PACIFICARE: Secure Horizons Alters Benefits to Remain in Medicare+Choice
New benefit programs and limited prescription drug benefits may allow Santa Ana-based PacifiCare Health Systems' Secure Horizons, the "nation's largest Medicare HMO," to remain in the "chronically under-funded" Medicare+Choice program, the Los Angeles Times reports. Earlier this year, PacifiCare announced that it was pulling out of Medicare in several states, but did not drop out of any California counties. To remain in California, the company "significantly raised [premium] prices" in several counties. Secure Horizons annual premiums will double for consumers in some counties, and the company also is implementing a cap on pharmaceutical reimbursements in many areas. But in counties such as Los Angeles, where Medicare reimbursements are higher, members will pay no premiums and will retain unlimited pharmaceutical coverage for generic drugs. As part of its plan to "make it financially feasible for PacifiCare" to remain in Medicare+Choice, Secure Horizons has launched programs in Ventura and San Diego counties that allow consumers to choose higher premiums in exchange for a greater choice of doctors and hospitals. Under the plan, Ventura County consumers can elect to pay an additional $20 per month to gain access to the region's more expensive doctors and hospitals, such as St. John's Medical Center and Simi Adventist Hospital. In San Diego, consumers can choose among three plans, each of which has a different range of benefits and a progressively higher premium. The changes are still pending approval by federal regulators. HCFA officials are slated to release data on approved changes and price increases for Medicare HMOs on Friday (Bernstein, 9/13).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.