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THE SYSTEM : A Weekly Check on Health Care Costs and Coverage
Tuesday, January 21, 2003; Page HE03
The Choice Is Yours -- for $110 a Month Jack Bagby
had one question when he strolled into a meeting room last week to learn about the
"Medicare+Choice" program that Aetna launched Jan. 1: Did the "Golden Choice" network
of doctors include the two that he and his wife use most often?
Bagby already knew a good bit about Aetna's latest offering to retirees: The monthly
premium is $110 per person; enrollees are free to see either a primary care physician
for a $10 co-payment or a specialist for $20; generic medications are available
for $15 in 30-day supplies from walk-in pharmacies and $30 in 90-day batches from
mail-order druggists.
Bagby also knew that Kaiser Permanente offers a somewhat comparable plan; its premiums
are higher, but prescriptions can be less costly. More problematic to Bagby is that
he would be able to use only Kaiser's in-house doctors.
"Elderly people are not given a great deal of choices," said Bagby, 68. Having just
left a part-time job that had allowed him to buy group health insurance, "I've got
to do something by the end of the month," he said.
Bagby lives in Anne Arundel County, one of six Maryland jurisdictions whose residents
can join Golden Choice. The plan is also available in Calvert and Charles counties,
but nowhere else in the Washington area. Kaiser's new Medicare HMO, which replaces
-- and costs consumers more than -- a plan it terminated at the end of 2002, is
available throughout the region.
As Aetna rep Maurice Wilson described Golden Choice ("We're getting a better reimbursement
rate from the federal government" than in earlier versions of Medicare+Choice, he
said, in addition to higher premiums from consumers and lower rates from participating
doctors), Bagby paged through Aetna's directory of providers, found the names he
was looking for and told Wilson: "You've answered my questions. . . . I have access
to my physicians." Sign me up, he said.
Such decisions are not always so easy for retirees, who are generally eligible for
the hospitalization benefits of standard Medicare at no charge and for the limited
medical benefits of Medicare Part B, which costs about $58.70 per person per month.
Neither part pays for prescription drugs -- a shortcoming that drives so many retirees
to despair or to Medicare+Choice and that may drive Congress to enact broader benefits.
With the Kaiser plan and Medigap policies (private insurance plans that supplement
basic Medicare) also available, consumers would be wise to figure out "dollar for
dollar which is the better option," said Robert M. Hayes, president of the Medicare
Rights Center, a nonprofit based in New York, but "you need a PhD in economics plus
a crystal ball to know what to do." Of course, given the complications of most plans,
he asked, "how is Grandma going to figure this out?"
One answer is for Grandma to visit
www.medicare.gov/MPHCompare/Home.asp. Once online, she might
also consult the Web site of Hayes's group, at
www.medicarerights.org/.
-- Tom Graham
The System welcomes reports from patients, providers, insurers and others about the
delivery of health care. WE CANNOT ADVOCATE ON BEHALF OF INDIVIDUALS PURSUING CLAIMS
OR COMPLAINTS. But we are looking for patterns of problems and excellence. By e-mail:
thesystem@washpost.com. By U.S. Mail: The System, Washington Post Health Section,
1150 15th Street NW, Washington, DC 20071. Include name and phone number; no phone
calls, please. We can't guarantee a response or return of submissions; do not send
original documents.
© 2003 The Washington Post Company
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