Elderly Face Tough Choices

By Year’s End

By The Associated Press

Thousands of Connecticut senior citizens must make critical choices about their health care – and soon.

More than 50,000 Connecticut residents are being forced to change health insurance carriers by Jan. 1 because many health maintenance organizations are getting out of the Medicare market. As a result, the elderly and disabled individuals must either change health plans or return to traditional Medicare, which doesn’t cover costly prescriptions.

And time is running out.

“People are frantic,” said Eric Rodko, coordinator for CHOICES, an affiliate of Western Connecticut Area Agency on Aging.

He said his agency fielded about 5,000 phone calls from June through Thanksgiving.

“Premiums are quite high. And they’re suddenly having to pay more out of pocket for prescription drugs. Never mind the oil bills. Out of pocket costs for health care are escalating. And it’s likely they will keep rising.”

Several insurers are dropping the Medicare HMO business because they say the federal reimbursement isn’t profitable. And those that aren’t dropping their Medicare HMOs are raising their rates.

“Our choice was reflective of issues facing the program throughout the country,” said Carol Pompano, spokeswoman for Anthem Blue Cross/Blue Shield. “Current funding levels and regulatory requirements just didn’t make it viable. Funding levels didn’t justify staying in the market. Anthem was losing money. Reimbursements remained flat. Our costs were increasing.”

Others pulling out of the Medicare HMO business include Aetna US Healthcare and Cigna Health Care for Seniors.

Some, including MedSpan Health Options Inc. and ConnectiCare 65, have either closed enrollments altogether or closed them to people living in certain counties. Others offer “Medigap” policies, which help cover what traditional Medicare does not for an additional monthly fee.

Mr Rodko said anyone who is overwhelmed or confused by having to make a quick decision should contact an agency on aging office.

“If they go back to traditional Medicare, they need some kind of supplemental coverage,” he said. “With a catastrophic illness, at least 20 percent is not covered by Medicare. And 20 percent of everything racks up bills pretty quickly. It could throw someone into a financial spin.”

Average Medigap policies cost $100 to $125 a month. Consumers should make sure the policy fits their needs before buying, Mr Rodko said.

William and Adelaide Grenier of Watertown have struggled with health insurance since August. The couple, in their 70s, switched to MedSpan Medicare Options when Waterbury Hospital dropped its contract with Medicare Blue Connecticut on Sept. 1.

This month Adelaide Grenier had a total hip replacement and said she was told that her insurer would not pay for her to temporarily go to an inpatient rehabilitation center once she left the hospital.

William Grenier has cancer and said it is hard for him to properly care for her.

“We believe she needed that inpatient care,” he said. “I’m sick. And so is she.”

Now, the couple’s doctor is ending his contract with MedSpan so the Greniers are switching policies back to traditional Medicare. They also are buying a Medigap plan to make up the difference in costs.

The new plan, their third in six months, takes effect Jan. 1.

“I don’t want to change doctors,” Adelaid Grenier said wearily. “It’s too late in life.”