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In the years 2001 to 2008 I illustrated the geographical
differences in access and cost of Medicare HMOs and PPOs between
“better off” Manhattan and neighbors Nassau and Suffolk
County. Beginning with 2009, I
planned to draw a comparison between those eight years and the present.
In the tenth year, 2010, Nassau and Suffolk Counties have
access to forty-five HMOs and PPOs vs. the forty-two plans offered in
Manhattan and the cost differences are also closing.
At this high point of participation by Nassau and Suffolk
Counties 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).”
Health Care
Insurance reform is expected to be in the news in the coming months and
history is believed to be a great teacher – I thought I might
give you some history.
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: March 24, 2010
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