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Managing Fine 

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To the editors,

As a senior with a limited income, I am as much concerned with the cost and quality of medicare as anyone else and agree that there is undoubtedly room for improvement. But it does seem as though Ben Joravsky's article on the subject [December 11] contains some confusion and misinformation.

Most particularly, the way the article was written or edited makes it seem as though medicare covers only hospitalization, and while it is true that routine office visits as well as other items are not covered at all, Part B pays some or all of many other costs. I feel certain the author knows this, but as printed the meaning is not entirely clear. There is also some blurring of the lines between medicare HMOs and supplemental policies.

Therefore it is not accurate to say that seniors are "forced" to dig deeply into their own to pay for supplemental insurance. Joining an HMO not only covers the $800 hospital deductible that was referred to but also pays for routine office visits, psychiatric counseling, prescriptions, tests, and many other services not covered by basic medicare, typically at no charge or with a small copayment. In this area most HMOs are available with no premium, and membership cannot be refused except to individuals with recent kidney transplants or end-stage renal disease.

It is true that some HMOs have terminated their contracts with medicare, but this is in areas where they are paid less per patient than in Cook County and its environs. It would seem as if this is a matter for Congress and medicare to repair, not the Chicago City Council.

As for emergency care, HMOs do cover it with a copayment, and even this is waived if the matter is serious enough to require hospitalization.

In my own experience, my primary physician has always been able to refer me to specialists or specialized tests in a hospital without consulting with any review board, and I can self-refer to professionals in the vision, hearing, dental, and mental-health fields, providing, of course, that they are members of the plan.

Since medicare is willing to pay HMOs $7,200 a patient to reduce the financial burden on seniors to a minimum, it is hard to understand why more of them don't avail themselves of this option rather than use fee-for-service plans, particularly since this route reduces the paperwork to zero. No bills, no confusing statements, no trying to work out who owes what to whom.

Ed Cohen

W. Chase

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