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To paraphrase Tip O'Neill's "All politics are local,"
all HMOs are local. I do not
have to look far from New York City to see two examples of geographical
differences from Manhattan (New York County) where 12 insurance
organizations offer 28 HMOs and 9 PPOs–- to two neighboring
counties – Suffolk and Nassau.
Suffolk County in 2008 has four HMO organizations offering
a total of seventeen HMO and PPO Plans.
Another neighbor, Nassau County, in 2008, has seven insurance
organizations offering twenty one HMO and PPO plans for
enrollment.
Additionally, the monthly premiums in the total of thirty-eight
plans in Nassau and Suffolk Counties range from $0 for ten plans to
premiums of $24.10 to $99.50 for the twenty-eight remaining HMOs and
PPOs -- whereas, in Manhattan (New York County), only four out of 37
HMO and PPO plans have premiums amounting to $24.10 to $85.
At this high point of participation in HMOs and PPOs, I
believe it would be useful to give you their history (few PPOs up to
2002) – food for a thoughtful discussion on private health
plans. The following information
is taken from my postings of 8/17/01 and 12/3/01 on HMO segment 5.
Suffolk County and Nassau County have come a long way
since 2001 and 2002 – two low point years. Suffolk County in 2001 had only two
HMO organizations offering plans – one HMO offered one plan for
enrollment, and the second offering two plans, announced a termination
of the plans in the summer of 2000 but changed their minds after
Thanksgiving. This decision to
remain in the market allowed over 11,000 members to continue in the HMO
program. Suffolk County in 2002
again had two HMO organizations offering three plans. Nassau County in 2001 had four HMO
organizations offering 8 plans and in 2002, three HMO organizations
offered nine plans.
In July 2000, according to a fact sheet released then by
the Health Care Financing Administration (the forerunner to the Centers
for Medicare and Medicaid) 65 HMOs did not renew their contracts and 53
reduced their service areas for the year 2001. This press release goes on to state
that “This change affects more than 934,000 Medicare
beneficiaries” and “About 775,000 of the affected
beneficiaries will be able to enroll in another Medicare HMO, if the
HMO is accepting enrollees.”
“…if the HMO is accepting enrollees” means if
the HMOs have not yet reached capacity limits as result of the
switching of beneficiaries who will be losing their current HMOs. And the fact sheet goes on to state
that “About 17 percent
or 159,000 of the remaining beneficiaries will be left
with no Medicare + Choice HMO options…” It seems to me that the above
statistics describe a volatile situation that may recur annually.
And in a
9/21/01 preliminary status report of the Centers for Medicare &
Medicaid Services, twenty-two HMOs did not renew their contracts and
thirty-two reduced their service areas for the year 2002. This change affected approximately
536,000 Medicare beneficiaries (all HMOs except one PPO) or 10 percent
of Medicare + Choice enrollees. This
press release goes on to state that most affected enrollees will have
another HMO plan to select. The
exceptions will be 38,000, who have no option but to return to the
Original Medicare fee-for-service program. Just over 50.000 will have access to a
Private Fee-for-service program.
I went on to
state in my second posting of 12/3/01 (HMO segment 5) that the above is
a fair two year view, but I believe we need a wider view. This was presented in the following
abstract from a September 2001 report on Medicare + Choice by The Henry
J Kaiser Family Foundation:
“The
number of HMOs available in the 1990s grew rapidly rising from 96 in
1990 to 346 in 1998. In 1999 and
each of the following two years, however, the number of plans
participating in Medicare declined.
Today (2001), 178 M + C plans participate in Medicare.”
In my 12/3/01
posting on HMO segment 6 regarding the HMO picture in the five boroughs
of New York City for 2002, I stated the following: “New York City
has been fortunate with Medicare HMO non-renewals – only one HMO
with 434 participants in just one of the city’s five counties,
New York (Manhattan).”
As is my custom at the end of each subject, I suggest that
you refer to the Resources Page for literature and personal assistance
– and I particularly highlight web sites, to indicate the importance of this source of information. I explained in the previous segment
the importance of medicare.gov. in selecting an HMO or PPO. Also, websites of various HMO
organizations can give you a preview of the summary benefit brochures,
before you receive the hard copy and in some cases give you additional
information such as network of physicians and listings of covered
prescription drugs. It has
proved to be a key tool, so I believe that all counselors and Medicare
beneficiaries should learn how to access the Internet. I realize that there are too many
seniors who are not computer/internet literate, but training and access
are available in libraries and similar community organizations –-
so do try. It can make a
difference.
Updated: January 10, 2008
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