Unprepared and Uninformed on Healthcare Can Wipe You Out

Unprepared and Uninformed on Healthcare Can Wipe You Out

After a number of years of working with a cross-section of organizations nationally and internationally in organizational development, I had the opportunity to provide consulting services to a healthcare organization.

I started nursing many years ago, before managed care, and several years ago took on a client that was looking to implement managed care principles. In order to better serve my client, and clients since then, I completed a nine-month certificate program in managed care at the University of San Francisco. The timing of my decision to enroll in this program was fortuitous as both of my parents were unexpectedly hospitalized for serious medical reasons.

Because of this experience I became knowledgeable about Medicare, Medi-gap insurance and HMO senior health plans. Following is an overview of some of the things to be aware of with Medicare coverage.

The option that has been available to senior citizens since 1965 is one where they can choose to see a physician (that accepts Medicare patients) who bills Medicare directly for the services provided. Many senior citizens like this method because they can choose their own doctor. The drawback to this system is that individuals who require hospitalization pay about $740 deductible when admitted to the hospital and after a prescribed benefit period they assume the remaining hospital costs. There are Medi-gap insurance programs that cover the difference.

A second option for senior citizens is to enroll in a senior program (where they chose a physician from a list of preferred providers) with one of several HMO insurance plans. The benefit of an HMO senior plan is that the plan pays for all of the services offered under the plan. I have a colleague that moved her mother to where she lives in order to enroll her in an HMO senior insurance program that was available in her area. For individuals who require a lot of health care, this program has a minimum of costs, however access to care may be a problem. Sometimes even getting an appointment to see the doctor becomes an obstacle.

Recently some of the healthcare plans have dropped the senior programs in rural areas because they have found them not to be cost effective. Some individuals in this predicament have had to return to the direct Medicare program and assume medical costs they had not anticipated. Whether HMO senior insurance plans will survive is anyone's guess. What is important for individuals who chose to use the traditional Medicare program is to consider enrolling in Medi-gap insurance. In this way they can protect their financial resources should they experience a catastrophic illness.

It is very clear to me that if my parents had not been enrolled in an HMO senior program that they would have depleted their savings to pay their medical costs. I was not knowledgeable about Medi-gap insurance so could not counsel them on healthcare insurance. Since then I have become actively involved in interpreting their health plan benefits. I have come to the realization that my parents are not able to understand the intricacies of their health plan. This is because the plan is not easily understood, and due to their age, have a limited attention span. By becoming actively involved, I can ensure that they utilize the preventive services offered by the plan, receive prompt service to keep them healthy and ultimately preserve the quality of their lives.

Because of this experience I look at the healthcare delivery system differently than I used to. With more and more costs being assumed by the consumer it behooves us to understand our health plans prior to the need to use them. To get a booklet on Medicare and Medi-gap insurance plans call 1-800-638-6833.

Rachel G. Huveldt, principal of RGH & Associates, is an RN with a BS in Management. She is enrolled at the University of San Francisco in a Masters of Public Administration - Health Services program. Tele: (408) 395-9364, e-mail: rghuveldt@rgh-associates.com

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This page is preserved from the original PBWC website. It is part of News and Newsletters in the PBWC Website Archive 1996–2015.