By SHARON SALYER
Herald Writer
When Raleigh Johnson opened his mail last week, a letter informed him that upcoming Medicare HMO changes will force him to sever his 15-year relationship with The Everett Clinic.
"This HMO thing has just been a nightmare," the 73-year-old Everett man said.
Johnson initially had Medicare HMO coverage through the Sisters of Providence.
"They dumped me; they went out of business," he said. "I got Regence Care. They raised their premium. I thought that would take care of it."
But earlier this year, Aetna, Premera, Regence and First Choice announced they were dropping their Medicare HMO plans in the county effective Jan. 1, leaving 7,600 Medicare patients in Snohomish County scrambling for options.
Even though 45 seminars have been held in Snohomish County to explain the changes, "they’re panicking," said Janet Chester, who as volunteer coordinator for the state Insurance Commissioner’s Office has scheduled the local meetings.
So far, an estimated 2,000 people have attended the meetings.
Locally, this leaves Group Health, supplemental or Medigap plans and Sterling Life Insurance Co., which is offering a plan described by the company as a cross between managed care and a standard Medicare supplement, allowing patients to go to any physician they want.
The plans pay for medical costs not paid by Medicare.
Although PacifiCare continues to serve patients in Snohomish County, the plan is not accepting new patients.
Seminars are scheduled through early December to help Medicare patients understand their options.
Recent Medicare workshops have often been packed beyond capacity, Chester said.
"We have 100 people seated and 40 to 50 waiting," she said. "When they see they may not get into the seminar, they’re upset."
That’s why preregistration is required at many of the upcoming meetings.
Unlike some seniors attending the seminars, Johnson said he knows what he will be doing next year. He’s already signed up for Group Health, but will have to absorb a significant premium increase.
Under his current Regence plan, Johnson pays $45.50 a month. Next year, that will jump to $84 a month, he said.
To remain at The Everett Clinic, Johnson and other Medicare enrollees would have to buy a supplemental Medicare plan, or go with Medicare alone.
The clinic recently sent out letters to all its Medicare HMO patients telling them that it has not contracted with any Medicare HMO plans next year.
"You may choose to continue your relationship with your physician at The Everett Clinic after Dec. 31. However, The Everett Clinic will not be available to Medicare managed-care enrollees," the letter says.
It’s this changing, often-confusing puzzle of Medicare health plans that Chester is trying to help residents solve.
"We’re getting 30 to 40 phone calls a day and have peaked up to 60 phone calls a day," Chester said. "Our No. 1 goal is to help the Snohomish County residents affected by this."
For more information, contact the Statewide Health Insurance Benefits Advisers help line at 1-800-397-4422.
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