CalPERS Announces Policy Change for Medicare Beneficiaries
Some Medicare beneficiaries who have supplemental coverage through CalPERS' Blue Shield of California Medicare HMO and whose primary care physicians are associated with a Sutter Health medical group that admits patients only to Sutter hospitals must enroll in a preferred provider organization plan to maintain access to their PCPs, CalPERS announced Wednesday, the Sacramento Bee reports (Rapaport, Sacramento Bee, 7/1). CalPERS last month voted to drop 38 of the most costly hospitals -- including some Sutter Health facilities -- from its Blue Shield HMO network beginning in 2005 in an effort to control premium rate increases. CalPERS said that an analysis by Blue Shield indicated that some of the hospitals being dropped had proposed rates for 2005 that exceeded the statewide average by as much as 80%. The move to drop the hospitals is expected to save CalPERS $36 million in 2005 and $50 million annually after that. Members whose providers are dropped but who wish to keep their physicians or hospitals will be able to enroll in one of two preferred provider plans offered by CalPERS (California Healthline, 6/25).
When CalPERS officials voted to drop the hospitals, they said that members who belong to Blue Shield Medicare HMOs would not be affected by the decision. However, in a letter to about 2,100 Medicare patients who have PCPs in medical groups associated with Sutter, CalPERS said that those beneficiaries would have to enroll in a Blue Shield PPO plan to continue using Sutter in 2005, according to the Bee. Beneficiaries who choose to stay with Sutter by joining a PPO would not pay more for coverage and would not be responsible for deductibles, copayments or other out-of-pocket costs, CalPERS said, noting that the only services that could cost beneficiaries more would be hearing aids. CalPERS noted that some Medicare beneficiaries would pay lower monthly premiums in 2005 under the PPO plan. "There should not be greater costs to Medicare patients as a result of this situation," CalPERS spokesperson Pat Macht said (Sacramento Bee, 7/1).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.