What to Tell Your Patients When Their Medicare Managed Care Plan Quits
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If you have patients among the 327,000 Medicare beneficiaries forced to change their coverage, here's how you can help.
Fam Pract Manag. 1999 Oct;6(9):13-14.
HCFA recently announced that 327,000 Medicare beneficiaries will need to change their coverage this fall. The managed care plans in which these beneficiaries are currently enrolled are either not renewing their contracts with Medicare or are reducing the number of counties they serve. Many Medicare+Choice plans are unhappy with HCFA's reimbursement structure, which assigns an adjusted average per capita cost per enrollee that varies widely from region to region. If your Medicare patients have questions about these changes, here is some advice you can share to help ease their minds.
Five things for patients to remember
No matter what happens, patients will still be covered by Medicare. The 327,000 beneficiaries affected by a Medicare managed care plan withdrawal will automatically be enrolled in traditional Medicare beginning Jan. 1, 2000, if they do not enroll in another plan by Nov. 30, 1999. Beneficiaries interested in purchasing a Medigap policy for supplemental coverage should contact a Medigap insurer by the end of November to ensure a Jan. 1 effective date.
Patients' current managed care plans must cover them until Dec. 31, 1999.
Patients affected by a plan withdrawal can choose who will provide their health care coverage. They should make sure they have answers to all their questions before they make a decision. In September, affected patients should have received information from their current Medicare managed care plan to help guide their decision. This material covers available Medicare and Medigap options.
Additional resources are available to help Medicare patients make a new health care coverage choice. (See “Medicare resources.”)
Managed care plans continuing to serve the Medicare population have been required to accept enrollment forms from affected beneficiaries since Sept. 15 and will continue accepting them through Nov. 30. New coverage under the plans will be effective Jan. 1, 2000.
Other things patients need to know
Patients enrolled in traditional Medicare are not affected. Likewise, patients enrolled in Medicare managed care plans that are not changing their contracts with Medicare are not affected.
Patients or their spouses with health care coverage through a former employer or union should contact their employer or union before they choose a new health plan. This is because the terms of a patient's secondary insurance may affect which form of Medicare the patient selects. Similarly, patients with Medicaid coverage should not make a new health plan choice until they contact their state's medical assistance or Medicaid program.
What physicians need to know
Your relationship with a managed care plan that's withdrawing from Medicare will terminate on Dec. 31, 1999, as well. Please consult your contract with the plan for more details about how your practice will be affected.
Also, when responding to your patients' questions on this issue, you are permitted to describe other Medicare managed care plans with which you are involved. However, HCFA discourages you from providing applications for those plans or otherwise steering beneficiaries toward particular plans with which you participate.
Medicare patients often view family physicians and their staffs as a source of information about their Medicare coverage as well as their health concerns. With this in mind, we hope this information will help you address any questions you may receive about changes in your patients' Medicare coverage.
To help beneficiaries and their caregivers, HCFA has established several information resources:
Medicare+Choice Help Line
800-MEDICARE (800–633–4227) This number is staffed by English-and Spanish-speaking customer service representatives. Hearing-impaired individuals using a telephone device for the deaf can call 877-486-2048 for assistance. Both toll-free numbers are staffed Monday through Friday from 8 a.m. to 4:30 p.m. during the caller's local time zone.
Local information activities
HCFA is planning local activities in many areas affected by plan withdrawals. For information about these events, call 800-MEDICARE.
Geared toward the public, this site provides information on the Medicare program, including the text of the “Medicare and You 2000” handbook and the “1999 Guide to Health Insurance for People With Medicare.” Visitors can check the Medicare Compare database to see if any new managed care plans have become available.
Most helpful to physicians, this site provides a more thorough explanation of the 1999 Medicare+Choice nonrenewal issues.
Kent Moore is the AAFP's manager for reimbursement issues and a contributing editor to Family Practice Management.
Copyright © 1999 by the American Academy of Family Physicians.
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