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About 7 million Medicare beneficiaries are enrolled in Medicare managed care plans, versus about 32 million that are enrolled in traditional Medicare. Two recent reports from the Government Accounting Office concluded that some serious weaknesses in the system must be corrected.

The reports were made public at a hearing held by the U.S.Senate Special Committee on Aging. Chairman Chuck Grassley (R-Iowa) stated "Congress has the responsibility of making sure Medicare works". He went on to state "We have to fix what's wrong with the materials from Medicare managed care plans" All 16 managed care plans studied by the GAO had provided seniors with "inaccurate or incomplete benefit information" even though HCFA had reviewed the benefit material. All seniors should become knowledgeable as to the preventative benefits available under Medicare. Many of them are free or are available with a low co-insurance cost. See Preventive Benefits Available

Officials at the Department of Health and Human Services agreed with the report's conclusion that they should scrutinize H.M.O marketing material more closely. Almost half of the HMOs surveyed distributed materials that incorrectly described benefits and the need for referrals incorrectly. Some of the plans provided incomplete information. The report also found that "beneficiaries frequently received incomplete notices that failed to explain their appeal rights." Some of the H.M.Os failed to inform the members of the right to appeal at all.

Medicare officials review and approve all booklets and marketing materials sent to Medicare beneficiaries by the H.M.O. Even if there are mistakes in the material Medicare officials were found to be deficient in having a follow-up procedure to make sure that the mistakes were corrected. The report also stated that there is no single document to fully describe the services covered by the Medicare H.M.O. Usually there are 4 or 5 documents to be read, and frequently one document will contradict the other.

FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"

By Allan Rubin

To e-mail: rehabstrat1@aol.com or rubin@brainlink.com

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