Thursday, January 22, 1998
Monterey County seniors worried about the much-ballyhooed changes in the national Medicare program can relax...at least for the rest of this year.
"The changes, as we speak, are not very significant," says Dan Callinan, program manager for the Alliance on Aging''s Health Insurance Counseling and Advocacy Program (HICAP). "Things will stay very much the same, with a little increase in benefits. People may pay $5 more here and there, but that''s it. The big changes will start taking place at the beginning of 1999."
The entire Medicare system, which offers health care coverage for Americans over 65 and younger people with disabilities or permanent kidney failure, is undergoing the biggest shakeup in its 32-year history.
Congress''s Balanced Budget Act of 1997 took the Medicare behemoth to task for over-spending federal monies. Medicare spending will be slowed by $115 billion over the next five years, from 1998 to 2002. Savings will come mainly from reduced payments to hospitals, physicians, home health care providers and medical equipment suppliers, but beneficiaries-i.e. Americans over 65-will also shoulder part of the financial burden.
HMOs suffered much of Congress''s wrath. Medicare HMOs in particular were targeted for belt-tightening, and Congress pledged to cap payments to them beginning next year.
In anticipation, HMOs nationwide have already announced deep cuts in their generous benefits to millions of elderly Americans. Some Medicare HMO plans are charging seniors monthly premiums for the first time. Others are cutting out some of the most popular benefits, including free or nearly-free prescription drugs, eyeglasses and dental care.
Cutbacks will be most harsh in states where the government has been spending the most in payments to Medicare HMOs. California is one of those states. But for the rest of 1998, Monterey County''s 41,000 Medicare recipients will pay the same $43.80 monthly premiums they have always paid for Part B benefits, which cover doctors'' office visits. Those premiums may be hiked next year, but there''s no word on that yet.
Instead, Medicare beneficiaries will actually reap increased benefits through the rest of this year. On Jan. 1, Medicare began to covers annual mammograms in women over 40, and pays for pap smears and pelvic exams for high-risk women once a year, and every third year for other women. Colorectal cancer screening is also now covered. Beginning July 1, Medicare will offer bone-density tests for women at high risk of osteoporosis and new benefits for diabetes sufferers. The county''s only Medicare HMO, Secure Horizons, with approximately 4,500 local members, raised its monthly premium from $25 to $30 on Jan. 1, but that''s the only change scheduled for 1998.
And it''s a lot less than many other California Medicare HMO clients are paying. Aetna Inc. has started charging monthly premiums of $49.50 for some of its San Mateo Medicare clients, who were previously paying nothing. California Blue Cross announced a new $65 monthly premium and has eliminated coverage for drugs, glasses and dental care for several thousand Medicare HMO clients.
Secure Horizons Product Management Director Larry Costello says benefits to Monterey County HMO customers will not change in 1998, and office visit co-payments will stay at $10.
Why no changes? The fact that the HMO benefits package is already so low in Monterey County may have something to do with it. Secure Horizons doesn''t have to cut its coverage for prescription drugs because it never offered this benefit to begin with.
Dan Callinan notes that HMO enrollment is very low in Monterey County, and so is the benefits package offered by Secure Horizons and its parent company, Pacific Care.
"When people come to me and say they can''t afford medical care but don''t qualify for MediCal, and they ask me what to do, I may sound facetious but I tell them to move," Callinan admits. "Santa Clara, San Mateo and other nearby counties have greater (Medicare HMO) benefits."
The real crunch for Medicare recipients will come a year from now, Callinan reiterates. "By the middle of this year, Monterey County seniors will begin hearing about the changes in the news, and they''ll become afraid and confused," he warns. "People will be faced with choices they didn''t have to make before."
For example, more options will be available to bridge the gap between what Medicare covers and what patients are still asked to pay for medical drugs and services, which comes to about 20 percent of the total cost.
Today, Medicare recipients bridge that gap by buying supplemental insurance, joining an HMO, or digging into their own pockets.
Beginning next year, they''ll have three new choices: 1) Provider Sponsored Organizations-groups of doctors and hospitals that band together to form their own network that will contract directly with Medicare; 2) Preferred Provider Organizations (PPOs)-something between the above and HMOs; and 3) Private fee-for-service plans, which will be private insurance plans that can charge whatever premiums they want.
As if that doesn''t complicate things enough, some Medicare recipients will be able to sock away up to $6,000 a year beginning next year in a new animal called a Medical Savings Account, which will look something like a medical IRA.
Henry Tyson, a customer relations official with the San Francisco office of the Health Care Financing Administration, says the Medical Savings Account program will be run on a demonstration basis only from 1999 through 2002, and will be limited to 390,000 participants in several states.
California has been proposed as one of those test states, but Tyson says no one knows for sure whether that will happen. "There are no guidelines or regulations yet for the program, so we don''t know what the geographic parameters will be," he says. The HCFA will issue more information on the new Medical Savings Account in four or five months, he says.
"It will be a real can of worms," Callinan predicts. "It will cause some concern. People are already worried."