And her home health care is being discontined. I didn't like the hospital. Each of these individuals have changed health insurance primarily because of aggressive marketing on the part of Medicare risk HMO companies. Medicare is used as the standard benefit package. To meet Medicare's requirements, HMOs offer add-on benefits such as prescription drug benefits and eye doctor visits.
Benefits vary from plan to plan.
To further complicate health insurance purchasing decisions, procedures vary in determining medical necessity by company, thus one procedure may be determined to be medically necessary by one company, but not by another. All this makes shopping for HMO coverage difficult to compare for even the most informed consumer. But a bigger problem exists for Medicare beneficiaries such as Mr. C, Mrs. R and Mr. P. Sales people are not skilled at determining mental status to make informed decisions, financial background to determine Medicaid eligibility, or medical status to determine medical necessity. Thus purchasing decisions are sometimes made without good consumer information, but also without full knowledge of other circumstances in the person's life affecting health care coverage. She has worked in the areas of policy, clinical practice, and education in gerontology for more than 20 years.