DAILY MAIL HEALTH REPORTER
Older West Virginians have no choice when it comes to Medicaremanaged care coverage, says a report to be released today by theconsumer watchdog group Families USA.
The managed care industry has ignored Medicare beneficiaries inrural areas, the executive director of the group, Ron Pollack, saysin the report.
Since West Virginia largely is rural and has a significant numberof elderly residents, the problem is pervasive. Some 76 percent ofthe state's rural Medicare beneficiaries, who live in 36 counties,have no access to HMOs, the report says.
The other 24 percent live in seven counties with only one HMO.
Without choice, seniors must remain in the Medicare fee-for-service plan that often is more expensive and lacks some of thepreventive services and safeguards HMOs offer.
But state insurance Commissioner Hanley Clark said a few NorthernPanhandle counties do offer a choice between two HMOs. Two of sevenHMOs licensed in West Virginia offer a Medicare product, he said.
The Health Plan of the Upper Ohio Valley serves 3,400 elderlywhile Health Assurance, also known as Coventry Health Plans, islicensed to offer Medicare managed care.
'Medicare is a very high risk business for HMOs,' Clark said.'You are dealing with the Medicare recipient, older and sicker thanthe average American.'
Because of the risk, many companies have withdrawn their Medicareproducts, leaving beneficiaries little choice, Families USA said.
Yet some Medicare reform proposals in Congress rely on competitionamong HMOs to help keep program costs down. This is unrealistic inrural areas, according to the report.
'Any restructuring of the Medicare program that relies oncompetition among HMOs at the expense of traditional Medicare wouldcause harm to the vast majority of rural Medicare beneficiaries,'Pollack said.
And while the HMO industry claims it is losing money in ruralareas, quite the opposite is true, Pollack said.
Several independent studies conclude that Medicare HMOs areoverpaid by the government, he said.
'The fact of the matter is that the industry has said, 'We can'tmake enough profit here,' and has chosen not to enter these markets,'Pollack said.
In West Virginia, there are 198,618 rural Medicare beneficiaries,the study says.
Nationally, nine of 10 Medicare beneficiaries in rural areas haveno Medicare-managed care choices.
The number of those without choice is expected to increase becausesome HMOs have announced plans to withdraw from certain areas.
But Clark said this doesn't mean seniors will lose their healthcare coverage.
'They just won't have the option for an HMO product for theMedicare portion covered by the federal government,' he said.
Writer Therese S. Cox can be reached at 348-4874.
