you request further study of this option. Access to Medigap and Prescription Drug Coverage To conclude, we strongly urge that before pushing forward with changes to Medigap that you ask the GAO and the CBO to study these proposed changes and their potential consequences. Add to the current Administration proposals serious review of other options, such as a supplemental policy directly through Medicare. No one expected that the Balanced Budget Act of 1997 would lead to 2.2 million Americans losing their HMO coverage and thousands struggling to secure a Medigap policy. No one would want to offer a change to Medigap that impeded access to needed care. That said, the greatest barrier to needed care right now is the lack of a Medicare prescription drug benefit. Prescription drug coverage through Medigap has proven to be unworkable. Now is the time for Congress to expand Medicare to include prescription drug coverage for everyone. Thank you. _________________________________ Maintained by info@medicarerights.org Last Modified: This site and its contents are © 1997, 1998, 1999, 2000, 2001, 2002 by Medicare Rights Center

Results from search: http://www.aarp.org/hcchoices/medicare/resources.html

AARP Webplace | Educated Health Care Choices search  jump to  - select one & press go - ........................ Member Services About AARP Computers & Technology Health & Wellness Learning Legislation & Elections Life Answers Money & Work Research Travel & Leisure Volunteering Medicare Resources Medicare Basics Making Medicare Choices Your Medicare Rights Selecting Medicare Supplemental Insurance Resources Glossary ON THIS PAGE: Telephone and Web Resources | Related Links on AARP Webplace Telephone and Web Resources For more free information on Medicare, Medigap insurance and health insurance, check out the web sites and call the telephone numbers listed below. 1-800-MEDICARE (1-800-633-4227) Someone at the Medicare helpline can answer your questions about the Original Medicare Plan and provide up-to-date information about Medicare, Managed Care Plans and Private Fee-For-Service plans in your area. You can also get information about the quality of care and member satisfaction in Medicare Managed Care Plans, such as Medicare HMOs. Medicare This official U.S. Government site for Medicare provides up-to-date information about Medicare, Medicare health plans, consumer publication, nursing homes, fraud and abuse. View the Medicare handbook, Medicare and You and the Guide to Health Insurance for People with Medicare . URL: http://www.medicare.gov Medicare Health Plan Compare Medicare Compare provides the costs and benefits of the Medicare health plans in your area, which you can compare side by side. This site also contains information about the quality of care and member satisfaction in Medicare Managed Care Plans, such as Medicare HMOs. URL: http://www.medicare.gov/MPHCompare/Home.asp Medicare Helpful Contacts Find the important Medicare contacts in your state and local community. These contacts include your State Health Insurance Assistance Program (SHIP) and Peer Review Organization (PRO). URL: http://www.medicare.gov/Contacts/Home.asp Medigap Compare Medigap Compare provides a list of the insurance companies (and their phone numbers) that sell Medigap (Medicare supplemental insurance) plans in your state. Some insurance companies have also provided to Medicare additional information such as which Medigap plans they offer, who the plans are offered to, and the rating method they use to price their plans. URL: http://www.medicare.gov/mgcompare/home.asp Medicare Rights Center The Medicare Rights Center, a national, not-for-profit organization, represents the interests of Medicare beneficiaries and provides a free counseling service to Medicare beneficiaries. Order a wide range of consumer publications covering Medicare basics, Medicare HMOs, Medicare appeal rights, home and hospice benefits and supplemental insurance by calling 212-869-3850, Ext. 10. URL: http://www.medicarerights.org Agency for Healthcare Research and Quality (AHRQ) AHRQ is the lead federal agency supporting research designed to improve the quality of health care, reduce its cost and broaden access to essential services. View AHRQ's publications; Checkup on Health Insurance Choices, Your Guide to Choosing Quality Health Care and Choosing and Using a Health Plan or order by calling 1-800-358-9295. URL: http://www.ahcpr.gov/consumer/ National Committee for Quality Assurance (NCQA) NCQA, a private nonprofit organization, is committed to improving the quality of health plans. Check out NCQA's Health Plan Report Card to find out if the health plan you are in or considering has met their standards and received NCQA accreditation or "seal of approval". You can also call NCQA at 1-888-275-7585 for this information. URL: http://www.healthchoices.org/ State Insurance Departments Link to your state insurance department websites, from the National Association of Insurance Commissioners (NAIC) website. State insurance departments are responsible for licensing and regulating insurance companies doing business in their state and approving their Medigap policies. They often have consumer information and can help with complaints. URL: http://www.naic.org/1regulator/usamap.htm Department of Labor, Pension and Welfare Benefits Administration(PWBA) PWBA works to protect the health and pension benefits of many workers, retirees and dependents. The website provides information and publications on how life and work events, such as retiring, affect employees' health benefit choices. View their brochures on-line or order by calling 1-800-998-7542. URL: http://www.dol.gov/dol/pwba/public/health.htm Related Links on AARP Webplace Medicare Basics Making Medicare Choices Selecting Medicare Supplemental Insurance Your Medicare Rights QMB: Dollars to Help Pay for Medicare Managed Care: What Consumers Need to Know Visit Health and Wellness for the latest information from AARP on Medicare, managed care, health insurance options, health care legislation that affects you, and more. | Selecting Medicare Supplemental Insurance | AARP home   |   advanced search   |   join/renew AARP   |   contact AARP   |   online community   |   what's new Copyright 1995-2002, AARP. All rights reserved. AARP Privacy Policy .

