Health Net Plans to Reinstate Medicare+Choice Coverage in San Mateo County

Officials from Health Net of California announced yesterday plans to reinstate Medicare+Choice coverage for 2,800 Medicare beneficiaries in northern San Mateo County, the San Francisco Chronicle reports. In September, Health Net had announced that it would pull its Medicare HMO out of San Mateo and four other counties as of Jan. 1, 2002. According to the Chronicle, at the time Health Net decided to drop its coverage, many other Medicare HMOs were following suit, citing "low reimbursement rates" set by Congress and "skyrocketing prescription drug prices." Health Net spokesperson Brad Kieffer said the company "was able to re-evaluate its decision" in San Mateo after it ended a "lengthy" contract dispute with Sutter Health, a network of hospitals and doctor groups that has an affiliate in San Mateo County and one in nearby Santa Clara County. "We feel we now have a network for our Medicare HMO members in that area in 2002," Kieffer said. Health Net officials said they will ask for federal approval to reinstate the Medicare HMO, adding that they were "confident it will receive government approval, but not until at least" February 2002. Meanwhile, if the reinstatement is approved, members who switched their coverage to another option before Dec. 31 will be able to return to Health Net. However, if they change their coverage after Jan. 1, the Chronicle reports, they may have to wait until 2003 to return to Health Net, because of Medicare rules that allow only one change between Jan. 1 and the end of June.

In addition to reinstating the Medicare HMO, Health Net officials said they would restore generic-only drug coverage for its 12,000 members in San Francisco. Health Net officials in September announced it would stop offering drug coverage to its Seniority Plus members in San Francisco, Contra Costa and Alameda Counties. The company has already applied for approval to expand the coverage, and expects to get approval by February of next year. The Chronicle reports that the expansion would not help patients who rely on brand-name drugs without a generic equivalent (Colliver, San Francisco Chronicle, 12/20).