|TRAFICANT, James A., Jr.,|
Friday, October 9, 1998
Washington, D.C. – U.S. Rep. James A. Traficant, Jr. (D–OH) is seeking to allay concerns voiced to his office by many senior citizens in the Mahoning Valley about health maintenance organizations (HMOs) discontinuing coverage for Medicare recipients. "Medicare HMOs have been unnecessarily scaring senior citizens all over America," said Traficant. "For the past several days, my office has been flooded with calls from frightened seniors in search of answers. I am working to addresses these concerns and provide answers in a forthright and expeditious manner." Traficant is putting out the following information:
Friday, October 2, 1998 was the final deadline for Medicare HMOs across the country to inform seniors that they were terminating insurance coverage. United HealthCare, which services Trumbull County, was among the Medicare HMOs that are discontinuing their coverage. According to United HealthCare, approximately 10,000 of its 51,000 Medicare Complete members in Ohio will be impacted by this decision. Six counties throughout Ohio will be impacted, including Trumbull County, with approximately 4,100 Medicare Complete members. These Medicare HMOs, including United HealthCare, maintain that Medicare reimbursement rate are too low to make providing health insurance profitable.
According to Traficant, "this argument is shaky at best. The fact is, Medicare HMOs have pulled out of the counties with the highest reimbursement rates." Trumbull County has the fourth highest reimbursement rate in the state ($554.20), behind Summit ($558.78), Cuyahoga ($564.30) and Lucas ($593.15). "What's worse, many of these Medicare HMOs that are hanging seniors out to dry actually recruited seniors away from conventional Medicare just months before their termination announcement," asserted Traficant. "While it's true that seniors can go back to traditional Medicare, they often face higher costs for Medigap and can be denied access to certain plans, such as those which cover prescription drugs, because they dropped out of previous plans based largely on inflated promises from Medicare HMOs."
Senior citizens in the Valley do have some options. United HealthCare will provide coverage for members through December 31, 1998, however, seniors may choose to terminate prior to that date. Members that do nothing will automatically return to the traditional Medicare fee-for-service plan on January 1, 1999. Seniors will be provided with the phone numbers of all remaining Medicare HMOs for Trumbull County, either through the Health Care Financing Administration or United HealthCare. Seniors may contact any remaining HMOs and enroll for 1999. In addition, United HealthCare members have the option of enrolling in a Medicare supplemental plan, such as the American Association of Retired Person's (AARP) Medicare Supplement Plan, which is underwritten by United HealthCare. The AARP supplement offers access to Medicare plans A through G. No pre-existing condition clauses or underwriting will be used. If seniors choose this option, they must enroll between November 1, 1998 and November 30, 1998 for coverage to begin on January 1, 1999.
To give senior citizens some protection and improve accountability of Medicare HMOs, Traficant recently cosponsored the "Medicare HMO Improvement Act of 1998." The legislation will:
Extend the contract period between the Department of Health and Human Services (HHS) and Medicare HMOs from 1 to 3 years. This change is designed to prevent HMOs from enrolling seniors on a short-term basis only.
Provide HHS with the authority to enjoin termination of coverage by a Medicare HMO for one year. HHS can exercise authority in order to protect public health or upon the request of the Governor. HHS can lift the restriction after concluding hat an adequate provider network has been established. This provision will ensure that coverage will be available to seniors before HMOs terminate coverage.
Require HHS to terminate a contract with a Medicare HMO for an entire metropolitan statistical area (MSA) in a state if the HMO withdraws coverage in a portion of the MSA in that state. This provision will prevent "cherry picking" in which HMOs offer coverage only in selected areas of a state based largely on reimbursement rates.
Require Medicare HMOs which terminate coverage to continue to provide insurance to former members to visit their primary care physician/continue ongoing treatment for 3 months after termination. This will ensure continuity of care while seniors make the transition to other doctors and networks.
Traficant is urging senior citizens in the Valley who have questions or want more information regarding Medicare, United Healthcare, or the Medicare HMO Improvement Act, to call office at 202-225-5261.2009