Results from search: http://www.legalassist.org/brochures/med_sup_ins.html

Help! I Need Information On Medicare Supplemental Insurance Printable Version What Is Medicare Supplemental Insurance? Medicare provides some protection against the high cost of health care. However, it does not pay all of your health care costs. Therefore, people may need additional protection to supplement Medicare. If you are considering the purchase of additional insurance to supplement your Medicare, make sure you understand what protections the supplemental policy contains. What Provisions Should I Look For In My Supplemental Policy ? Coordination of Benefits The policy should have a "coordination of benefits" clause which means the policy will not pay when another insurer pays or each insurer will pay part of the costs, not to exceed the actual cost. Duplicate coverage is costly and often means multiple premiums with no greater protection than a single good policy. Preexisting Condition Generally, the policy will not pay for medical conditions occurring before the policies effective date. Make sure you know the effective date as you are responsible for all medical costs resulting from an illness before this date. Discuss medical conditions which are permanently excluded or are not payable until a future date. You will be responsible for the costs of these conditions. Always get the information in writing. Waiting Period Check to see if there is a waiting period before the new coverage begins to pay. You are responsible for medical costs during the waiting period. Do not keep an inadequate policy just because you have had it a long time. However, if you do replace it keep your old policy in force until the new one becomes effective. Maximum Benefits Discuss the maximum payment amounts under the entire policy or for specific treatments , and the maximum number of days or visits . You are responsible for all medical costs over these maximums. Get the maximums in writing. Make sure the limits meet your needs. Renewal Rights Avoid policies "renewable at company option" as the company could cancel your individual policy for any reason at the end of a policy year or when the premium comes due. Grace Period Make sure the policy gives you at least 10 days after you receive the policy to look it over. During that time, if you decide you don't want it, you can return it for a full refund of your premium. Is It Okay To Withhold Medical Information? No! Give all your medical information. Withholding medical information on a policy application may lead to nonpayment for a later claim. Never believe salespersons who say you don't have to furnish such information when the application requests it, or say they will fill in that information later. Should I Ask For a Written Coverage Description? Yes! Always ask for a written description of the policy you are considering buying - in simple language. A company selling a good policy will always provide a simplified description of the policy. Read the policy carefully. If you have questions, now is the time to ask. Should I Pay Cash for the Policy? No! Always pay by check, money order, or bank draft made out to the insurance company - Never to the agent or anyone else. ALWAYS WRITE DOWN THE NAME, ADDRESS, AND TELEPHONE NUMBER OF THE AGENT OR INSURANCE COMPANY, SO YOU CAN FOLLOW UP LATER IF THERE IS ANY PROBLEMS WITH YOUR POLICY. Take Your Time! Beware of "last chance to enroll" statements. Don't be high pressured. Shop carefully and compare policies for what they cover and what they cost. Buying insurance is an important decision. Take enough time to feel confident about your choice. Consult others, if you can, before you buy. December 1998 Published in conjunction with Department of Aging Services - Title III

