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:
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".
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"
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