Medicare Made Simple

How does Medicare work and who’s eligible? Is it better to stick with traditimanneronal Medicare or pick a Medicare HMO? Whether you’re looking for basic information about the Medicare program, or specifics about plans offered in your area, https://www.medicare.gov--the federal government’s official site--is the place to go.

I started with “What is Medicare?” to get my bearings and search for some information for my friend’s parents. The basics were clearly explained: Medicare Part A provides medical insurance for hospital and skilled nursing care, while Part B provides coverage for doctor visits and outpatient services or care outside the hospital.

The site offers basic information about Medicare in English and Spanish, as well as some in Chinese.

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One nifty feature of the site is “Medicare Compare,” a database that allows you to comparison-shop among Medicare HMOs in your area based on benefits, out-of-pocket costs, locations of doctors’ offices and hospitals, and about 20 other factors. (While traditional Medicare allows patients to choose virtually any doctor, Medicare HMOs--in which a person picks a private health plan to coordinate medical care--limit the members’ choice of doctors and hospitals. Most Medicare HMOs provide some extra benefits, however, such as prescription drug coverage.)

To use “Medicare Compare,” you just plug in your ZIP Code or state. The site asks you what county you live in and which topic you’d like to search. To help you easily compare plans, you can view the features of two HMOs side by side on your computer screen. For example, you can see how the plans differ in cost, benefits, and the choice of doctors and hospitals. You can also check out what current members say about how satisfied they are with the plans’ doctors and services. Or you can see what percentage of women in the plan received mammograms.

You can also find out the percentage of doctors or specialists in a health plan who are board-certified. While board certification won’t tell you whether your doctor is a good surgeon or has a nice bedside manner, it does mean that he or she has been trained and supervised in a specialty and demonstrated competence in a rigorous examination.

Moreover, the Medicare Compare feature lets you answer such questions as: Does the plan offer chiropractic care? What mental health services are covered? Are there any provisions for getting transportation to and from doctor visits?

“Doctor Choice” tells you whether the plan requires you to go to certain participating doctors, hospitals and specialists, and whether you need referrals for specialists--important considerations for most people. Included are toll-free phone numbers for the plans so you can call to see if your doctor participates.

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Under the “Publications” category, you can read about medical savings accounts, guides to nursing homes, and supplemental health insurance coverage, or Medigap. This area includes a group of government publications that have been scanned and placed on the Web site. That means you can’t just click where you want to go from the table of contents, you actually have to scroll down or advance to that page. But the information is well-written and organized.

If you’re worried that you’re paying into the Medicare program for nothing, you might find solace in President Clinton’s proposal to expand the program and assure its solvency well into the next century.

“Important Contacts” was my final destination so I could obtain a contact in Kansas, where my friend’s parents live. I was able to find local phone numbers for state health insurance assistance programs that could answer questions about benefits, Medicare bills and other topics.

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Still need more information? The site also provides answers to 20 questions that the agency frequently receives from consumers on its toll-free telephone hotline ([800] MEDICARE--available in English and Spanish).

Although only 15% of Americans older than 65 are online, I still think this site is a good idea. That percentage will no doubt increase over time, and I know there are lots of people under 65, like me, who are searching the Web for information for their parents and friends.

Besides, you don’t have to be of Medicare age to learn something of interest on the site. The current national political debate over Medicare benefits is affecting us all. Will the federal-budget surplus go toward expanding prescription-drug coverage for Medicare recipients or for tax cuts? If you want to contact your representative in Congress about this issue, this site can help you jump into the debate well-informed.

* Marla Bolotsky is managing editor and director of online information for the Henry J. Kaiser Family Foundation. She can be reached by e-mail at [email protected]. Cathy K. Purcell contributed to this article.

* Your Health Online runs every other Monday in Health.