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Despite warnings of higher rates, many bay area seniors are still stung by the magnitude of the increases.
By KRIS HUNDLEY
© St. Petersburg Times, published January 4, 2001
Dorothy Gilronan, 81 and legally blind, has trouble reading letters from her Medicare HMO or remembering the details after the letters are read to her.
So Gilronan is uncertain exactly how her "Medicare and More" policy through BlueCross BlueShield of Florida changed Jan. 1. One thing she knows for certain: her monthly premium jumped from $35 to $63.
"I'm on a very fixed low income, so I'm hurting quite badly," she said. "I just hope the drug coverage hasn't changed too much."
In fact, there's more bad news for Gilronan and BlueCross BlueShield's 33,000 Medicare HMO members in the Tampa Bay area: the plan's cap on brand name drugs has been cut in half, and the charge for hospital stays has increased.
Nor are BlueCross BlueShield members alone. Gilronan is among the 154,000 local residents who are struggling to adjust to increases in Medicare HMO premiums and the paring of benefits that became effective with the New Year.
Adding to the confusion, Medicare HMOs soon may be announcing additional changes in their plans -- this time perhaps to members' advantage -- in response to additional funding from Congress.
Maria Escobales, who runs the Senior Help Line for residents of Pasco and Pinellas counties, said her service has been getting calls from seniors who were caught short by higher HMO premiums.
"The HMOs had notified their members in October that these changes would happen, but some people are still surprised to see their premiums going up," she said. "Lots of our callers have monetary constraints, but we don't have a magic wand where we can solve everybody's problems."
Perhaps the biggest shocker in bills that arrived around Christmas: Humana Gold Plus Enhanced raised its monthly premium from $19 to $179.
Since October, Humana has been offering members the chance to switch to a different Humana HMO that has no monthly premium but offers very limited drug coverage. Pam Gadinsky, Humana's spokeswoman, said the response was strong.
"In excess of 10,000 members in the Tampa Bay area made the change," she said.
Folks who dragged their feet making the switch are stuck with a $179 premium for January. The deadline is Jan. 10 for changing to another Medicare HMO for coverage effective in February. But the choices are dwindling.
Though Humana, AvMed Health Plan, United Healthcare and Well Care are still accepting new members, BlueCross BlueShield has closed its Medicare HMO. Rick Curran, spokesman for the Jacksonville insurer, said Medicare and More probably won't take new members until November. Curran said the insurer is worried about overwhelming its provider network with hordes of new members.
"We want to keep it a viable product for the folks who are in it," he said.
The next round of changes might mean some relief.
Just a few days before Christmas, Congress passed a bill giving Medicare HMOs an additional $11-billion over the next five years, with the first increase taking effect March 1. The Health Care Financing Administration, the federal agency that regulates Medicare, expects to tell insurers within a few days what that means in terms of higher reimbursement. The HMOs have until Jan. 18 to tell the government how it intends to spend the bonus.
Among the options: reduce premiums, improve benefits or increase pay to doctors and hospitals. But HMOs also have the option of putting some of the money aside to offset rising medical costs, in which case members would not see any immediate benefit.
Stephen Dunn, vice president of Medicare sales and marketing for Well Care of Tampa, said he couldn't comment on how his company might respond until it analyzes the new rates.
"Physicians have complained about reimbursements, so maybe this is an opportunity to open that up," he said. "We'll do something that makes good sense to our company."
Meanwhile, Dorothy Gilronan of Largo is waiting to see if President-elect George W. Bush will make good on campaign promises of prescription coverage for all Medicare recipients.
"There was so much talk about it in the campaign, I certainly hope something will be done," she said.