Buyer Beware: Medicare
private plans luring potential enrollees

[New York, NY] – As some Medicare private plans unveil new and improved benefits packages to take effect this March, people with Medicare across the country are faced with an important health care decision this month: whether to join one.   

 “With private plans getting increased payments as a result of the new Medicare law, some are revising their benefits packages.  To the people with Medicare tempted to join, we say, ‘Watch out,’” says Robert M. Hayes, president of the Medicare Rights Center (MRC).  “Read the fine print, look for hidden costs and make sure you know which doctors and medical facilities you can use and at what cost,” said Mr. Hayes.  

“The advantages of joining a Medicare private plan depend on an individual’s health care needs and lifestyle,” says Mr. Hayes.  MRC urges consumers to ask themselves the following questions:

• Would you be willing to change doctors if yours was not in (or leaves) the private plan’s network?
• Would you mind having to get a referral to see specialists?
• Would you be willing to pay more for your care if you travel outside your plan’s network area?

And then consult MRC’s chart designed to help people understand what option would best meet their needs (available for free at www.medicarerights.org/compareframeset.html).

 Private plans contract with Medicare and are paid a fixed amount per enrollee to provide Medicare benefits.  They can be managed care plans, such as Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO), or private fee-for-service (PFFS) plans.  If they choose, these plans can provide additional benefits that Medicare does not cover, such as some drug coverage, and they can—and often do—charge a premium in addition to the Medicare Part B premium. 

In 2003, the vast majority of people with Medicare were enrolled in the traditional fee-for-service program, with only 11 percent enrolled in a Medicare private plan—sometimes called a Medicare+Choice plan or Medicare Part C—down from 17 percent in 1998. 

 

Medicare Rights Center (MRC) is the largest independent source of Medicare information and assistance in the United States.  Founded in 1989, MRC helps older adults and people with disabilities get high-quality, affordable health care.