CATEGORY: USA Federal Government

AUTHOR: MARTY

HED:Expert: Medicare mailings don't apply

By Marty Russell

Daily Journal

Medicare recipients in Northeast Mississippi are being notified by mail of options to their regular coverage brought about by the 1997 Balanced Budget Act.

The mail information on the new Medicare+Choice options being offered by the federal government may seem confusing.

But one local expert on Medicare says there really is only one option for area recipients: Toss the mailing in the trash.

"It probably will not have any impact on our area at all," said Gerald Wages, who serves as chief operating officer for North Mississippi Health Services and who has testified before Congress about Medicare.

The new options include the choice of joining a managed care plan or setting up a medical savings account, but neither option is available in the Northeast Mississippi area simply because such plans don't exist here.

Open enrollment

"They continue to change the rules and one is that they have to have open enrollment," Wages said of Medicare requirements on health maintenance organizations. "That's made it less attractive to HMOs."

The open enrollment requirement under the new options was put in place to prevent participating HMOs from signing up only healthy patients.

Under the new plan, Medicare would pay a fixed monthly fee to HMOs or other provider plans to provide all the care the recipient needs.

But Wages said current Medicare reimbursement rates in the largely rural areas of the state prevent HMOs from coming in and setting up shop.

"The strange thing about Medicare and HMOs is the capitation rate set by Medicare," Wages said. "That's the rate per month Medicare is willing to pay to take care of all your needs. The capitation rate is so low for most of Mississippi that no Medicare HMOs have come in."

Medicare payments

Wages said Medicare Part A recipients currently are capped at $218 per month in relatively rural Lee County compared to $347 a month in populous Jackson County.

"Nobody has an interest," he said, "because the rates are so low."

That means the options under Medicare+Choice aren't available to local recipients.

"So for Medicare patients in the area, they just need to hang on to their basic benefits and look for good supplemental coverage if possible," Wages said. "There are no other options at this time."

Ron Woods, manager of the Tupelo Social Security office, said his office had not received any calls from Medicare recipients about the mailings but said senior citizens on Medicare would be slow to change anyway.

"I think they would be hesitant even where it is available," Woods said. "Older people don't want change."

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