A new health plan option for seniors

Combining care for Medicaid, Medicare beneficiaries

Pennsylvania is creating a new health plan option for older people who participate in both the Medicare and Medicaid programs. State officials say, right now, care for these dual-eligible seniors is often fragmented. (Photo:http://www.flickr.com/photos/maryamgh/ / CC BY-NC-ND 2.0)
Listen: [audio:090828tecare.mp3]

Similar to an HMO, private insurance companies will offer the integrated care plans, and coordinate all the paperwork and benefits. The Secretary of the Department of Aging says better care management will help older people stay healthy and live independently longer.

Holly Lange is a vice president at the Philadelphia Corporation for Aging.

Lange: The part of this that we’re not sure about is that insurance companies have a very good history with medical and acute care, with hospitals and bill paying. Where we are skeptical is that the insurance companies do not have any experience with long term care.

The insurance companies will receive a flat-rate payment from the state for the Medicaid services they provide. Some aging advocates are concerned that care decisions will be driven by finances instead of consumer needs.

Kathy Cubit is a spokeswoman with the Center for Advocacy for the Rights and Interests of the Elderly.

Cubit: These are individuals that are often referred to as dual eligible. So they are dealing with two different major systems, Medicare and Medicaid, in terms of accessing and getting health care.

Many Pennsylvania seniors already belong to an HMO plan — called Medicare Advantage — which manages hospital and doctors visits. But plan coordinators generally don’t help seniors find long-term care, wheel chairs or hospital beds — which are Medicaid benefits.

Kathy Cubit says each integrated care plan will offer a limited number of in-network doctors.

Cubit: If someone is accustomed to going to a particular doctor and they are no longer in that network that can be difficult for people to go to somewhere new or feel comfortable with that aspect.