CHOICES AVAILABLE TO MEDICARE BENEFICIARIES WHO ARE DROPPED BY THEIR HMO
If your HMO drops a Medicare beneficiary, because the HMO is
dropping Medicare coverage in your area, you have 2 choices
available to you:
1.Enroll in another HMO that does cover HMO beneficiaries in your
area.
2.Re-enroll in Medicare. The problem is, however, Medicare does
not cover the cost of drugs.
In order to be able to cover the expense of the drugs you must however purchase a Medigap policy. There are 10 standard Medigap policies designated "A" through "J". The Federally guaranteed Medigap policies that must be made available ("A","B","C" and "F") provide basic benefits, but do not cover prescription drugs.
Anyone dropped from a Medicare HMO has a right to buy Medigap insurance in the first 63 days of 1999.
If you are a New York resident, you are protected in the following ways:
Open Enrollment
NYS law requires that any insurer writing Medicare supplemental
policies must accept new applicants at any time throughout the
year. Insurers may not deny the issuance of a policy or make any
premium rate distinctions because of your health status, claim
experience, receipt of health care or medical condition. NYS law
protects you in these ways even if you voluntarily disenroll from
the Medicare HMO prior to 12/31/98. NYS guarantees you the right
to select from all Medigap policies "A" through
"J".
Portability
Although Medigap policies may contain up to a 6 month
"pre-existing condition" waiting period, NYS law
provides that as long as there is no more than a 60 day break in
coverage, the Medigap carrier must credit the time you were
covered under the prior coverage towards the new waiting period.
Thus, if you had your Medicare HMO for at least 6 months and you
replace it with a Medigap policy within 60 days, you will have no
"pre-existing condition" waiting period. If you had
your Medicare HMO for 4 months, you will have a waiting period of
only 2 months. New York's web site is http://www.ins.state.ny.us.
Or call 1-800-342-3736.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Allan Rubin
http://www.therubins.com
To e-mail: RehabStrat@aol.com or rubin@brainlink.com