Seniors Urged To Get Involved With HMO Issues

By Jan Howard

A representative of the Western Connecticut Area Agency on Aging CHOICES program urges senior citizens to become active in writing to their state legislators and congressmen in regard to health care issues.

“Legislators have to hear from people being affected,” CHOICES Regional Coordinator Eric S. Rodko said during a Lunch and Learn program February 13 at Ashlar of Newtown. “They must get your phone calls and letters.

“Be an advocate, get your legislators to do more,” Mr Rodko said. “A lot is going on at the state level.”

Medicare HMOs have withdrawn from several Connecticut counties as indicated last fall, and the Medicare Part B premium has gone up, raising pressing issues that affect senior citizens, Mr Rodko said.

“If things don’t change, you will be sharing more of the cost of health care,” Mr Rodko told about 60 attendees. “Some people are having to go back to work so they can get insurance.”

Mr Rodko discussed supplemental, or Medigap, plans available to seniors who receive Medicare benefits, as well as ConnPACE, Connecticut’s prescription assistance program for eligible seniors.

Last summer, HMOs offering Medicare managed care plans announced they would be withdrawing from the service in Fairfield County by December 31. As of January 1, only PHS Smart Choice still remains, following a preferred provider agreement with Danbury Hospital.

Mr Rodko said Medicare HMOs were introduced to help contain health care costs. “The goal was to monitor utilization and provide more preventive care,” he noted. “The government gave them so much each month.” At that time, he said there was mass migration into the HMOs.

However, Medicare HMOs failed to meet their goals. They were losing money each year, Mr Rodko said. They said Congress was not giving them enough money, and Congress was saying they were getting more than they should.

When the HMOs ceased coverage, 53,000 seniors in Connecticut were without supplemental coverage on January 1, he said.

However, Mr Rodko said, so many people had been dropped by other HMOs that PHS hit its capacity waiver limit. “Access issues came into view,” he said, noting the plan is now closed to new beneficiaries. “It won’t reopen until next January 1, even if they’re around at all.”

He said it is highly unlikely the company will reopen in Fairfield County. “We could be looking at PHS pulling out, but we won’t know until summer.”

Mr Rodko said if PHS remains active in the county, it would probably reduce coverage on certain brand name drugs. “You can expect the premium to rise again. It’s a very volatile market to remain in.”

He said if the county is not profitable to a company, it will pull out, noting he expects full withdrawal by the end of this year. “Higher premiums and co-pays can be expected, if PHS stays open.”

Mr Rodko said companies must notify the government in July if they are staying in the market for 2002. “PHS is good until the end of 2001,” he said.

Medicare Premiums To Rise

 The Medicare premium will slowly rise as more of the cost is shifted to beneficiaries, possibly from $80 to $100 a month, he said.

“You won’t see your benefits deteriorate,” Mr Rodko said. “Medicare has good benefits,” he added, noting that preventive care benefits are being added.

 “The addition of coverage for an annual exam would be helpful,” he said.

Cost of health care in New England is very high, Mr Rodko said. He noted that Medicare and Medicaid have not kept pace with the costs. “This affects how health care is delivered.”

He said it is important for seniors to have a supplemental policy to pay for the 20 percent of health care costs that Medicare does not cover. “Costs can rack up quickly. Many people have no real grasp of what an ambulance or CAT scan can cost.

“You should have coverage to cover the 20 percent,” Mr Rodko said. “That cost could be very high if you don’t. You must be on Medicare to obtain a Medigap policy.”

He discussed the different rates and benefits of Medigap plans. “The benefits are standardized no matter what company you go through,” he said. “That doesn’t mean the premiums are the same.

“For those with Medigap supplemental insurance, as people withdraw from HMOs and go to Medicare supplements, you can expect from a five to 15 percent increase in rates,” he said.

Once there is more demand for their services, companies providing Medicare supplemental insurance coverage will apply to the Department of Insurance to request an increase in rates, he said.

 There are no subsidies from the government for Medigap policies, he noted. “The cost for running the program comes from the premiums.”

The rates vary depending on how many people have a particular insurance policy, Mr Rodko said. Also factored in is the average age of policyholders. “If one average is 70 years old and another is 90, there will be more claims on the 90 than the 70-year-old, and that affects the rates,” he said.

He also noted that as preventative care benefits are added, benefits increase, or eligibility is expanded, companies would be paying out more. “Benefits are a good thing but someone has to pay for it,” Mr Rodko said. “There is no way to predict where the rates will go from year to year. As people go to lower cost premiums, those premiums will rise.

“There could be some rapid market shifting here,” he noted. “As more people go into other plans, the cost will go up again.”

He said the hottest seller currently is USAA Life, but a 20 to 25 percent increase in premium is expected there if it can be justified to the Department of Insurance. A 13 percent increase is expected with Nationwide Insurance, which now has a lower premium.

Wait And See

Mr Rodko advised seniors to wait and see what their plan’s increase will be before changing their supplemental policies. “You might jump into another plan that might have a higher rate increase than the one you have now.

“We don’t want to see Medigap companies pulling out of the market,” Mr Rodko said.

He advised seniors if they have access to group insurance, to never leave it. “If you are a retired worker, look into it. You may be able to have benefits.” He noted that some civic organizations are beginning to offer individual health insurance to seniors.

“You’re paying for stability,” he said regarding the supplemental plans. “You can go to any doctor. You’re paying more but getting good care.

“Some plans are still under $100 a month, but you have to have money in the bank to pay the deductibles,” he said.

A worst-case scenario would be if managed care companies leave the state entirely, Mr Rodko said.

While there is talk of offering new health care options, “We’re a couple of years away from seeing anything new,” Mr Rodko said.

If prescription benefits are passed this spring, the earliest they would be available to beneficiaries would 2002 or 2003, he noted.  “It will take a year to sort out what the benefits mean. I must emphasize you have to start writing your congressmen and legislators.”

Mr Rodko said there are 50 bills for changes to ConnPACE, though it does not look like there is either a governmental nor popular movement to raise its limits.

ConnPACE is an important program, Mr Rodko said. “ConnPACE B is the only thing that offers real help to people in need. It needs to be enhanced and supported.

“President Bush wants to funnel more money down to the states for prescription coverage. That money would be helpful, but it’s touch and go,” he noted. “I don’t know how that will translate into better benefits for you.”

Mr Rodko re-emphasized the importance of contacting legislators and congressmen. “Find out if there is any activity going on about ConnPACE. Become active.”

For additional information about Medigap policies, contact a WCAAA Choices counselor at 800/994/9422.