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Recently, Mr. C was asked with whom he had health insurance coverage, but he says he can't remember. In going through the unopened mail, we find that Mr. C has signed up with the third HMO Medicare risk product in less than six months. As we explained this to him, he says " I am seeing that physician because the company that provides transportation to the doctor will not go to my other doctors". He does not understand he has signed up with a new health insurance company nor does he remember he is suppose to see only one primary care physician in the future for health care.

Mrs. R has recently been signed up with an HMO and is a Medicaid recipient. She now pays $5 for a co-pay for a physician's visit, instead of $2. Her prescriptions cost $7 per medication, instead of fifty cents. And her home health care is being discontined. Her family enrolled her because they thought she "needed health insurance".

Says Mr. P who enrolled in his sixth Medicare Risk HMO in the past twelve months on December 1, 1996, "I was looking for something cheaper, but I wanted better care. I didn't like the hospital."

Each of these individuals have changed health insurance primarily because of aggressive marketing on the part of Medicare risk HMO companies. Although the marketing materials and techniques that are used by HMOs are carefully monitored by the Health Care Financing Administration (Medicare), they do not take into consideration the types of problems faced by Mr. C, Mrs. R and Mr. P.  HMOs use telemarketing, direct mail, free seminars, and a host of other marketing programs to enroll new members. Sales people come to the individual's home and make very attractive offers such as "no monthly premiums". Medicare is used as the standard benefit package. To meet Medicare's requirements, HMOs offer add-on benefits such as prescription drug benefits and eye doctor visits.

Benefits vary from plan to plan. To further complicate health insurance purchasing decisions, procedures vary in determining medical necessity by company, thus one procedure may be determined to be medically necessary by one company, but not by another. All this makes shopping for HMO coverage difficult to compare for even the most informed consumer.

But a bigger problem exists for Medicare beneficiaries such as Mr. C, Mrs. R and Mr. P. Sales people are not skilled at determining mental status to make informed decisions, financial background to determine Medicaid eligibility, or medical status to determine medical necessity. Thus purchasing decisions are sometimes made without good consumer information, but also without full knowledge of other circumstances in the person's life affecting health care coverage.