Results from search: http://www.northstateoutdoors.com/more_products.htm

Insurance-Chart.net - for General Insurance information, research and free quotes What are your Insurance needs ? Welcome to Insurance-Chart.net . This site is dedicate to providing you with valuable insurance inforamtion. The more information you have - the easier it will be to make the right desicion about your insurance needs. Today more than ever - consumers need to be more informed and involved in their financial lives. Insurance is a very important and initigral part of every families financial fitness. We're here to help ! indiana farmer insurance insurance policy search insurance premium finance insurance rate increase joint term life insurance kaiser health insurance kemper auto insurance level term life insurance life insurance lead life insurance oregon life insurance trust lost insurance policy louisiana dental insurance low cost dental insurance low cost health insurance low cost life insurance low cost medical insurance lowest cost term life insurance major medical health insurance major medical insurance malpractice insurance policy malpractice insurance rate maryland dental insurance maryland health insurance massachusetts dental insurance massachusetts health insurance medical insurance carrier medical insurance cost medical insurance law medical insurance rate medical insurance specialist medical insurance texas medical savings insurance medicare gap insurance medicare insurance supplement medicare supplemental insurance medicare suppliment insurance met life dental insurance mortgage protection insurance new jersey dental insurance new jersey health insurance new york dental insurance new york health insurance nonstandard car insurance north carolina dental insurance north carolina health insurance ohio dental insurance ohio health insurance ohio home insurance old insurance policy online home owner insurance online medical insurance oregon dental insurance oregon health insurance Free Insurance Quotes: Auto | Life | Home | Health | General Insurance help Your #1 General Insurance resource for free information! more products © 2002 All Rights Reserved

Results from search: http://www.cnn.com/ALLPOLITICS/1997/07/24/counterpoint/frech.html

AllPolitics - Counterpoint: Should Lawmakers Raise Medicare Premiums For The Affluent? - July 24, 1997 Wrong Fix, Wrong Time By Joe White 1997 1996 A Small Step In The Right Direction By H.E. Frech III and Kenneth L. Danger The Senate's proposal to charge higher premiums for Part B (physician's services) insurance for higher income Medicare beneficiaries is a small step in the right direction. It recognizes reality: Medicare is a welfare program, part of the governmental safety net. The details of Medicare are not part of the social contract. Medicare can be changed and still provide high quality coverage and access, but at a lower cost. This is the social contract. The Senate's action sets a useful precedent by changing something that's obvious to beneficiaries. Medicare has been treated as a political sacred cow, immune to serious reform, for too long. Like the rest of Social Security, Medicare is primarily paid for by taxes on those currently working. What Medicare beneficiaries receive is unrelated to what they paid in the past. This means that Medicare doesn't follow insurance principles; it redistributes income in complex ways, some favoring the poor and some favoring the wealthy. Perhaps unintentionally, the higher premiums for the wealthy will have good indirect effects on Medicare's benefit structure. Some of the wealthy will drop Part B and pick up private insurance instead. Competition will force these insurers to make intelligent use of copayments and managed care. Because the wealthy tend to be relatively big users of Medicare benefits, their defection may save money. Perhaps most important, the defection of some of the wealthy sets a good precedent for future reforms, increasing choice and pluralism. But, even at best, the Senate's proposal will only delay Medicare's financial problems. In the long run, it will do little to change the fundamental structure. The idea that rapid movement into efficient Health Maintenance Organizations (HMOs) will solve the problem is wishful thinking. Because the elderly often have valuable established relationships with physicians, they are reluctant to switch to traditional HMOs that don't include their physicians. The key problem is that many Medicare enrollees have additional private Medigap or state Medicaid insurance. The Physician Payment Review Commission (PPRC) estimates that nearly 90 percent of Medicare enrollees are covered by this supplemental insurance which often covers the deductible, the 20 percent coinsurance and balance billing by the physician. In effect, many Medicare beneficiaries have nearly 100 percent coverage, without the utilization control or limited provider panels of normal managed care plans. It should no longer be controversial that such complete coverage leads to high and wasteful utilization. Indeed, the effects of Medicare supplemental insurance coverage have been extensively studied by economists. Recently, the PPRC estimated that beneficiaries with private supplemental insurance consume 28 percent more care than those without it. Most of the extra utilization is paid for by Medicare, at an annual cost of about $1,000 per beneficiary. The growth of these supplemental plans over the years has progressively destroyed the cost controls sensibly built into Medicare in the beginning. We are surprised that Congress has allowed this to happen. Increased Medicare premiums will only slow Medicare's slide into bankruptcy. A more promising proposal by the Senate Finance Committee, dropped by the full Senate, was to increase the Medicare deductible for wealthy Americans. Adopting that proposal, or at least indexing the deductible to inflation, would slightly (but usefully) increase cost sharing. Indeed, in the last 30 years of Medicare the deductible has only been allowed to increase to $100. If it had been indexed to inflation, the deductible would be about $235 today. Medicare's design, never modern, has become more outdated over time. While increasing the deductible is a useful part of reform, much more can be done. Sensible economic incentives need to be created. First, Congress should first prohibit or sharply discourage private supplemental insurance coverage. Second, Medicare should be redesigned to improve catastrophic coverage (including drugs). Third, Medicare's managed care option should be expanded to include looser managed care plans, such as Preferred Provider Organizations (PPOs) or Point of Service (POS) plans. Such plans are more attractive than traditional HMO's, as they allow seniors to continue their established relationships with physicians. We would expect a rapid movement into PPOs and POS plans as a result of these reforms. The Senate's minor reform should be applauded. It is a small step in the right direction and a good precedent. But, we urge Congress and the Clinton administration to take the bolder steps outlined above. Large reforms in medical insurance have lead to equally large efficiency gains. When faced with a bankrupt Medicaid program, Tennessee promptly enrolled all of its Medicaid beneficiaries into HMOs, allowing an expansion of the program to 300,000 previously uninsured citizens. In a similar situation, California instituted competitive hospital contracting, saving hundreds of millions of dollars. Frech is professor of economics at the University of California, Santa Barbara, and an Adjunct Scholar at the American Enterprise Institute. Danger is a Ph.D. student and a lecturer at the University of California, Santa Barbara. home | news | in-depth | analysis | what's new | community | contents | search Click here for technical help or to send us feedback . Copyright © 1997 AllPolitics All Rights Reserved. Terms under which this information is provided to you.

