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It's decision time for the millions of Americans enrolled in Medicare. The question: Should you stay or should you go? The alternative to traditional Medicare--154 private health plans collectively called "Medicare Advantage"--just became a lot more attractive. This year, the Medicare Modernization Act began giving the plans, mostly Health Maintenance Organizations, $1.3 billion, which is now being used to cut costs, upgrade benefits, and widen health-care choices through increased provider lees.
The government's aim is to entice more enrollees to join private plans in the hope that competition among them will curb Medicare spending, although studies show that Medicare HMOs haven't done a good job of curtailing costs in the past.
Whether the HMOs will cut healthcare costs for Medicare's 36.4 million recipients not in private plans--89 percent of enrollees--is also not clear. As we discovered, the plans' potential big savings come with equally large risks.
PROS AND CONS
The federal Centers for Medicare & Medicaid Services trumpets that of the 4.6 million Medicare members in Advantage plans, 3.7 million have better benefits in 2004. But depending on where you live and the services you use, you may save little of nothing at all. People in many areas don't even have access to private plans.
Then there are the risks. Your new insurer could decide to drop out of the Medicare program, leaving you without coverage. HMOs have done it before, and there is nothing to prevent them from doing it again. Since 1999, some 2.5 million Americans nave had to scramble to find new coverage after insurers have pulled the plug.
Worse, your plan could suddenly reduce benefits. If, as a result, you decide to return to traditional Medicare with a Medigap policy to supplement it, you may end up losing drug coverage. If you switch back within a year of joining an HMO--or if your insurer stops covering your area of you move--you nave a right to resume your drug coverage with the same Medigap provider. However, if that policy is no longer available, you're not guaranteed coverage in another plan that ...