HICAP helps seniors find primary care doctor

by Lesley Politi on February 24, 2009

By SHANNA MCCORD

SANTA CRUZ — Carol Fuller was approaching 65 and in fine health.

The longtime Santa Cruz resident and former business owner had little reason to visit the doctor in previous years and relied mostly on annual visits to the gynecologist to catch anything wrong.

Just before her 65th birthday, Fuller was surprised to discover that in leaving her private medical insurance provider and becoming a Medicare recipient, she would need to find a primary care physician to coordinate her health coverage from here on out.

Such an endeavor isn’t easy in Santa Cruz County, where many doctors have closed their practices to new Medicare patients because of significantly lower reimbursement rates than other areas.

“It would be really damned impossible,” Fuller, now 66, said about finding a primary care physician. “Because we’re this rural designation reimbursement rate, no physician seems to want to add new Medicare patients.”

Fuller was guided through the complex world of Medicare and landed a primary care physician with the help of the Health Insurance Counseling and Advocacy Program, known as HICAP, a free service operated by Senior Network Services on Capitola Road in Live Oak.

The one-on-one counseling service has offices statewide geared to educate Medicare beneficiaries about their options. The program is funded by the California Department of Aging.

Locally, HICAP helps about 1,000 clients each year navigate the confusing world of Medicare — from simply signing up for the program to specifics like solving bill problems, picking a prescription plan and explaining the various options available.

 

The counselors can also point seniors like Fuller toward local doctors who accept new Medicare patients, though they are difficult to find, HICAP program manager Sally NeSmith said.

It’s particularly tough for seniors who are new to Santa Cruz County to get a doctor’s appointment, NeSmith said. HICAP receives a couple of phone calls each week from seniors new to the area and looking for a doctor.

“We have a very short list of doctors we can give them,” NeSmith said.

But if someone has an established relationship with a primary doctor and doesn’t move, rarely will doctors drop an existing patient after they turn 65 and switch to Medicare insurance.

“It is easier if you already have a primary care doctor,” Fuller said. “But I didn’t have one. I didn’t know.”

Fuller was forced to go with the Medicare Advantage plan to get access to a new doctor.

Medicare Advantage operates like a health maintenance organization in which the doctors are paid a monthly sum for each Medicare patient regardless of how many visits the patient might need. All of the patient’s central medical needs are funneled through the doctor assigned by the plan.

The drawback is that the plan does not cover treatment or doctor visits if you travel or leave the geographical area, NeSmith said.

Patrick Peer, executive director of the Dominican Medical Foundation, said the low Medicare reimbursement rate in Santa Cruz County makes it difficult for many doctors to see Medicare patients and still support their practices.

His foundation, which has about 38 primary care physicians serving patients at seven clinics from Boulder Creek to Capitola, is one of the few places Medicare recipients can find a doctor willing to take them.

“Our foundation wants people with Medicare insurance to have access to good doctors,” Peer said. “We’ve opened access and extended our hours. We hope it’s going to be easier than it has been for seniors to get access.”

Source: www.mercurynews.com

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