Results from search: http://www.state.de.us/inscom/press12.htm

Delaware Insurance Department Commissioner Donna Lee H. Williams 841 Silver Lake Boulevard * Dover, DE 19904 * (302)739-4251 (Hours: Mon-Fri 8-4:30 EST) NewsMakers Commissioner Discusses Withdrawal of Medicare HMOs from Delaware (10/15/1998) 400,000 Medicare beneficiaries nation-wide will lose their managed care coverage as of December 31, 1998. While some maybe able to sign up with another HMO right away, others may not have that option for some time. In Delaware, 11,031 senior citizens are receiving termination notices by their Medicare HMOs and they are furious, frightened and bewildered. Why can the HMOs just cancel their coverage? Where will they get the health insurance coverage they need? While I cannot stop the carriers from pulling out of our market, I can help you understand the dynamics that have lead to their withdrawal. More importantly, I can explain your options for obtaining health insurance now. Why Are the Plans Withdrawing? The federal government provides Medicare benefits in two different ways: through traditional fee-for-service plans or through HMOs. In the traditional setting, the federal government reimburses you, the beneficiary, for most medical services, minus deductibles and coinsurance. For excess charges and those services not covered by Medicare, such as vision care and prescription drugs, you may purchase private coverage through a Medicare supplement ("Medigap" policy). In the second setting, the federal government contracts with managed care plans to provide all Medicare covered services to beneficiaries. The federal government pays the HMOs a monthly amount for each enrolled Medicare member in exchange for providing the services. Many HMOs throughout the country have decided not to renew their contracts with the federal government. Considering their options as independent businesses, weighing the costs of new federal mandates against the reimbursement from the federal government, they figured they could no longer afford to remain in business and pulled out of the market in 300 counties, including Delaware's. What Are My Options? (1) You may remain enrolled in your health plan until the end of the contract period, which is December 31, 1998. If you choose this option, you will be disenrolled automatically from the plan and returned to the Original Medicare fee-for-service plan as of January 1, 1999. (2) You may disenroll from the HMO and return to the Original Medicare Plan before the end of the contracting period. However, if you choose that option you may not be guaranteed certain protections with regards to Medicare supplemental insurance. (3) You may join another HMO. Currently, this option is only available to residents of New Castle County. The new contracting HMO is Cigna Health plan and can be reached at 1-800-465-9249. In time, residents of Kent and Sussex County, too, will have the option of signing up with another HMO. (4) If you return to the Original Medicare plan, you have the right to buy selected Medicare supplemental insurance plans to help pay for some or any of the services not covered under Medicare. As long as you apply for such coverage by March 4, 1999, you may not be denied coverage, regardless of your age or health status and must be issued a policy at the companies' standard rates. The ELDERinfo program at the Insurance Department is available to assist you in understanding this information and in making any important decisions. Please call us at 1-800-336-9500 for a comprehensive information package, including the Guide to Health Care for Senior Citizens which explains Medicare supplemental insurance, provides a list of companies authorized to sell them, and a comparison of benefits and prices. You don't have to go this difficult path alone. (302) 739-4251 This page was last updated on 06/16/2000

