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HCFA Understates Medicare HMO Withdrawal Problems

Wed, 08/02/2000 - 11:00pm — Karen Stevenson
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Press Release from HealthMetrix Research Inc.
For Immediate Release July 26, 2000

There is "more than what appears on the surface" to the HCFA announcement this week regarding the 934,000 Medicare beneficiaries whose enrollment in Medicare HMO plans will terminate at the end of this year. The HCFA announcement (7/24/00) concludes that about 83% (775,000) will be able to enroll in another Medicare HMO, if the HMO is accepting enrollees.

Based on telephone contacts with Medicare HMOs this week, HealthMetrix Research Inc. president Alan Mittermaier anticipates that fewer than 50% (467,000) of those losing their Medicare HMO coverage will be able to join another Medicare HMO by next January 1. "The widespread exodus by Medicare HMOs in many markets has triggered remaining HMOs to suspend enrollment or consider doing so very soon. In most instances, these plans simply do not have adequate numbers of primary care physicians to absorb a large influx of new members. From a bottom-line standpoint, it is a losing proposition for the last remaining Medicare HMO in a market to keep its enrollment open when there is a disproportionate number of high-risk, high-cost beneficiaries leaving other Medicare HMOs with nowhere else to go."

Houston is the hardest hit area where six Medicare HMOs will exit at year-end leaving nearly 60,000 beneficiaries without an HMO option. PacifiCare of Texas is the only remaining HMO that will serve the Houston market in 2001. Other hard hit markets include Albuquerque, Atlanta, Baltimore, Cincinnati, Galveston, Hartford, Minneapolis, Santa Fe, Sarasota, Seattle, and Tucson.

HealthMetrix Research predicted in March that up to 1 million enrollees would be impacted by next year's HMO withdrawals. For additional background on HMO withdrawals, visit the HMOs4seniors.com website.

Press Release from HealthMetrix Research Inc.
For Immediate Release July 26, 2000

There is "more than what appears on the surface" to the HCFA announcement this week regarding the 934,000 Medicare beneficiaries whose enrollment in Medicare HMO plans will terminate at the end of this year. The HCFA announcement (7/24/00) concludes that about 83% (775,000) will be able to enroll in another Medicare HMO, if the HMO is accepting enrollees.

Based on telephone contacts with Medicare HMOs this week, HealthMetrix Research Inc. president Alan Mittermaier anticipates that fewer than 50% (467,000) of those losing their Medicare HMO coverage will be able to join another Medicare HMO by next January 1. "The widespread exodus by Medicare HMOs in many markets has triggered remaining HMOs to suspend enrollment or consider doing so very soon. In most instances, these plans simply do not have adequate numbers of primary care physicians to absorb a large influx of new members. From a bottom-line standpoint, it is a losing proposition for the last remaining Medicare HMO in a market to keep its enrollment open when there is a disproportionate number of high-risk, high-cost beneficiaries leaving other Medicare HMOs with nowhere else to go."

Houston is the hardest hit area where six Medicare HMOs will exit at year-end leaving nearly 60,000 beneficiaries without an HMO option. PacifiCare of Texas is the only remaining HMO that will serve the Houston market in 2001. Other hard hit markets include Albuquerque, Atlanta, Baltimore, Cincinnati, Galveston, Hartford, Minneapolis, Santa Fe, Sarasota, Seattle, and Tucson.

HealthMetrix Research predicted in March that up to 1 million enrollees would be impacted by next year's HMO withdrawals. For additional background on HMO withdrawals, visit the HMOs4seniors.com website.