| drug is not a part of the formulary, are you willing to use a
generic? · Does the HMO provide transportation? If so, are there any charges or
geographical restrictions? How much advance notice will I have to provide to use the
transportation benefit? Will the transportation meet my needs if I need an unscheduled
visit to the physician or if I have to use another physician who is not located near my
home?
· How many unresolved complaints have been validated by the Texas Department of
Insurance?
· Do plan salespeople present information that is clear and not misleading? Are
potential customers pressured to make a decision?
· How friendly and helpful are the customer service representatives? How soon are
grievances resolved?
· Does the HMO conduct client satisfaction surveys? What are the results?
The next step should include a financial assessment to determine if beneficiaries can
afford to pay for the gaps in Medicare which include a $768 deductible, per benefit
period, for the first 60 days of hospitalization of a covered medical problem, and a
$100.00 annual deductible for physician services with Medicare only paying for 80 percent
of approved care thereafter. Supplemental or Medigap policies can cover most gaps, but
premiums are usually high and increase every year. Also, traditional Medicare does not
generally provide prescription drug benefits and the most expensive supplemental plan
(plan J) only covers up to $3,000 in prescription drugs and participants must meet a $250
deductible. Then the plan pays for 50 percent of the drug costs. On the other hand, local
Medicare |
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co-payment. Managed care may require advocacy by the beneficiary if he or she is more
comfortable being treated by a specialist on a regular basis. For the person who lives on
a small fixed income and is not eligible for financial assistance from the "Qualified
Medicare Beneficiary Program"(QMB) or the "Specified Low Income Medicare
Beneficiary" Program (SLMB), HMO participation can be a bright light at the end of
the road.
Overall, knowing what medical care should be provided to Medicare beneficiaries and
realizing that HMOs are mandated to provide everything that traditional Medicare provides,
seniors and the disabled population can empower themselves with knowledge. If they choose
the HMO option and are dissatisfied, they can switch back to traditional Medicare by
completing form 566 at their local Social Security office or forward a certified letter
with a return receipt, directly to the HMO indicating the desire to cancel participation.
Traditional fee-for-service will be reinstated on the first day of the following month
after Medicare is notified of the change. Until then, the beneficiary must receive needed
care from the HMO or pay for it out-of-pocket.
For additional information,
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Medicare beneficiaries residing in Harris County should
contact a Benefits Counselor at The Houston/Harris County Area Agency on Aging at (713)
794-9001 or 1-800-252-9240.
Award
The Metropolitan MSC Advisory Council's Disabilities Arts Festival was awarded a
1999 Leadership Houston Award in the arts category. The festival was a joint project of
the advisory council and the MSC staff in collaboration with numerous community resources.
Principal organizers of the event were Nick Cavallaro, Community Relations Representative
at Metropolitan MSC, Lois Miller and Catherine Gleitz of the advisory council.
All Advisors are invited to attend the awards ceremony at the Leadership Houston Gala
at the Rice on Friday, May 14. The Disabilities Arts Festival took place Saturday, July
25, 1998. More than 100 visual and performing artists with disabilities displayed,
performed or sold art at the Metropolitan MSC. The festival is now known as the Arts of
Freedom Festival. The next festival is scheduled for Saturday, July 31 at Metropolitan
MSC. |
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Advisory Council Newsnotes
is published quarterly by the Houston Department of
Health and Human Services
8000 N. Stadium Dr., Houston, Texas 77054
· M. desVignes-Kendrick, MD, MPH Director
· Kathy Barton Chief, Office of Public Affairs
· Marco Milazzo Public Information Officer and Editor
· Rita Rodriguez Senior Community Liaison
Call 713-794-9021 to report news
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