Results from search: http://dcoa.dc.gov/health/health_insurance.shtm

District of Columbia: Office on Aging Office on Aging DCOA HOME SERVICES Adult Learning Employment/Volunteer Health and Wellness Health Insurance     Counseling Housing Independent Living     Skills Program Lead Agencies Legal Information     and Assistance Meals and Nutrition Needs Assessment Nursing Home Services Outreach Senior Activities Service Programs Transportation INFORMATION ONLINE SERVICE REQUESTS   Health Insurance Counseling The George Washington University National Law Center's Health Insurance Counseling Project provides free health insurance information, education, and counseling services to Medicare beneficiaries and seniors who live in the District of Columbia. In addition to assistance with health insurance issues, HICP also assists seniors with resolving unpaid medical bills, making appeals for denials of medical services, and obtaining prescription medications. HICP can answer questions and provide assistance on issues relating to health insurance including Medicare, Medicaid, Medigap (Medicare supplemental insurance), Medicare+Choice (Medicare managed care), long-term care insurance, long-term care, federal employee health benefits, unpaid medical bills, HMOs, durable medical equipment, and hospice care. Information is also available from the federal government by phone or Internet by contacting 1-800-MEDICARE or www.medicare.gov . George Washington University National Law Center HICP 2136 Pennsylvania Avenue, NW Washington, DC 20052 Contact: (202) 739-0668 Fax: (202) 293-4043    Government of the District of Columbia John A. Wilson Building 1350 Pennsylvania Avenue, NW, Washington, DC 20004 Citywide Call Center: (202) 727-1000 Feedback & Comments | Privacy Policy | Terms & Conditions of Use

Results from search: http://www.consumeradvocateins.com/2000/healthHMO/articlesHealth/medicareSupplements.asp

