Thanks to generous reimbursements set by the new Medicare drug bill, Tampa Bay HMOs go all out to court members.
By KRIS HUNDLEY
Published February 5, 2004
[Times photo: Cherie Diez]
Victoria Sparks massages Jack Machbitz, 73, at Classical Medicine in St. Petersburg. Patients like Machbitz could opt for new Medicare HMO plans that cover alternative therapies.
If you are eligible for Medicare, prepare to be wooed.
Medicare HMOs want your business. Starting March 1, the private alternatives to traditional Medicare will bump up their offerings in some Tampa Bay markets with such bonus benefits as $10 massage therapy, free dental cleanings and reimbursement for cab rides to the doctor. One insurer in Hernando County is even offering to fatten members' Social Security checks by picking up the cost of Medicare Part B.
The reason for the unprecedented enhancement in Medicare HMO benefits is last year's Medicare drug bill, which changed the way the plans are reimbursed.
In 1997, Congress limited reimbursement increases to Medicare HMOs to 2 percent a year, leading many insurers to leave markets or whittle benefits. Medicare HMO enrollments declined as a result, dropping more than 27 percent to 4.6-million in September 2003 compared with 6.35-million at the end of 1999.
Last year lawmakers, intent on privatizing Medicare and the drug benefit to come in 2006, decided that Medicare HMOs deserve to be paid as much, if not more, than traditional Medicare. The result was an additional $500-million in reimbursements for Medicare HMOs this year and a total of $14-billion between 2004 and 2013.
Nationwide that will translate into reimbursement increases beginning in March averaging 10.6 percent. But in some Tampa Bay markets, where about 500,000 seniors and disabled are on Medicare and 140,000 are in Medicare HMOs, it will mean much more.
Hernando County, which Medicare HMOs deserted three years ago saying government payments were too low, is the big winner. It is getting more than a 20 percent increase in reimbursements. Base reimbursement rates in Pinellas County will rise by 16 percent. Pasco and Hillsborough reimbursements will go up 8 and 7 percent respectively. Citrus has not had Medicare HMOs.
Congress put few stipulations on how HMOs spend the extra cash, giving them leeway to expand networks or build reserves.
But most local Medicare HMOs, whose changes are pending government approval, have responded by sweetening their benefit assortment for seniors. Medicare HMO premiums in the highly competitive Tampa Bay area were already zero.
Current plan members will be notified of the changes in the coming weeks and all local plans are accepting new members. People who sign up by mid month become eligible for coverage the first of the following month.
At the risk of being a killjoy, Gail Shearer, director of health policy analysis for Consumers Union in Washington, D.C., criticized the HMO windfall, saying it's like pouring money down a drain.
"Congress threw money at HMOs to give them an incentive to expand their benefits and participate in this marketplace," she said. "The problem is, they failed to build in any requirement that these private sector HMOs actually save money or operate in any efficient way."
Shearer also said the HMO reimbursement system perpetuates unfair geographic inequities. These are especially stark in some parts of the Tampa Bay area.
In Hernando County, which has the area's highest reimbursements, one Medicare HMO charges members just $100 for each hospital stay, regardless of its length. Across the border in Pasco County, the same HMO charges $100 a day for hospital care.
WellCare of Tampa will reimburse transportation costs for members in Hernando and Pinellas counties for two round trips a month to health care providers. An additional benefit for Pinellas residents under WellCare's proposed changes: six visits a year to a massage therapist, acupuncturist or dietetic counselor for a $10 copay.
Medicare Masterpiece, available only in Hernando, thought its members would prefer cash over enhanced benefits. It worked out an arrangement to pick up each members' Part B supplement fee of $66.60, deducted monthly from Social Security checks.
UnitedHealthcare's Medicare HMO cut the annual out-of-pocket maximum for residents of Hillsborough and Pinellas from $4,800 to $1,800 and added limited coverage of brand drugs in those counties.
UnitedHealthcare also offers a PPO in all four counties. Though details were not available, a company spokeswoman said the PPO's premium, now $85 a month, will be "significantly lowered."
Humana's Medicare HMO, the largest in the Tampa Bay area with about 60,000 members, has added a free dental cleaning each year for members in Hermando and Pinellas, as well as a discount on arthritis supplements in those counties. It has also reduced the nursing home copay in Hillsborough to $75 from $100 a day.
For Humana's PPO in Pasco, Pinellas and Hillsborough, limits have been removed on brand drug coverage. Scott Latimer, regional vice president for Humana in Central Florida, said focus groups with seniors showed brand drug coverage to be the No. 1 concern.
"There was a lot of confusion about the noncoverage part of the new drug bill," he said. "The other clear request was greater freedom of choice and less restriction. So we're optimistic this PPO product should have pretty good appeal."
Seniors who experienced the boom and bust of Medicare HMOs over the past decade may be leery of insurers' sudden largess. But Humana's Latimer said the change in HMO's federal funding formula should ensure the latest benefits won't evaporate any time soon.
"Congress was explicit that HMO funding would rise in parallel to medical inflation," he said. "And as long as that occurs, I'm very confident Medicare HMOs should be a much more stable, predictable health insurance."
The Consumers Union's Shearer is not so certain the benefits will last. Noting that the Bush administration just raised the estimated cost of the Medicare drug bill by one third, to $530-billion, she said, "There will be tremendous pressure to cut back on overpayments.
"People need to proceed with caution, because there's no guarantee these benefits will be there next year or the following year. What's offered today may not be offered tomorrow."
From The Times: 
