Unraveling Medicare Mysteries
Pop quiz: What’s the name of the new program that's meant to give the elderly more options in their government-sponsored health care? A) Medicare, B) Medigap, C) Medicaid, D) Medicare+Choice or E) Metamucil? The correct answer is D, but don't feel bad if it all sounds the same to you. Medicare, the federal government's health insurance program for people over 65, has always been a little baffling. Simply figuring out the difference between Part A (hospital) from Part B (supplemental) was never easy. And then seniors were lured into Medicare HMOs with the promise of more benefits at lower cost in exchange for less control over their care. The task of understanding Medicare will get even more confusing for people this fall, when the program rolls out an expanded menu of choices for the elderly. Among the new concepts they'll be expected to grasp are medical savings accounts (MSAs) that will provide recipients with a limited pot of money to spend on medical care as they want, and provider sponsored organizations (PSOs) which are basically HMOs operated by doctors and hospitals, who think they can care for patients better than an insurance company can.Consumer advocates are worried that older Americans who already lack a grounding in the complexities of the program will be thoroughly confused by the changes. In fact, in a recent survey that shockingly few recipients of Medicare have a clue about how the current, relatively uncomplicated system works. Just 11 percent of those surveyed understood enough about the Medicare program to make an informed choice between traditional Medicare and an HMO. Just half understood what is meant by a "primary care provider" or "network" of doctors, both of which are crucial to basic use of a managed care plan. So what to do in the face of all this change? Well, if you're visiting this site, you have everything you need to also access some of the most helpful consumer information about Medicare short of talking to a real live human being. The federal government has designed a new Web site that allows you to compare the relative merits of various Medicare HMOs side by side. It's called Medicare Compare, and if it's new to you, you're not alone. Medicare hasn't done a lot to publicize the service, and even declined to discuss it for this article because it's still working the bugs out. But that doesn't mean you can't give it a whirl. It's located at www.medicare.gov. Eventually, it will include detailed information about the new choices to be available later this year. Now it includes information about standard (known as fee-for-service) and managed Medicare (HMOs). Basically, you just plug in your ZIP code or state and the program will bring up all the Medicare managed care plans in your area. You can compare the benefits they offer such as annual physical exams. You can also compare those plans with the benefits you would receive under regular Medicare. While the information Medicare Compare provides may not be the be-all and end-all of your search, it's a good place to begin, say consumer advocates who've tried it. "It's a starting point," says Julie Schoen, attorney and special projects director for the Orange County, Calif., office of HICAP, a Medicare consumer advice service. "People call us and ask what's the best plan to join, but we can't answer that. People have to do their own investigation." Still, consumer advisers such as HICAP can offer some pointers in the search. For instance, check whether your own doctor and nearby hospital is used by the plan. Ask your doctor whether she or he has any opinions about which plan is best. And, Schoen urges, don't simply attend one HMO's nifty meeting and let their donuts and slick brochures convince you. Do some shopping around before making a decision. “If you put as much time into picking as you do buying a car, you’ll probably be OK,” she says. Besides HCFA's Web site, try some of the other consumer advice sites on the Web, such as that offered by Schoen's organization (www.hicap.org) or the so-called "intermediaries" that help carry out Medicare. The intermediary that serves Illinois and Indiana has an information-packed Web site at www.medicareinfo.com. Unless you're unusually well versed in the health care system, though, there's a chance you'll need a real live human being to help you through the process at some point. The best place to find one is through a network of consumer advice centers called Information Counseling and Assistance, or ICA. Check the www.medicare.gov Web site for its "who to contact" list, or check with a local senior center. For general information about Medicare or a referral to a state counselor, call the Medicare hotline at (800) 638-6833.
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