FORT WAYNE, Ind. -- Franklin Perkins of Fort Wayne has learned the hard way that not all Medicare-type plans are created equal. His message to others: "Buyer, beware."

When the federal government implemented the Medicare prescription drug, or Part D, plan in January 2006, the focus was to provide beneficiaries with drug coverage, something previously available only through private supplemental plans. But the government also allowed private insurance companies, approved to sell Part D, to sell their own comprehensive health plans that replace traditional Medicare.

Last winter, when an agent selling private Medicare plans called Perkins' mother, Gertrude Jenkins, who was then living at home, Perkins listened to the agent's spiel.

His mother, 88, also of Fort Wayne, was taking only a few medications at the time. The $12 monthly cost for Part D "looked really good," Perkins said. Her co-pay for doctors' visits was just $20.

But in October, his mother broke her hip, requiring surgery, hospitalization and rehabilitation. Perkins was then told the hospital could not get the private Medicare company to approve in-hospital rehabilitation, something traditional Medicare covered when she broke her other hip a few years back.

So it was off to a nursing home for rehabilitation. That's when the real shocker came, Perkins said: "There was only one nursing home in Fort Wayne that was in (the company's) network."

If he moved her to an out-of-network facility, any one of Allen County's 24 other nursing homes, the out-of-pocket cost for his mother would be $150 per day, or 10 times the cost of the in-network one.

If his mother had kept the traditional plan, Medicare would have paid all costs for the first 20 days in the nursing home, and all but $124 a day after that. Medicare pays part of the cost up to a possible 100 days for a nursing-home resident who comes directly from the hospital.

"I think (the insurance companies) are so busy signing up enrollees that they haven't taken time to sign up providers," said Sherri Hampton, director of field accounting for Indianapolis-based American Senior Communities, which owns 31 nursing homes, including three in Allen County. Her company has been working since September to join the network of one of the largest insurers in central and southern Indiana.

Mary Jo Burden is the bookkeeper for Woodview Healthcare Center in Fort Wayne. What once involved billing one single Medicare source has turned into hours spent sorting out what is covered and for how long by various private companies.

"The problem is when they go to the hospital or a nursing home. People are looking at their outpatient costs -- their doctor's visits -- and the Part D costs.

They are not being told what may or may not be covered under the private insurance. It's probably there in the fine print, but most people don't know what to ask."

Fred Taube is a counselor with the Senior Health Insurance Information Program, which assists older adults with insurance issues. The program has fielded some complaints about private policies, particularly early on, he said.

At one nursing home, an agent sold residents a private plan. Taube said nursing home officials told him not only did the agent fail to ask permission to meet with residents, the policy sold did not cover that particular nursing home.

"When I first started doing this and when someone would come in and go on Medicare," Taube said, "I'd say, 'Here are the 10 standard Medigap (Medicare supplemental) plans.' I'd tell them to call the agent, get a quote and then pat them on the head and send them on their way.

"Now you've got to tell them about Medigap, preferred providers, private fee-for-service companies -- and there are two or three (permutations) or combinations of each of those. It's very confusing."

Betty Foy, deputy commissioner of Consumer Services for the Indiana Department of Insurance, said her department has not logged many complaints but said it's likely they don't know where to turn.

"It's such a combination of a variety of issues. Most seniors make decisions based upon the dollars. Most won't say, 'What happens if ... what happens if ...'"

Tina Morgan works for A Step Better in Fort Wayne, which sells special shoes and inserts for people with diabetes. She previously worked for a home health company.

"These plans are not the same as traditional Medicare," Morgan said. "They're signing up people who are really not capable of (making) these decisions. I've been there, heard them in senior or apartment complexes saying, 'Throw away all your (Medicare) cards. We'll take care of everything.' "

Under some private plans, she said home-health companies are asked to tell insurers how much service patients will need before they are even seen. Under traditional Medicare, doctors write the orders and nurses visit patients to assess their needs.

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