HMO fallout opens, closes options


Herald Writer

The 7,600 area Medicare patients who are being dropped from their HMOs at the end of the year have both one more and one less choice to consider.

For anyone who is considering PacificCare, but hasn’t already made the switch, it’s too late. The company is not accepting new members in Snohomish County because the plan has already reached its enrollment limits and physicians are not accepting new patients, spokeswoman Mimi Haley said.

"We are working to increase capacity in the Edmonds and Everett areas," she said. "I wouldn’t hold out too much hope that we could open up again by the beginning of the year."

However, a new company, Sterling Life Insurance Co., will be offering a health plan for Medicare patients, joining Group Health in offering coverage in Snohomish County.

To help give seniors the information they need to choose a new health plan, 13 seminars, sponsored by the state insurance commissioners office, have been scheduled between now and the end of November.

The first of the workshops will be this morning 1in Mill Creek.

Sterling’s move comes during a year when the local Medicare health plan market has been rocked by changes, in many cases forcing seniors to change their primary care physicians.

"It puts seniors right in the middle, and they get squeezed," said Jim Stevenson, spokesman for the insurance commissioner’s office.

Earlier this year, Aetna, Premera, Regence and First Choice announced they were dropping their Medicare HMO plans in the county effective Jan. 1.

That leaves Sterling, Group Health, so-called Medigap or Medicare supplements, and using Medicare alone as the options for seniors to consider.

Without some type of health insurance in addition to Medicare, seniors can face significant health care bills.

Sterling’s Medicare-plus choice plan is a hybrid between managed care and a standard Medicare supplement, said Debbie Ahl, chief operating officer for Olympic Health Management Services. The Bellingham-based company manages the program for Sterling.

"Unlike managed care, there is open access to all providers," Ahl said.

For 2001, the charge will be $65 a month. There’s a $10 co-payment required when seeing a physician, a $300 deductible for a hospital visit and a $25 a day charge when admitted to a facility such as a nursing home.

Nurses will be available 24 hours a day for telephone consultations.

It does not cover the cost of prescriptions, but an identification card is provided that qualifies enrollees for discounts, Ahl said.

Nationally, Sterling’s Medicare plan is available in 25 states.

Last month, Group Health announced it was raising its Medicare HMO rates next year from $29 to $84 a month for one of its most popular plans, while another plan with more benefits will jump from $48 to $103 a month.

Stevenson said seniors shouldn’t feel panicked about making a choice for a new health care plan. They have until Dec. 31 to decide.

"There’s more danger in making a decision too quickly," he said. "You may close down an option you wish you had later on."

Under Medigap plans, patients are not limited on the physicians they see, as they are in managed care, he said.

"You decide when to see the doctor, which doctor to see, you visit the doctor and then you’re reimbursed," Stevenson said. "You handle the billings."

Under Medicare-plus choice plans, monthly premiums are paid. Other than deductibles, "you never really have to handle money," Stevenson said.

For more information, contact the Statewide Health Insurance Benefits Advisers help line at 800-397-4422 or visit the state insurance commissioners Web site at

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