HMOs Pull Out of Medicare+Choice Program in Four Bay Area Counties
On Jan. 1, four HMOs -- Aetna, Blue Shield, Blue Cross and National Health Plans -- withdrew from the Medicare+Choice program in several Bay Area counties, the San Diego Union-Tribune reports. According to Liz Foley, associate regional HCFA administrator, the withdrawal will require 16,000 Medicare HMO beneficiaries in Alameda, San Mateo, Contra Costa and San Joaquin counties to find new plans this year. The California HealthCare Foundation estimates that 8.1% of Medicare+Choice enrollees in San Joaquin County will have to find new plans, while 2.3% of enrollees in Alameda County and 2.1% in Contra Costa County will also need to seek new plans. San Mateo County was "particularly hard hit," the Union-Tribune reports, with 27.5% of Medicare+Choice beneficiaries required to switch plans. The withdrawal by the four companies leaves Alameda, Contra Costa and San Joaquin counties with four remaining Medicare+Choice plans; San Mateo has three remaining plans. This year, 65 HMOs pulled out of Medicare+Choice plan nationwide, while 53 reduced their services (Bohan, San Diego Union-Tribune, 12/26).
The Bay Area is not the only California region undergoing changes in its Medicare+Choice system. California Blue Shield 65 Plus, which serves 4,000 seniors in Riverside and San Bernardino counties, ended its contract with PrimeCare Medical Network Inc. on Dec. 31, the Los Angeles Times reports. PrimeCare provides services at several sites in the Inland Valley region, including the San Antonio Community Hospital in Upland, the Chino Valley Community Hospital and the Inland Valley Regional Medical Center in Wildomar, Blue Shield spokesperson Laura Perry said. She stated that costs were a determining factor in the HMO's decision to end the contract. "It wasn't an easy decision to make. We get a 2% increase each year, but our health care costs have gone up 6% to 7% and our pharmacy costs have gone up 20%. We want to pay our providers fairly, but we want to offer our members particular benefits too," Perry said. Seniors wishing to keep their primary care physicians can either return to traditional fee-for-service Medicare or switch to another insurance company that still contracts with PrimeCare, such as Health Net, which serves about two million individuals throughout the state. Health Net public relations manager Brad Kieffer said it "wouldn't be a surprise" to see its membership rise due to Blue Shield's departure. "Typically, when there is a termination like that and people wish to retain their existing physician, we do see an increase in membership" (Noles, Los Angeles Times, 1/1).