Bennies ignore new Medicare+Choice pilot

Wednesday, April 30, 2003

WASHINGTON — It doesn’t look like the Bush administration’s plan to move more Medicare beneficiaries into managed Medicare programs is going to be an easy sell.

As of March 1, fewer than 57,000 of an eligible 11 million beneficiaries had enrolled in the administration’s pilot PPO program. Those numbers don’t bode well for the administration’s desire to see even more of the nation’s 40 million Medicare beneficiaries move from fee-for-service to health plans operated by private companies, the Chicago Tribune reported.

That lack of enthusiasm doesn’t surprise home medical equipment providers.

“I think it’s once bitten, twice shy,” said Linda Saul, director of reimbursement for LifecCare Solutions in Ft. Lauderdale, Fla. “I think all the things that enticed the Medicare population to go into Medicare HMOs have been taken away.”

For example, in south Florida in 2002, Humana charged beneficiaries no copay for hospital stays but began charging $200-a-day this year. Last year Humana had no maximum on drugs; this year it caps the drug benefit at $100-a-month. Last year, Humana offered vision and dental coverage; this year it doesn’t, Saul said.

Given those bad experiences, it’ll be some time before beneficiaries embrace even a new improved Medicare+Choice program, Saul said.

“It will take word getting around that someone had a good experience,” she said. “But it’s the old saying, You tell three people if you had a good experience, and you tell seven if you had a bad one.”

The pilot program, unveiled by the Bush administration last August and in effect since January, gives seniors in 23 states greater access to PPOs through the Medicare+Choice program. Beneficiaries who choose to enroll in PPOs — which “allow a wide choice” of in-network providers and the ability to see an out-of-network doctor for an additional charge — pay a $60 to $80 monthly premium, compared with an average $54 monthly premium for coverage under both an M+C HMO and fee-for-service Medicare.

Seniors’ apparent lack of enthusiasm stems in part from the fact that most PPOs do not offer coverage for the newest and most expensive prescription drugs, the Tribune reports. CMS Administrator Tom Scully also blamed the lack of participation on participating HMOs not doing a good job of marketing.

Maybe so, but if you listen to providers like Fran Burke, it becomes clear that CMS may have its hand full convincing beneficiaries and providers to return to the Medicare+Choice program.

“The fundamental problem was that the only winner on these Medicare HMOs were the insurance companies administering them,” said Fran Burke, owner of Burke Medical Equipment in Chicopee, Mass. “The recipients got lousy service. The providers got lousy money. At the end of the day it was a loser for everyone around, but not the insurance company that was rolling away in a Mercedes Benz.” HME