Nevada County Picayune and Gurdon Times Newspaper Archive

Witcher Explains Medicare To Adult Center

The Gurdon Senior Adult Center hosted a special health presentation June 19 on a topic that has received a lot of attention lately.

Ramona Witcher, a registered nurse with the Arkansas Foundation for Medical Care (AFMC), was the featured speaker. Her topic was Medicare managed care.

While not yet available in Clark County, Medicare is moving in the direction of managed care nationwide and will offer several managed care options through the Medicare Plus Choice program beginning later this year.

Center activity director Cindy Rhodes, who introduced Witcher to the nearly 60 seniors in attendance, was pleased with the event. "She explained it well," said Rhodes. "We do a lot of things in-house, but at times we bring someone in from the outside. She did her job really well."

"Managed care plans have arrived in 12 counties in Arkansas, and will be here eventually," began Witcher. "Managed care can be thought of as a combination insurance company and a health care delivery system.

"But there is a common misconception that when you join a managed care plan you give up your regular Medicare. That's not true", said Witcher.

A Medicare managed care plan must provide at least the same level of coverage as traditional Medicare, though some plans offer additional services.

To be eligible for one of the current managed care plans a beneficiary must be entitled to Medicare Part A, enrolled in Part B and continue to pay the part B monthly premium ($43.80 in 1998), and cannot have end stage renal (kidney) disease or be enrolled in hospice care for the terminally ill.

The person must also live in the plan's coverage area and must choose a physician and hospital that participates in the plan.

Two of the three managed care plans now operating in Arkansas charge a monthly premium. The third has no premium.

The 12 counties where managed care is now available include Pulaski, Hot Spring, Saline, Garland, Crawford, Sebastian, Lonoke, Montgomery, Prairie, Scott, White and Woodruff. Other counties will be included later.

Beneficiaries have the same rights and benefits under managed care as under traditional Medicare. If they disagree with a managed care decision regarding their health care, they have the right to appeal, said Witcher.

As a non-profit peer review and quality improvement organization for Medicare in the state, AFMC reviews appeals made by beneficiaries regarding denial of hospital admission, early discharge from the hospital, and quality of care complaints.

AFMC's toll free helpline number is 1-800-272-5528, extension *211.

There are many factors to consider before enrolling in a managed care plan, said Witcher. "You will not be forced to change," she said. "But you do have the freedom to try it (managed care) if you want to. If you don't like it you can go back to traditional Medicare."