Medicare+Choice Plans in California To Increase Cost-Sharing Measures While Decreasing Some Benefits

Seniors in the East Bay area will face "sharply higher" Medicare+Choice costs in 2003, but the cost of prescription drug coverage under the health plans will remain relatively stable, the Contra Costa Times reports. The cost of premiums, copayments for doctors' visits and hospital stay deductibles is expected to increase for many M+C beneficiaries, including those in Contra Costa and Alameda counties. For example, Kaiser Permanente plans to raise premiums for its 2003 Senior Advantage plan from $65 per month to $80 per month. It also plans to increase the deductible for hospital admissions from $200 to $500 and increase copayments for doctors' visits to $20. In addition, Medicare HMOs might require greater cost sharing for previously free or inexpensive services, including outpatient surgery, prosthetic devices, eye care and ambulance services, according to the Times. The increases reflect a national trend of rising prices and greater patient cost sharing over the past several years, the Times reports. According to a report released today by the Commonwealth Fund, out-of-pocket costs for Medicare beneficiaries enrolled in HMOs nationwide increased 24% from 2001 to 2002 (See related story). However, prescription drug costs under M+C plans in the East Bay area will remain stable next year, the Times reports. Kaiser will make "minimal changes" to copays for prescription drugs; copays for brand-name medications will increase from $25 to $30, copays for generics will remain at $10 and the $1,000 annual limit on drug coverage will not change. Prescription drug benefits included in M+C plans offered by PacifiCare and HealthNet also will remain constant, the Times reports (Silber, Contra Costa Times, 11/1).

In Orange County -- where 39% of Medicare beneficiaries are enrolled in M+C plans, compared with 12% of Medicare beneficiaries nationwide -- Medicare HMOs are increasing copays, deductibles and premiums while cutting benefits, including prescription drug coverage, the Orange County Register reports (Wolfson, Orange County Register, 10/30).