MEDICARE: Secure Horizons Tries to Fight Rate Hike in Three CA Counties
Starting next month, more than 100,000 Medicare recipients in San Bernardino, Riverside and Kern counties will pay an extra $20 per month for their health coverage because the federal government has disallowed their HMO, Secure Horizons, from cancelling a scheduled price increase, the Los Angeles Times reports. The federal government said that Secure Horizons' petition to cancel the price hikes came too late -- well after the July deadline for setting the next year's rates -- and that the request must be reviewed. Under federal rules, the government, which seeks to prevent surprise price increases, must approve all rate changes for HMOs that cover Medicare patients. Spokesperson Tyler Mason, representing Secure Horizons' parent company Pacificare, said that he hopes the increase will be repealed. PacifiCare had originally intended to increase the premium $20 for residents of the three counties, where federal reimbursement for Medicare is substantially lower than in Los Angeles and Orange counties. The payments are based on the average spending for Medicare patients outside HMOs, and Los Angeles and Orange counties' hospitals and physicians typically charge more than the rural areas. Accordingly, the federal government reimburses Medicare HMOs $628 in Los Angeles County each month; $593 in Orange; $519 in Riverside; $522 in San Bernadino; and $502 in Kern. But last month, PacifiCare asked HCFA to drop the proposed rate hike. Although Secure Horizons missed the July rate deadline, the plan could seek government approval to improve their benefits by eliminating the $20 increase sometime in February, 30 days after the plan year starts. Federal regulators then would review the proposal for financial feasibility before giving their consent (Rosenblatt, 12/17).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.