Rural Medicare Patients Jettisoned by CareFirst

Article excerpt

CareFirst BlueCross BlueShield yesterday became the last local health maintenance organization to drop coverage of Medicare enrollees for rural areas in Maryland, meaning about 14,000 elderly patients on Medicare no longer can join a Medicare HMO in most of the state.

CareFirst, the largest Medicare HMO in Maryland and the District, is one of several HMOs this week to announce plans to drop coverage of more than 200,000 Medicare enrollees nationwide next year because they say government payments are not keeping up with rising medical costs.

This round of cuts follows two years of similar moves by other HMOs. The health plans were required to notify federal regulators by yesterday of any changes to their Medicare HMO operations.

The HMOs are warning that in areas where they will continue operations, seniors can expect to pay higher premiums and receive fewer benefits.

"We have stayed in the market longer than any of our competitors, but we felt that we could no longer ask our other subscribers to subsidize the significant and growing losses we were experiencing in these counties," said David D. Wolf, executive vice president of medical management and strategic planning for CareFirst.

Medicare enrollees who use only traditional fee-for-service insurance pay about $700 more a year for health care than HMO subscribers, according to estimates from the American Association of Health Plans, an HMO association.

Seniors have signed up with HMOs as an alternative to Medicare's traditional fee-for-service coverage because the HMOs offer them prescription-drug coverage and fewer co-payments.

Most other HMOs in the area, including Aetna Inc. and Mid Atlantic Medical Services Inc., have discontinued Medicare HMO service in Maryland. The Health Care Financing Administration (HCFA), the federal agency that oversees Medicare, was not aware of any filings from HMOs with intent to discontinue coverage in the District or Virginia by press time.

For the Maryland counties and the District where it will still provide service, CareFirst requested permission from HCFA to increase its Medicare HMO rates $50 per month. …