Less is not more. Though newcomers are venturing into Medicare and other HMOs are expanding their territories, they plan to survive by limiting benefits, choices and raising premiums.

Managed-care companies continue to bail out of the Medicare HMO business, but many plans are staying in the game, believing they can be winners. They're using creative survival strategies as well as old standbys such as cutting services or increasing seniors' out-of-pocket costs. Says Thomas Lucksinger (left), chief executive officer of AmCare Health Plans: "It's going to be a low-margin business but still a very good business for us."