Ride For Life: Advocates say Medicare drug benefit need growing

Reuters September 11, 2002 11:52 AM ET

NEW YORK (Reuters Health) - Many seniors will choose to return to traditional Medicare when their health plans drop out of the Medicare program in January, further underscoring the need for a Medicare drug benefit, patient advocates say.

While the final number of health plans exiting the Medicare+Choice (M+C) program in 2003 is still being tallied, an estimated 200,000 Medicare beneficiaries are expected to be affected, according to the American Association of Health Plans.

Monday was the deadline for health insurers to notify the Centers for Medicare and Medicaid Services (CMS) if they intend to drop any Medicare product offerings next year. HMOs have until October 2nd to inform seniors enrolled in the affected plans. Indeed, many seniors still don't know about the looming disruptions, advocates said.

"It all goes without saying that any beneficiary that's affected is obviously going to be inconvenienced, unhappy and potentially facing higher out-of-pocket costs and reduced benefits," said Joyce Dubow, a senior policy adviser with AARP's Public Policy Institute.

Medicare HMOs generally offer richer benefits than traditional Medicare, covering many preventive services and providing, in some plans, some level of outpatient drug coverage.

With the latest round of health plan pullouts, affected seniors must choose another managed care plan--if available--or go back to the traditional Medicare program.

"We expect people with Medicare will continue to vote with their feet and return to original Medicare," said Robert Hayes, president of the Medicare Rights Center in New York. "The Bush administration and Congress should fill the coverage gaps in Medicare and enact a meaningful prescription drug plan immediately," he said.

So far, Congress has been stymied in reaching agreement on legislation to create a prescription drug legislation benefit in Medicare. Advocates say the unraveling of the Medicare+Choice program highlights that need. "Clearly it speaks to the benefit of having a drug benefit in Medicare," Dubow said. "Lots of people joined M+C plans for the drug coverage that's offered."

AARP has been very outspoken about the need for Congress to address the drug benefit issue before it considers so-called provider "givebacks" to provide additional Medicare funding for doctors, hospitals and HMOs.

Health plans, meanwhile, are shedding unprofitable Medicare operations while continuing to press for additional funding.

Aetna Inc., the giant Hartford, Connecticut-based insurer, said on Monday that it expects to pull its Medicare HMO products for individuals in three Pennsylvania counties and two New Jersey counties. It will continue offering a Medicare HMO product in 26 counties in four states.

Los Angeles-based Health Net Inc. said it is dropping Medicare HMO products in portions of two California counties, a move affecting fewer than 1,000 beneficiaries, it said.

Health Net plans to continue coverage in 27 counties in five states. It also announced plans to reopen Medicare+Choice HMO enrollment in three counties in Arizona and four counties in Florida, lift enrollment caps in three Connecticut counties and add an individual product in two California counties.