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GEN: A Shoe Waiting to DropFrom: art fougner, md (evsono@pipeline.com)Fri Mar 1 08:39:03 2002
This in today's ReutersHealth - Seniors unaware of HMO "lock-in" Last Updated: 2002-02-28 16:14:16 EST (Reuters Health) By Karen Pallarito NEW YORK (Reuters Health) - A little-known provision of federal law is about to catch up with the 5 million Americans who are enrolled in Medicare HMOs, a new survey suggests. The rule, which took effect this year, prevents Medicare HMO enrollees from freely switching in and out of health plans on a monthly basis or opting back into traditional Medicare. For many older Americans, the so-called "lock-in" requirement will likely come as a shock, say experts at the Medicare Rights Center, a national advocacy group. In survey results released today, a staggering 83% of people enrolled in a Medicare HMO or considering joining one did not know about the lock-in rule. Congress passed the lock-in requirement as part of the 1997 Balanced Budget Act. Under the rule, Medicare beneficiaries may change coverage only once between January and June of this year. The rule prohibits any changes for the rest of the year. The lock-in is set to take full effect in 2003. "All of the surveys show that the vast majority of older and disabled Americans do not understand many Medicare basics, so it's not surprising that they were not aware of this rule," said Diane Archer, special counsel to the Medicare Rights Center. "But the consequences can be devastating." Archer told Reuters Heath of one HMO enrollee who was diagnosed with cancer and had to move in with a family member in another state temporarily. The enrollee couldn't change coverage because of the lock-in, but his HMO didn't provide out-of-state coverage, she said. A woman from New York experienced a similar dilemma after traveling to Wisconsin and going into diabetic shock, Archer said. The HMO paid for her emergency out-of-state hospitalization, but when she decided to remain with her daughter out of state, she couldn't get coverage for ongoing therapy. "People aren't thinking about what kinds of care they're going to need if and when they become really sick," Archer said. "The rule can undermine continuity-of-care, which can be critical to people with serious health conditions, and it can prevent people who become sick from accessing care they need if they need to leave the service area in order to get the care." Some lawmakers recognize the problem and are pushing for repeal. While the House of Representatives has passed a bill to delay the lock-in until 2003, the Senate has yet to move a similar measure. The lock-in also poses potential difficulties for the already-embattled Medicare+Choice program. Mohit Ghose, a spokesman for the American Association of Health Plans, says it adversely impacts enrollment in Medicare+Choice plans by discouraging beneficiaries from choosing an HMO. Seniors are more likely to choose an HMO "if they know they can step out of it," he explained. Since HMOs typically offer richer benefits than traditional Medicare, the lock-in only serves to take away the possibility of beneficiaries getting enhanced benefits, he added. Ghose said the lock-in dilemma "just makes it that much more important" for Congress to act "as soon as possible" to shore up the troubled Medicare+Choice program. if you think AARP is worked up over prescription drug benefits - wait til this one hits. more doubtless to follow. art
-- art fougner, md ich bin ein New Yorker
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