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THE SYSTEM : A Weekly Check on Health Care Costs and Coverage

Tuesday, January 21, 2003; Page HE03

The Choice Is Yours -- for $110 a Month Jack Bagby had one question when he strolled into a meeting room last week to learn about the "Medicare+Choice" program that Aetna launched Jan. 1: Did the "Golden Choice" network of doctors include the two that he and his wife use most often?

Bagby already knew a good bit about Aetna's latest offering to retirees: The monthly premium is $110 per person; enrollees are free to see either a primary care physician for a $10 co-payment or a specialist for $20; generic medications are available for $15 in 30-day supplies from walk-in pharmacies and $30 in 90-day batches from mail-order druggists.

Bagby also knew that Kaiser Permanente offers a somewhat comparable plan; its premiums are higher, but prescriptions can be less costly. More problematic to Bagby is that he would be able to use only Kaiser's in-house doctors.

"Elderly people are not given a great deal of choices," said Bagby, 68. Having just left a part-time job that had allowed him to buy group health insurance, "I've got to do something by the end of the month," he said.

Bagby lives in Anne Arundel County, one of six Maryland jurisdictions whose residents can join Golden Choice. The plan is also available in Calvert and Charles counties, but nowhere else in the Washington area. Kaiser's new Medicare HMO, which replaces -- and costs consumers more than -- a plan it terminated at the end of 2002, is available throughout the region.

As Aetna rep Maurice Wilson described Golden Choice ("We're getting a better reimbursement rate from the federal government" than in earlier versions of Medicare+Choice, he said, in addition to higher premiums from consumers and lower rates from participating doctors), Bagby paged through Aetna's directory of providers, found the names he was looking for and told Wilson: "You've answered my questions. . . . I have access to my physicians." Sign me up, he said.

Such decisions are not always so easy for retirees, who are generally eligible for the hospitalization benefits of standard Medicare at no charge and for the limited medical benefits of Medicare Part B, which costs about $58.70 per person per month. Neither part pays for prescription drugs -- a shortcoming that drives so many retirees to despair or to Medicare+Choice and that may drive Congress to enact broader benefits.

With the Kaiser plan and Medigap policies (private insurance plans that supplement basic Medicare) also available, consumers would be wise to figure out "dollar for dollar which is the better option," said Robert M. Hayes, president of the Medicare Rights Center, a nonprofit based in New York, but "you need a PhD in economics plus a crystal ball to know what to do." Of course, given the complications of most plans, he asked, "how is Grandma going to figure this out?"

One answer is for Grandma to visit www.medicare.gov/MPHCompare/Home.asp. Once online, she might also consult the Web site of Hayes's group, at www.medicarerights.org/.

-- Tom Graham

The System welcomes reports from patients, providers, insurers and others about the delivery of health care. WE CANNOT ADVOCATE ON BEHALF OF INDIVIDUALS PURSUING CLAIMS OR COMPLAINTS. But we are looking for patterns of problems and excellence. By e-mail: thesystem@washpost.com. By U.S. Mail: The System, Washington Post Health Section, 1150 15th Street NW, Washington, DC 20071. Include name and phone number; no phone calls, please. We can't guarantee a response or return of submissions; do not send original documents.

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