How HMO Pullout
Affects State’s Seniors

by Benjamin L. Cardin
U.S. Congressman, 3rd District
     Thousands of Maryland seniors signed up for Medicare through an HMO thinking that they would get better coverage for a more affordable price. The HMOs’ lower costs allowed greater benefits, most notably a prescription drug benefit.
     Unfortunately, HMOs offering Medicare may have been promising more than they could deliver. In recent months, four of the HMOs operating in Maryland have decided to pull out of the market. Three of them--Aetna/US Healthcare, Prudential Health Care and MAMSI/Optimum Choice--decided to terminate their Medicare HMO policies. Another, United Healthcare, is pulling out of some of its coverage areas.
     Approximately, 41,000 seniors in Maryland will be affected, and will need to arrange new Medicare coverage.
     Fortunately, all are eligible to enroll in traditional Medicare, which does not cover prescription drugs--a significant health care cost for many seniors.
     Seniors in traditional Medicare generally arrange for prescription drug coverage through a supplemental Medigap plan. Unfortunately, none of the Medigap policies offers a prescription drug benefit without a much higher fee for pre-existing conditions or other exclusionary provisions.
     I want to change that policy. I recently introduced the “Medigap Access Protection for Seniors Act,” H.R. 4862, which would enable seniors to continue prescription drug coverage through a supplemental Medigap policy should their Medicare HMO leave the service area. I will reintroduce this bill in January when the new Congress convenes.
     Under current law, if a beneficiary’s Medicare HMO discontinues participation with the program, the senior is only guaranteed enrollment in four of the 10 standardized Medigap plans: A, B. C, or F, none of which offers prescription drug coverage.
     A senior may apply for one of the other supplemental plans that includes drug benefits, but insurance companies may deny coverage, place pre-existing condition restrictions on those polices, or charge a higher premium.
     My legislation would permit beneficiaries to enroll without additional costs or exclusions in Medigap plans H, I and J, which provide varying levels of prescription drug coverage. This is the same protection currently available to seniors when they first become eligible for Medicare benefits.
     Prescription drugs are a vital part of medical care, but very few seniors can shoulder the full cost of the drugs they need. We must give seniors the opportunity to purchase supplemental policies that will help them pay the cost of their prescription drugs. It’s good sense and good medicine.

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This story was published on Jan. 6, 1999.