WASHINGTON – The last health insurer offering Medicare HMO coverage in Maryland announced Friday that it is quadrupling its premiums and capping enrollment at the current level.
Kaiser-Permanente is raising monthly premiums in the mid-Atlantic region, from $19 to $69 in the Washington suburbs and to $79 in Baltimore. It will also keep enrollment at its current regional level of 28,000, including 14,000 Maryland seniors.
Kaiser’s decision came after three out of four plans — FreeState, United Healthcare and Cigna — announced that they would withdraw HMO coverage for Medicare recipients in Maryland by Dec. 31. Those plans covered an estimated 55,000 Medicare recipients in the state.
A national Kaiser spokeswoman said the withdrawals by those other insurers left Kaiser with an overload of people to serve.
“We are capping enrollment because we don’t have enough physicians to handle people in that area,” said Laura Marshall, the spokeswoman.
“Since so many Medicare HMOs left the market and we’re staying in, we only have so many physicians to serve people. If we didn’t cap, they [physicians] wouldn’t be able to eat, sleep or breathe,” she said.
Kaiser attributed the premium increases to “skyrocketing” drug prices.
The changes caused the Maryland AARP great concern.
“We obviously want plans that seniors can get into and can afford. A plan that they cannot afford does them no good,” said Maryland AARP Director Frank Bailey.
Maryland officials said Friday that the issue of Medicare coverage is more of a federal problem, but they said seniors who have been left without insurance have some options.
Maryland Insurance Administration spokeswoman Tori Leonard said her agency can provide guidance for those who choose Medigap, a supplemental plan that can cover the gaps of Medicare plans but does not cover prescription drugs.
Seniors in 17 rural counties can also apply to the Rural Senior Prescription Drug Program, which was approved by the legislature and took effect July 1.
Under the plan, managed by CareFirst, eligible seniors who pay a $40 monthly premium can receive $1,000 in prescription drug benefits, after paying a $50 deductible. After the $1,000 in benefits, members can get a 15 percent CareFirst discount.
“For those people with heavy drug costs and who are paying out of their pockets, this is relief for them. And any relief is helpful,” said Debbie Rosen McKerrow, spokeswoman for CareFirst BlueCross BlueShield.
But the program ends after two years. It was created to help relieve seniors who lost coverage under Medicare+Choice HMO last year. CareFirst President William Jews said in a prepared statement that the program “is a stopgap, an important one, but a stopgap nonetheless.
“The problems plaguing Medicare require strategic, not piecemeal, solutions. Legislators, insurers and health care providers must focus on meaningful long-term Medicare reform,” his statement said.
The 17 counties covered by the program are Allegany, Calvert, Caroline, Carroll, Cecil, Charles, Dorchester, Frederick, Garrett, Kent, Queen Anne’s, St. Mary’s, Somerset, Talbot, Washington, Wicomico and Worcester.
Seniors in other counties are left only with Kaiser-Permanente’s prescription drug plan if they want government-supported prescription coverage.
Along with the increase in premiums, Kaiser beneficiaries will see their co-payments at community pharmacies for a 60-day supply of brand-name drugs rise from $20 to $80. For generic drugs, the co-pay will increase from $20 to $30, although the payment for drugs ordered by mail will be “much lower,” said Susan Whyte Simon, Kaiser’s mid-Atlantic states spokeswoman.
Rep. Benjamin L. Cardin, D-Baltimore, said the pullout by the HMO’s points up the need for Congress to include guaranteed prescription medicine coverage as a part of Medicare.
“If seniors are not currently in the Kaiser plan, they have no opportunity to enroll in any plan in the state,” Cardin said. “There is no choice now. It’s a sad day.”