What is Medicare Supplemental Insurance, MediGap? - Consumer Insurance Advocate Health/HMO Life and Accidental Death Disability       History   Attorney Profiles   Significant Cases   Related Links   Health / HMO Health Care Articles HMO Articles Glossary of Terms Acronyms FAQ's   Life/Accidental Death   Disability   Traditional Insurance & HMO's : Traditional Insurance Articles : Medicare Supplement Insurance, Medigap Briefly, Medicare is a federal health insurance program for people 65 and over and the disabled of any age. Under Medicare Part A, the federal government will pay a portion of your expenses for hospitalization, skilled nursing facility care or Hospice care ( not long term care ). Medicare Part B will pay a portion of medical expenses such as charges made by doctors, therapists or ambulances, and the cost of laboratory tests. For each medical service Medicare covers, there is some part Medicare DOES NOT PAY: Medicare Part A (hospitalization) and Medicare Part B (medical expenses) each has a deductible (the amount you must pay before Medicare will begin paying). After paying the applicable deductible, you must also pay a portion of the hospital or medical expenses called, "co-insurance" or "co-payment" (the portion of the expense you are responsible for paying). Medicare Supplemental policies (also known as Medigap policies), are designed to cover some of the gaps in the Medicare coverage. In July 1992, Congress passed legislation creating federal standards for Medicare Supplement insurance policies. As a result of "standardization," comparison shopping for insurance benefits is relatively easy. However, since most health insurance sold to seniors is sold by insurance agents in the home of the purchaser, it is easy to forget that the purchase of insurance is a business transaction. Whether you need more health insurance is a decision that only you can make. If you decide to buy more insurance, shop carefully and buy a policy that you can afford and offers the benefits you think you need most. Here are some helpful tips for you to keep in mind when shopping for health insurance. Shop Carefully Before You Buy Policies differ as to coverage and cost, and companies differ as to service. Contact different companies and compare the premiums before you buy. Don't Buy More Policies Than You Need Duplicate coverage can be expensive and generally is unnecessary. A single comprehensive policy is better than several policies with overlapping or duplicate coverage. Federal law prohibits an insurer from selling you a second Medigap policy unless you state in writing that you intend to cancel the first policy after the replacement policy goes into effect. Recent changes in the law affect beneficiaries who get help from the state through its Medicaid program in paying their health care costs. Anyone who sells you a policy in violation of the various anti-duplication provisions is subject to criminal and/or civil penalties under federal law. Call 1-800-638-6833 to report suspected violations. Consider Your Alternatives Depending on your health care needs and finances, you may want to consider continuing the group coverage you have at work, joining a managed care plan, buying a Medigap policy, or buying a long-term care insurance policy. Check For Pre-existing Condition Exclusions In evaluating a policy, you should determine whether it limits or excludes coverage for existing health conditions. Many policies do not cover health problems that you have at the time of purchase. Pre-existing conditions are generally health problems you saw a doctor about within the 6 months before the date the policy went into effect. If you have had a health problem, the insurer might not cover you for expenses connected with that problem. Medigap policies, however, are required to cover pre-existing conditions after the policy has been in effect for 6 months. Some companies have shorter waiting periods before covering a pre-existing condition. Beware of Replacing Existing Coverage Be careful when buying a replacement Medigap policy. Make sure you have a good reason for switching from one policy to another-you should only switch for different benefits, better service, or a more affordable price. On the other hand, don't keep inadequate policies simply because you have had them for a long time. If you decide to replace your Medigap policy, you must be given credit for the time spent under the old policy in determining whether and to what extent any pre-existing conditions restrictions apply under the new policy. You must also sign a statement that you intend to terminate the policy to be replaced. Do not cancel the first policy until you are sure that you want to keep the new policy. You have 30 days to decide. Policy Delivery or Refunds Should be Prompt The insurance company should deliver a policy within 30 days. If it does not, contact the company and obtain in writing the reason for the delay. If 60 days go by without a response, contact your state insurance department. Prohibited Marketing Practices It is unlawful for a company or agent to use high pressure tactics to force or frighten you into buying a Medigap policy, or to make fraudulent or misleading comparisons to get you to switch from one company or policy to another. Deceptive "cold lead" advertising also is prohibited. This tactic involves mailings to identify individuals who might be interested in buying insurance. If you fill in and return the card enclosed in the mailing, the card may be sold to an insurance agent who will try to sell you a policy. Be Aware of Maximum Benefits Most policies have some type of limit on benefits. They may restrict either the dollar amount that will be paid for treatment of a condition or the number of days of care for which payment will be made. Some insurance policies (but not Medigap policies) pay less than the Medicare-approved amounts for hospital outpatient medical services and for services provided in a doctor's office. Others do not pay anything toward the cost of those services. Policies to Supplement Medicare Are Neither Sold Nor Serviced by the State or Federal Governments State insurance departments approve policies sold by private insurance companies, but approval only means the company and policy meets requirements of state law. Do not believe statements that insurance to supplement Medicare is a government-sponsored program. If anyone tells you that they are from the government and later tries to sell you an insurance policy, report that person to your state insurance department or federal authorities. This type of misrepresentation is a violation of federal and state law. It is also unlawful for a company or agent to claim that a policy has been approved for sale in any state in which it has not received state approval or to use fraudulent means to gain approval. Know With Whom You're Dealing A company must meet certain qualifications to do business in your state. You should check with your state insurance department to make sure that any company you are considering is licensed in your state. This is for your protection. Agents also must be licensed by your state and may be required by the state to carry proof of licensure showing their name and the company they represent. If the agent cannot verify that he or she is licensed, do not buy from that person. A business card is not a license. Keep Agents' and/or Companies' Names, Addresses and Telephone Numbers Write down the agents' and/or companies' names, addresses and telephone numbers or ask for a business card that provides all that information. Take Your Time Do not be pressured into buying a policy. Principled sales people will not rush you. If you are not certain whether a policy is what you need, ask the salesperson to explain it to a friend. Keep in mind, however, that there is a limited time period in which new Medicare Part B enrollees can buy the Medigap policy of their choice without special conditions being imposed (see page 16). Once this open enrollment period ends, you may be limited as to the Medigap policies available to you, especially if you have a pre-existing health condition. If You Decide To Buy, Complete the Application Carefully Do not believe an insurance agent who says your medical history on an application is not important. Some companies ask for detailed medical information. If you leave out any of the medical information requested, coverage could be refused for a period of time for any medical condition you neglected to mention. The company also could deny a claim for treatment of an undisclosed condition and/or cancel your policy. Look For an Outline of Coverage You must be given a clearly worded summary of the policy . . . READ IT CAREFULLY. Do Not Pay Cash Pay by check, money order or bank draft made payable to the insurance company, not to the agent or anyone else. Get a receipt with the insurance company's name, address and telephone number for your records. #   #   #   # Need Assistance? HICAP Health Insurance Counseling and Advocacy Program Administered by the California Department of Aging. Free health insurance counseling and assistance for California residents 60 years old or older. To avoid conflicts of interest, HICAP counselors may not be licensed to sell insurance or actively work for any insurer or insurance agency. CALIFORNIA DEPARTMENT OF INSURANCE (800) 927-HELP (4357) Offers complaint history of any licensed insurer.   home | disclaimer | contact us | site design credits | about us | health/HMO life and accidental death | disability copyright 2000 - 2001, Ernst & Mattison, Inc.  

