HMO benefit reductions put seniors at risk

Originally printed at the Ventura County Star

Ventura County Star

URL: http://www.insidevc.com/vcs/opinion/article/0,1375,VCS_125_934404,00.html

Re: your Dec. 28 article, "HMO deadline for county seniors looms":
The Star has not begun to tell the whole story when it comes to Kaiser. The monthly fee increase from $30 to $75 is not the real issue. It is what one gets for $75 compared to last year. (As a side note, the year before it was zero dollars.)

The other changes, which are all reductions in benefits, are as follows:

-- A $50 co-payment for an emergency department visit; was $0.

-- A $50 co-payment for medically necessary emergency ambulance services; was $0.

-- A $200 co-payment for each inpatient hospitalization (up to $800 annual maximum); was $0.

-- A 20 percent co-payment for durable medical equipment, prosthetics and orthotics; was $0.

-- A $10 co-payment for a 100-day supply of generic drugs and a $25 co-payment for a 100-day supply of brand-name prescription drugs, according to Kaiser drug formulary (not all drugs are covered); was $10 for 100-day supply for generic or name-brand drugs in its formulary.

-- And, the big one, a $2,000 annual maximum of all prescription drugs; was no maximum.

Most seniors have little idea of how much their current prescription drug costs are for a total year and, therefore, may be in for a big surprise later in the year when they use up the $2,000 maximum and have to pay full price.

Blue Cross is no bargain either, at a $40 monthly fee, with the following:

-- A $50 co-pay for emergency room and urgently needed services.

-- A $250 co-pay for ambulance services.

-- A $250 per day co-pay for inpatient hospital (up to a $2,000 annual maximum).

-- A $12 co-pay for a 30-day supply of generic drugs from a retail pharmacy or a $30 co-pay for a 90-day supply of generic drugs from its mail-order service.

The drugs must be in its drug formulary, but there is no annual maximum. Without knowing what drugs are in its formulary, how do seniors make a decision as to what their costs for drugs will be?

Where will seniors come up with the co-payments on either of these so-called HMOs? Will they not call for an ambulance, go to emergency room or go to the hospital because they don't have or don't think they can afford the co-pay money? Do they have family to help?

Congress has let seniors down while members pass a large raise in pay for themselves and have their own medical and retirement plans that far exceed what working folks have or can obtain. Why else would someone spend millions of dollars to get elected for one term of office?

They have no concept of helping people 65 or older who have worked all their lives (some are still working) and trying to live on less than $20,000 or $15,000 or even $10,000 a year.

-- Robert L. Wiborg, Ventura

January 9, 2002