Health Care Talk Targets Seniors Address Confusion Over Medicare, Managed Care
Insurance companies are working hard to lure Spokane County senior citizens away from their traditional Medicare plans.
Seniors wade through a confusing myriad of new options from companies aggressively marketing their plans - sometimes charging no premiums at all.
“It’s kind of frightening,” said Reed Hansen, an American Association of Retired Persons volunteer. “They don’t want to leave something they’re familiar with.”
People looking for help might find it Thursday at a free public forum designed to explain the pros, cons and costs of competing plans.
In Washington and the rest of the nation, more and more seniors are opting for managed care plans, following the footsteps of the younger generation.
Managed care plans are designed to cut medical costs, in part by limiting patients to certain doctors. Patients have low out-of-pocket expenses but at a cost: “Gatekeepers” often decide when they can see specialists.
Republican leaders are encouraging the trend as a way of rescuing the expensive Medicare program from bankruptcy.
About 14 percent of the 700,000 people eligible for traditional Medicare in Washington have switched to managed care plans, according to AARP statistics. In Oregon, a quarter of seniors are enrolled in managed Medicare programs.
Some older people are choosing that route for lower premiums. Many managed care plans offer low out-of-pocket expenses for hospital and doctor visits, while Medicare patients may pay 20 percent of costs themselves.
Other people reject managed care because they’d be forced to choose from a limited number of doctors and specialists.
Dr. Leonard Vanderbosch, a north Spokane general practitioner, said about 100 of his patients have switched to managed Medicare. “I’m seeing new ones every day.”
People who see just one doctor like the plans best, he said.
“The only people who get real concerned are the people who see multiple specialists and worry they won’t be able to,” Vanderbosch said. “Some are frightened by it because they think they’re managed out of care.”
Managed care also can be tricky for people who travel a lot or who summer elsewhere - far from their assigned doctors.
“We’re not saying they should buy it right off the bat,” said Chris Carlson, a representative for the state insurance commissioner.
“It’s not the best for people who travel or want to keep their specialists. We just say it’s up to them to decide.”
So far, Carlson said she’s heard few complaints about Medicare managed care, popular in Washington only recently.
In Spokane County, Group Health, PacifiCare, Qual-Med and Sisters of Providence offer such plans. Monthly premiums range from zero to $106.
Some companies absorb the premium because they’re reimbursed so well by the federal Health Care Financing Administration, said Carlson.
Insurance companies are basically subcontracting with the federal government, which usually pays a fixed amount per patient, regardless of the care given.
For seniors favoring stability, the options can seem daunting, said Dr. John Gollhofer, president of the Spokane County Medical Society.
“Medicare policies have been pretty straightforward,” said Gollhofer. “Now it’s very confusing. One will cover the cost of medicine; another will cover medicine with a $5 premium. One covers hearing aids, another doesn’t.”
Gollhofer will try to ease the confusion at Thursday’s forum, along with representatives from the AARP and insurance commissioner’s office. The two-hour meeting begins at 10 a.m. in the downtown Spokane library.
Hundreds of seniors turned out for similar forums this week in Tacoma and Seattle.
, DataTimes MEMO: This sidebar appeared with the story: AARP ADVICE The American Association of Retired Persons has these suggestions for people switching from traditional Medicare to managed care insurance plans: If you have doctors you don’t want to leave, find out if they participate in a managed care plan you can join. Get this information from plans you’re interested in: benefits and premiums; participating doctors; participating hospitals and medical facilities; a copy of the member’s handbook and grievance procedures. Think twice about joining if you travel often or spend several months a year in a second home. If you join a managed care plan, consider keeping your Medigap policy for a few months while you make sure the new plan is working. If you leave a Medicare managed care plan, notify the Social Security Administration promptly to assure you’re re-enrolled (1-800-772-1213).