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WSHIIP Wyoming State Health Insurance Information Program (WSHIIP) Trained counselors promote consumer understanding of Medicare, Medicaid, Medicare supplement and long-term care insurance.  Call 1-800-856-4398 for: Free service Specially trained counselors Unbiased information providers Consumer retains all rights to choices Free Long Term Care Insurance Buyers Guide available Free Medicare Supplement Insurance Buyers Guide available WSHIIP volunteers must attend yearly in-services to keep them up-to-date on Medicare issues. Towns with WSHIIP Volunteers Arapahoe Baggs Buffalo Burlington Casper Cheyenne Cody Dixon Douglas Dubois Elk Mountain Encampment Evanston Fort Washakie Gillette Glenrock Green River Greybull Hanna Hulett Jackson Kemmerer Lander Laramie Lusk Medicine Bow Moorcroft Newcastle Pinedale Rawlins Riverton Rock Springs Saratoga Sheridan Shoshoni Sundance Teton Village Thayne Thermopolis Torrington Wheatland Worland Wright Call 1-800-856-4398 for further information, specific names and phone numbers of volunteers.           Medicare+ Choice in Wyoming We all know that Medicare does not pay 100% of medical bills. In Wyoming, the only choice available for beneficiaries to help fill in the gaps is supplemental insurance. Medicare is encouraging companies to offer the other options, such as HMOs, MSAs, PSOs, etc., but again, as of now supplemental insurance (Medigap) is the only choice available in Wyoming.   Wyoming Senior Citizens, Inc. in partnership with the Aging Division of Wyoming and the Administration on Aging began a three-year project entitled Senior Patrol. The Senior Patrol project is designed to educate seniors and the general public to identify Medicare/Medicaid fraud, waste and abuse. Wyoming Senior Citizens, Inc., Ombudsman and the Wyoming State Health Insurance Information Program will lead the project. The WSHIIP Volunteers will also be very involved. Visit our Senior Patrol Project link to learn more about Medicare/Medicaid fraud, waste and abuse. For an explanation or address of insurance companies that carry MEDICARE SUPPLEMENT "MEDIGAP" INSURANCE or LONG-TERM CARE INSURANCE click on either title. The Wyoming Aging Division and HCFA are sites for information for seniors in Wyoming. contact the WSHIIP representative nearest you: email Janet Hackleman WSHIIP Manager P.O. Box BD Riverton, WY 82501 1-800-856-4398 Fax: (307)856-4466 Virginia King WSHIIP Coordinator 951 Werner Court, Suite 295 Casper, WY 82501 1-307-235-5959 Fax: (307)235-5960 OMBUDSMAN     COMPANIONS     PATROL    HOME    EMPLOYMENT    RESPITE CAREGIVER

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