"Choosing a Medicare Managed Health Plan"
To evaluate a Medicare managed care plan, get a complete written explanation of its coverage, costs and procedures. These are usually contained in a printed brochure called a Summary of Benefits. Also, get a chart showing premiums and copayments. Compare that written information with each important category discussed in this article. If you do not understand exactly what the coverage, costs and procedures are, ask a plan representative to point out where they are explained in the written information. If you can't get an important piece of information in writing, don't join the plan. Look at a number of specific factors when evaluating a managed care plan. -- Herbert Hoover (American President, 1874-1964)
On December 4, 2006, the Pennsylvania Health Care Cost Containment Council (PHC4) announced the release of its sixth annual guide for Pennsylvanians, "Choosing a Medicare Managed Health Plan". PHC4 is "an independent state agency responsible for addressing the problem of escalating health costs, ensuring the quality of health care, and increasing access for all citizens regardless of ability to pay." Its latest Guide is available on the internet here, and also in a printed pamphlet directly from PHC4.
Of course, the federal government's Centers for Medicare & Medicaid Services (CMS) offer the most extensive information about Medicare here, including certain official resources about "Medicare Advantage Organizations". For example, in its online Publication No. 100-16, "Medicare Managed Care Manual", CMS provides a complete & extensive Medicare program explanation. However, these are not simple resources.
There are nationally-oriented consumer resources available. For example, FindLaw posted a helpful article entitled "Tips on Choosing a Medicare Managed Care Plan", originating from Nolo, that offers practical tips in selection of a Medicare managed care plan that would meet anticipated needs:
And so, PHC4's Guide offers complete information about Medicare Managed Medicare Plans in a more understandable format with data specific to Pennsylvania consumers:PHC4's Choosing a Medicare Managed Care Plan lists managed care plans by county, provides comparisons on monthly premiums and co-payments, gives an overview of the benefits offered, and presents information about several quality measurements, as well as the results of patient satisfaction surveys.
PHC4 offers these online resources related to the Guide:
Updated information about the Medicare "Part D" Prescription Drug Program, which began in January 2006, is also included. In addition to an overview of the drug benefit, the report features county-specific information about the Medicare-approved Managed Care Plans that offer this prescription drug coverage.
The Guide does not include information about those Medicare-approved "stand-alone" drug plans that only offer the prescription drug benefit.
The Guide was mentioned in an excellent article by Linda Rhodes, a former Pennsylvania Secretary of Aging, that appeared in the Patriot News (Harrisburg, PA) on December 11, 2006 entitled "Medicare Drug Plans Undergo Changes", made available by PennLive here. Her article mentions that one of the best ways of comparing plans -- managed care and prescription -- is by going to Medicare's website at http://www.medicare.gov/.
As to additional resources, she advises in the article:If you have specific questions about either type of plans, call the state Department of Aging APPRISE program at 800-783-7067. They'll put you in touch with a great group of expert volunteers who can advise you. Also check out your local senior center as they often host APPRISE counselors. If you have parents who live out of state, call 800-677-1116 to reach their state health insurance counseling program referred to as SHIP programs.
Go ahead, compare plans! Both the system, and the consumer, will be the better for it.“Competition is not only the basis of protection to the consumer, but is the incentive to progress.”
