Once again, seniors and the disabled who use HMOs for their Medicare coverage are seeing their options erode. In early July, three of the four HMOs in Maryland announced plans to withdraw entirely from Medicare by the end of the year.

Currently, CareFirst Blue Cross/Blue Shield offers HMO Medicare coverage to 32,000 enrollees; CIGNA Health Care has 8,100 enrollees and United Healthcare has 15,500 enrollees. Only Kaiser Permanente, a non-profit with 17,000 enrollees, has said it will remain in the program, pending approval from HCFA. This fall, HCFA will announce the new Kaiser contract, which is likely to include substantially higher premiums and copayments for services.

Some 55,000 Maryland Medicare beneficiaries who are currently in either CareFirst, CIGNA, or United will have to scramble to find new health coverage after Dec. 31, 2000. They can always return to traditional Medicare, but many joined HMOs because of the promise of a prescription medicine benefit. Those beneficiaries will find it impossible to duplicate what they had with their HMOs by purchasing Medigap insurance.

In 1997, Congress created Medicare+Choice as a way to expand health care options for seniors. Unfortunately, it has had the opposite effect. In 1997, there were eight Medicare HMOs in Maryland; by January 2001, there will only be one.

The continued disappearance of HMOs from the Medicare program highlights the need for Congress to act quickly to make prescription medicines a standard part of Medicare coverage. Congressional Democrats have proposed creating a voluntary, guaranteed Medicare prescription medicines benefit. Unfortunately, the Republicans in the House of Representatives have passed legislation that would make prescription medicines available only through the private insurance market.

In light of what has happened to the private insurance companies that participated in the Medicare HMO market -- CareFirst, CIGNA and United -- it's not hard to imagine what will ultimately happen to seniors who depend on the private market to purchase coverage for prescription medicines.

If we fail to make prescription drugs part of Medicare and offer it only through private insurance companies, seniors will once again find their options eroding and their access to prescription medicines limited.

Meanwhile, Medicare beneficiaries who will need to make a change because they are losing their HMO Medicare coverage will be notified personally by their HMO concerning their options in early October. The Maryland Department of Aging provides excellent, free counseling and can be reached at 1-800-243-3425 or 410-767-1074.

Seniors should not have to see their options shrinking as insurance companies try to figure out what is best for their bottom line. Instead, seniors should have the security of knowing that Medicare is there for them and can provide for all their health care needs, including their prescription medicines.