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'Good Tool' for Seniors in Need of an HMO

Medicare: New consumer guide offers comparisons on costs, services offered by health plans in California.

July 02, 2001|DAVID R. OLMOS | TIMES HEALTH EDITOR

For about 1.5 million California seniors enrolled in Medicare health maintenance organizations, the task of selecting a health plan has been daunting. Many people rely on recommendations from friends, feel-good advertisements or finding their doctor in the HMO's booklet.

What's been needed is information that would allow people to directly compare how Medicare HMOs throughout California measure up on costs and services. A new consumer guide helps fill that need by providing such information as the cost of office visits, descriptions of the prescription drug benefits and how satisfied current members are with their HMOs. The guide rates HMOs in every county in the state.

The report, "A Guide to California Medicare HMOs," was prepared by Consumers Union, the Yonkers, N.Y.-based nonprofit organization that publishes Consumer Reports magazine. The study was funded by a $261,000 grant from the California HealthCare Foundation, a nonprofit charity and research organization based in Oakland. Some of the information in the guide relied on public data available from the federal agency that runs Medicare.

"There have been no standard comparisons of HMOs by county until now," said Ann Monroe, director of the California HealthCare Foundation's program on medical quality. "We thought it would be a good tool not just for seniors, but for the families and organizations that advise them to make better-informed decisions."

The research by Consumers Union found that there were significant differences in the benefits offered by Medicare HMOs, and that the more expensive plans did not always offer better services.

About 4 million Californians are eligible for Medicare, and about 38% of people in the federal health program opted to join an HMO rather than participate in the traditional Medicare program.

The Good News for L.A.

The good news for Los Angeles County residents was that five of the 14 plans surveyed received a five-star rating for offering the "best overall value" to Medicare recipients. Those five plans were: UHP Healthcare for Seniors, Maxicare's MAX 65plus, SCAN Health Plan, Blue Cross Senior Secure and Blue Shield 65 Plus. The value rating is based on a calculation that takes into account the generosity of the benefits offered in relation to the premiums you have to pay, according to Consumers Union.

The ratings do not necessarily mean that the higher-rated plans will deliver the best medical care when the patient needs it.

The closest the Consumer Union survey comes to providing information on the quality of medical care are surveys that measure how "satisfied" members are with their health plan. It's important to know that satisfaction surveys include information from patients who see doctors throughout an HMO's vast network--not just the doctor or medical group the patient may belong to.

"What the survey doesn't tell you, and probably couldn't tell you, is the quality of services provided by the individual doctors within the plan," Monroe said.

The guide does include information, culled from government data, on how well the plans perform on key preventive services such as breast cancer screenings, beta blocker treatment after a heart attack, and retinal eye exams to prevent blindness among diabetics.

Copies of the complete guide are available for free by calling (888) 430-2423. The report may also be viewed on the Internet at http://www.chcf.org and http://www.consumerreports.org.

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Rating the Medicare HMOs

Los Angeles County

HMO Plan Name: UHP Healthcare for Seniors

Plan value (Five stars, highest; one star, lowest): * * * * *

Cost per office visit: $0

Plan monthly premium: $0

-How members view the plan-

Overall satisfaction: Above average

Ease of referrals: Below average

*

HMO Plan Name: Maxicare MAX 65plus

Plan value (Five stars, highest; one star, lowest): * * * * *

Cost per office visit: $0

Plan monthly premium: $0

-How members view the plan-

Overall satisfaction: Average

Ease of referrals: Below average

*

HMO Plan Name: SCAN Health Plan

Plan value (Five stars, highest; one star, lowest): * * * * *

Cost per office visit: $5

Plan monthly premium: $0

-How members view the plan-

Overall satisfaction: Average

Ease of referrals: Below average

*

HMO Plan Name: Blue Cross Senior Secure

Plan value (Five stars, highest; one star, lowest): * * * * *

Cost per office visit: $0

Plan monthly premium: $0

-How members view the plan-

Overall satisfaction: Average

Ease of referrals: Below average

*

HMO Plan Name: Blue Shield 65 Plus

Plan value (Five stars, highest; one star, lowest): * * * * *

Cost per office visit: $5

Plan monthly premium: $0

-How members view the plan-

Overall satisfaction: Average

Ease of referrals: Below average

*

HMO Plan Name: Inter Valley Health Plan Service to Seniors

Plan value (Five stars, highest; one star, lowest): * * * *

Cost per office visit: $5

Plan monthly premium: $0

-How members view the plan-

Overall satisfaction: Above average

Ease of referrals: Above average

*

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