Fewer Top-Value HMO Plans for Seniors, Disabled
California seniors and disabled people who are looking for good value in Medicare HMO plans have a diminishing range of choices, according to a guide released Wednesday by Consumers Union and the California Health Care Foundation.
The 2003 Guide to California Medicare HMOs, which calculates consumer value by weighing benefits such as prescription drug coverage against costs, gave top ratings to only 11% of Medicare health-maintenance organizations this year, contrasted with 44% two years ago. Nearly all of the top-rated Medicare HMOs are in the greater Los Angeles area.
Over the past three years, the plans, which expand upon basic Medicare coverage, have been trimming benefits such as prescription drug coverage as they have been raising premiums and other out-of-pocket costs, said Ann Monroe, director of the Quality Initiative for the California HealthCare Foundation, an Oakland-based health-care philanthropy and research group.
"People can't assume the plan that they've had for a number of years is still the right plan for them because there have been so many changes," Monroe said. She recommended that Medicare HMO participants consider their individual needs for prescription drug coverage and doctors' visits when choosing a plan.
Medicare HMOs all over the country are asking beneficiaries for more money and cutting benefits, said Karen Davis, president of the Commonwealth Fund, which sponsors health-care research.
Nationwide, Medicare beneficiaries are paying $37 a month in premiums this year, up from $14 in 2000. In that same time period, the percentage of Medicare plans with prescription drug coverage has dropped from 78% to 69%.
HMO industry representatives blame coverage cutbacks and price increases on low federal reimbursements that haven't kept pace with the costs of medical care. Medicare HMOs are "a powerful example of how private health plans can bring affordability, flexibility and new choices to the Medicare program," Karen Ignagni, president of the American Assn. of Health Plans, said in a statement last week. But, she added, "insufficient funding continues to limit beneficiaries' ability to receive these coverage options on a wider scale."
The highest rating among the state's plans in the Guide to California HMOs -- marked with five stars -- went to two plans that operate only in Los Angeles and Orange counties. Both of the plans, Blue Shield 65 Plus Value Plan and CareMore California Medical Advantage, are in their first year of operation.
