Is A Medicare HMO A Better Choice Than
Standard Medicare |
Crucial decisions about healthcare face the senior population all the time. The choice between a Medicare HMO instead of standard Medicare fee for service for their healthcare benefits may be one of the most important yet unfortunately very confusing. Understanding the differences by asking some key questions may help the senior person and family when making this critical decision. The disparity between Standard Medicare and a HMO can be in the medical benefits one actual may be able to receive compared to services that may be denied or insurmountable in getting approved.
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There are three important questions that must be answered in order to evaluate which benefits may be best for a senior deciding between Medicare fee for service and a HMO.
The first is choice of provider. Research indicates that Medicare age individuals prefer having the privilege to see their own physician or a physician they chose rather than being forced into a provider panel. Medicare fee for service allows the selection of one’s own doctor and the privilege to change and get second opinions when desired. HMO’s provide a panel of pre-selected physicians which a selection must be made for all primary services. The primary physician serves as the gate keeper to any additional, ancillary or second opinions. Approval of the primary can be difficult for these additional services even when medically necessary.
The second question is cost. Seniors continually rank cost of their premiums and medicines as the second most important consideration when choosing between Medicare fee for service and a HMO. Many HMO’s provide considerable savings on medications compared to fee for service but are limited to generic and smaller lists of what medications physicians in the network can prescribe. This often limits the use of newer or improved medication for chronic conditions and diseases like Parkinson’s, Arthritis and M.S. Now with Medicare part D providing a medication discount program a close comparison between Standard Medicare and a HMO must be evaluated from an annual cost basis. The disparity in costs has been significantly narrowed.
Third is the question of over-all quality of care. A study completed and published in the Archives of Internal Medicine rated the quality between standard Medicare and HMO services in nine areas. The areas were: access, continuity, integration of care, comprehensiveness, whole person orientation, clinical interaction, clinician-patient partnership, financial access and preventive counseling. The standard Medicare services were rated with more favorable performance in every area except for financial access. More integrated, personalized and patient oriented care were the hallmarks of standard fee for service Medicare benefits.
These three questions when evaluated for personal need and preference will help many seniors considering which program, Medicare fee for service or a HMO program, may better serve their needs. Understanding the fundamental differences is the beginning in making this crucial decision.
Matthew Green Esq.
LifeCare of Florida ~ Outpatient Physical, Occupational & Speech Therapy
