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Lewes, Delaware
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November 6, 1998     Cape Gazette
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November 6, 1998
 

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CAPE GAZETTE, Friday, November 6 - November 12, 1998 - 33 HEALTH & FITNESS HMOs pull out; elderly scramble :/or coverage By Kerry Kester When contracts for three com- panies that provide insurance to Medicare recipients expire in Delaware Dec. 31, more than 2,000 Sussex County senior citi- zens will be left with no options for continuing insurance with a managed-care system. The high cost of health care in the United States, combined with a rising senior citizen population, is pressuring private, managed- care companies to review whether they can afford to retain their con- tracts for insuring Medicare recip- ients. Nationally, the alarming trend is for the managed-care compa- nies to drop Medicare contracts. Federally regulated reimburse- merits are. no .longer sufficient to meet the demands on the compa- nies; their profit levelshave dropped. Statewide, moro than 11,000 people will be dropped from health maintenance organizations (HMO) plans. Nationwide, HMOs are discontinuing their Medicare business in 400 counties of 31 states, leaving more than 600,000 people facing a decision about how they want to be in- sured. Those who want to maintain the same benefits through other corn- panics Or supplemental, Medigap policies may face paying higher premiums. For those whose in- comes prevent them from paying higher premiums, accepting re- duced coverage may be the only option. In some of the states where HMOs are not renewing their con- tracts for Medicare coverage, oth- er companies are continuing to conduct business as usual, so the insured need 0nly to select a new insurance provider. Delaware choices In Delaware, for example, Aet- na, AmeriHealth and Optimum Choice, the only companies to ad- minister managed care for Medicare clients, are all pulling out of the state; however, CIGNA Healthplan has contracted with the federal Health Care Finance Administration to offer policies to New Castle County residents. CIGNA, an HMO, contains costs like any managed-care com- pany, by providing customers with a network of health-care providers who agree to set fees for specific kinds of care. Physicians who contract with. HMOs usually take a pay cut flmm what they re- ceive from indemnity, or fee-for- servke plffns. The task for devel- oping a provider network, al- though easier to do in a suburban area such as New Castle County, is a monumental task. Whether CIGNA will eventually expand to Kent and Sussex counties is unde- termined. Sussex and Kent countians, however, left without the option of another HMO plan like CIGNA, may opt to have original Medicare fee-for-service cover- age only; they may enroll in the original Medicare plan and sup- plement it with one of the Medi- gap policies; or they may buy in- dependent coverage, which is typ- ically extremely expensive. The annual rates for the HMO insurance were as follows: Aetna - $0, $247 or $780; AmeriHealth - $0, $480 or $1,200; and Optimum Choice - $780; prices varied as appropriate for the different ages and health status of the enrollees. What is Medigap? Delawareans may opt to supple- ment their Medicare with one of the five Medigap policies avail- able in Delaware: Plan A, Plan B, Plan D, Plan E, Plan I or Plan J. Within each of the plans, the law requires standardized coverage from the contracted insurance providers. Often, the rates are higher than those offered in the HMO plans. Medigap policies may include covering coinsurance fees not covered by Medicare, certain de- ductibles or" services that Medicare doesn't coer. Rates vary significantly, depending on coverage and cust tnner service. A 70-year-oMlmrson on Plan A, for example, could pay between $363 and $772 per year; on Plan J, the price could range between $1,750 and $2,280. Delawareans who continue with their health plans through the end of their contract periods in 1998 will automatically be returned to the original Medicare fee-for-ser- vice plan, effective Jan. 1, 1999. Those who want to discontinue their plan before the expiration period to return to the original Medicare plan may do so, but if they do, they may lose some of their options for Medicare supple- mental insurance. Those who return to the original Medicare plan may purchase the supplemental plans that provide coverage for that which is not Continued on page 35 Making time for exercise pays off Time. One of the most precious commodities in our lives. There are days when we wish there were more minutes in the day, and days where the sun doesn't go down soon enough. With all the big and little jobs we all do in an average day, how does one squeeze in the time for fitness? If you find yourself saying, "1 don't have time for exercise," take the time right now to sit down with your schedule and get ready to reorganize. Finding that precious time to give to yourself will also enable you to pass that gift on to your family, friends and co-worKers. You'll be happier, healthier, less stressed and basking in a new- found self-esteem. HEALTH TOPICS Kim Schell is an aerobic co- ordinator at Sussex Family YMCA. For more informa- tion, call 227-8018. How much time are we talking here? For the severely time- crunched person, 20 to 30 min- utes, three to seven times a week, should suffice. If you can't devote 20 minutes at a time in one shot, try breaking it up into two 10-minute sessions; try setting your alarm clock 10 to 20 minutes earlier and get in a walk while everyone .else is still asleep. If walking is not an option for you, try an exercise video, station- ary bike, dancing, calisthenics or .any other form of cardiovascular movement that you enjoy. Time yourself for the first few weeks, adding a little more each week. If you're not a morning person, and can't bear the thought of set- ting your clock any earlier, decide what time of day you are most likely to have the most energy. Maybe it's lunch time at work. Take a look around your work area. Is the area outside suited for a walk/jog/bike ride? Is there a health club nearby where you can spend half of your lunch hour tak- ing care of your heart? How about an empty office to do some yoga, aerobics or dancing? The opportu- nities are there if you're looking for them. If you're a busy parent and chil- helping yourself at the same time, all the better. There are baby joggers, carts and seats for the back of adult bikes, plain old strollers for taking walks with baby, mother and child exercise videos and plain old playing with your kids. If your children are older than 6 or 7, they may enjoy working out with you. If you're excited about your fitness regimen, they may catch your excitement. Remember, time is limited for all of us, And the "ultimate" time is our life span. Exercise can help dren seem to make it impossible ward off cancer, heart disease, to get your work done, try some of cardiovascular disease and other these tips. potentially life-shortening illness- Time spent with your children es. Time invested in yourself to- is time well-spent, and if you're day will help you tomorrow. i t i ! i t I i t