A special report released today by Consumers Union and the California HealthCare Foundation found that the value of Medicare HMO plans varies widely and that paying more for an expensive plan does not guarantee a better value. It found that prescription drug coverage was especially inconsistent -— many plans offer no drug coverage at all, while California’s most generous plans cover two-thirds of an average senior’s drug costs.
The study, conducted by Consumers Union’s Center for Health Care Choices, rated every Medicare HMO offered in California. To pick the best plan for them, Consumers Union urges seniors to evaluate their individual health care needs and use the report to compare the Medicare HMO options available in their county.
Medicare HMOs are currently offered in 35 California counties. Where plans are available, seniors may select an HMO plan instead of traditional Medicare. Medicare HMOs generally offer more benefits than traditional Medicare, but they may limit participants’ ability to choose a physician or seek care from a specialist. Four million Medicare beneficiaries live in California and more than 1.5 million of them are currently enrolled in Medicare HMOs.
"Because of their low-cost and expanded benefits, HMOs may be the best choice for many Medicare beneficiaries," said Trudy Lieberman, director of Consumers Union’s Center for Consumer Health Choices. "It's an option seniors should definitely consider."
"To make the best choice, seniors must carefully study the plans available and choose the one that comes closest to meeting their individual health care needs," said Ann Monroe, director of the California HealthCare Foundation's Quality Initiative. "Now, all California seniors have the information they need to help choose the right plan for them."
The California HealthCare Foundation also announced the launch of a broad outreach campaign to educate seniors about their Medicare options and the information available in the Guide to California Medicare HMOs. Over the next several months, the Foundation will partner with community-based organizations to develop outreach activities, such as conducting town hall meetings, providing mini-grants to organizations helping to publicize the Guide, and raising awareness about health care quality issues generally.
About the Consumers Union Ratings
Consumers Union assigned ratings to all Medicare HMO plans offered in California on a scale of one to five stars. Ratings were determined by measuring the total benefits provided to plan members and subtracting the amounts they pay for premiums and copayments. "Best Pick" designations were awarded to the plans with the highest scores for overall value and prescription drug benefit value. More details about the study’s methodology are published as Appendix D of the report.