"Thinking about Joining a Medicare HMO?" is one of a series of guides for Medicare beneficiaries in New York City. It offers an example of nondirective support .
To decide for yourself about Medicare HMOs, you need balanced and objective information.
Choosing a Medicare HMO can be difficult. An HMO can be good at some things but no so good at others. For example, one HMO may cost less but not have doctors who communicate well with their patients. You need to weigh the pros and cons of each Medicare HMO that operates where you live in New York City. This worksheet asks questions to help you find a plan that does well in the areas that are most important to you.
Step 1:
Find which Medicare HMOs are available where you live.
Step 2:
Find out which HMO your doctor is in. Some doctors are in more than one HMO.
Step 3:
Decide what's most important to you in a health plan.
Step 4:
Then find out which HMOs do a good job in the areas that are most important to you.
Step 5:
On the worksheet, put a check mark to identify the HMOs that did well in each area.Step 6:
Make your choice.Step 7:
Contact the organization listed on page 13 if you need help.
Step 8:
Know your rights.
Step 9:
Review your decision regularly.
1. Which Medicare HMOs are available where I live?
Before you start to compare NYC Medicare HMOs, eliminate the ones that are not available in the borough where you live. Some NY Medicare HMOs are only offered in some of the boroughs. If you live in a borough where a certain plan is not offered you can't join that plan. Using this chart, check the plans that are available in the borough where you live. Cross out the others on the worksheet.
Plan name
2. Find out which Medicare HMOs your doctor is in.
Many people already have a doctor they trust who knows their history. If you have a doctor, you want to know which NYC Medicare HMOs your doctor is in. Some doctors are in none of the plans, some are in just one, some are in more than one.
Call your doctor's office and ask the staff which Medicare HMOs, if any, your doctor is in. Make sure the doctor can see you if you join the HMO. Sometimes doctors only accept a limited number of patients from an HMO. Also check whether the doctor plans to stay in the HMO. On the list below, check off the plans that your doctor is in and is accepting patients.
3. Decide what's most important to you in a health plan.
For some people, premiums are critical. Others may be willing to pay more to use the doctors they want. Some are concerned with what services are covered, especially prescriptions; others worry more about getting the right services if they get sick. Review the list and check the items that are most important to you.
4. Then find out which HMOs do a good job in areas that are important to you.
Review the booklets on the topics that are most important to you. For instance, if you checked:
5. On the Worksheet below, put a check mark to show which HMOs did well in areas important to you.
Some of the booklets have information on more than one specific topic. For example, in the booklet Doctors in the Plans there is information on four specific topics. One chart shows how many members found it easy to find a doctor. Another shows what members said about how doctors in the plan communicate with patients. A third chart shows how members rated HMO health care providers overall. The last chart shows how many doctors in each HMO have stayed with the plan for at least a year. If one topic is particularly important to you, you can pick the HMOs that did best on that question. Or you can look at all the charts and see which plans do well on most or all of the topics.
Which plans have a premium I can afford? (See the green booklet.)
Cover the services I need most and don't cost too much when I use health care? (See the green booklet.)
Provide good coverage for prescription drugs at a cost I can afford and without a lot of hassles? (See the burgundy booklet.)
Have good doctors in their plan? (See the purple booklet.)
Make it easy to get the health care I need? (See the light blue booklet.)
Make it possible to stay healthy and get better? (See the yellow booklet.)
6. Make your choice.
Now the choice is up to you. Look over the worksheet to see which health plans you have checked off. See if you can find a pattern. Are there one or two Medicare HMOs that you have checked all the time, or almost all the time? If one HMO does well on some features and another plan does well on others, you'll have to decide what matters to you most.
7. Contact these organizations if you need help.
There are people who are trained to help you think through your choices. Call the agencies below for help.
Medicare Rights Center
1460 Broadway, 11th Floor
New York, NY 10036
(212) 869-3850
NYC Department for the Aging (DFTA)
Health Insurance Information, Counseling,
and Advocacy Program (HIICAP)
2 Lafayette Street
New York, NY 10007-1392
(212) 333-5511
8. Review your decision at least once a year.
Your health may change. Your financial resources may change. And, your Medicare HMO may change. Doctors may leave the network and others may join. The HMO premium may change; so can the services they cover. New Medicare HMOs may start, or the one you are in could close down, at least where you live.