Published in the Pawtucket Times on November 19, 2001

Across the nation, seniors who enrolled in Medicare HMOs are getting hit hard in the pocket book. Premiums and co-pays for hospital care, nursing services and prescription drugs are skyrocketing. Complaining about the inadequate federal funding offered to provide health care services to seniors, a growing number of Medicare HMOs are opting out of the program, leaving their senior enrollees high and dry.

In Rhode Island, seniors are also seeing this alarming trend. Last year, United Healthcare discontinued its Medicare Plus Choice program, first in Newport County, then in Bristol County. Now Blue Cross and Blue Shield of Rhode Island BCBSRI) informs its seniors that higher premiums and copays come net year for two of their three BlueCHiP for Medicare plans. The increases include prescription drugs, inpatient care, skilled nursing services and more.  The added out-of-project costs impact about 41,000 seniors across the state.

However, Rep. Patrick Kennedy (D-RI) is not buying  BlueCHiPs request for rate increases.

In a strongly worded letter to Tom Scully, the administrator of the Centers for Medicare and Medicaid Services (CMS), the agency charged with overseeing the Medicare program, the Rhode Island congressman strongly protested the rate hikes.

He called on the federal official to investigate whether the current market for Medicare HMOs in Rhode Island has created a situation where the types of increases charged by BCBSRI are more likely to occur and be approved.

Furthermore, he requested a review to determine if the increases are actuarially sound.

Scott Fraser, BCBSRI spokesperson, acknowledges that the premium increases of the two BlueCHiP plans were the result of higher medical costs passed onto the BlueCHiP plans by hospitals and other medical providers. “It’s medical inflation,” he quips, adding that even higher medication costs charged by drug companies has resulted in an increase in drug copays.

Even with next year’s increases, the BlueCHiP plans will not increase the premiums for the most commonly used services, specifically physician visits, laboratory tests and X-ray services, Fraser adds.  “These co-pays have been the same for the last three years,” he says.

CMS has reviewed BCBS’s application for the changes in rates and benefits over the summer, says Fraser, adding that the rate increases were given a thumbs up by the feds.

Are BCBSRI’s rate increases actually sound, thus justifiable?

CMS spokesperson Peter Ashkenaz told All About Seniors “the fact that the request has been approved by CMS speaks for itself. If the costs seem to be higher than what would be  paid for in fee-for-service Medicare, we would have questioned them.”

Ed Zesk, president of Aging 2000, a non-profit consumer advocacy group, believes that Rep. Kennedy has asked the right questions in his letter to CMS, specifically, “Are these premium and deductible increases justifiable.”

“Consumers just don’t have access to that type of information,” Zesk said.

With Medicare reforms now on the back burner as the nation gears up to fight terrorism, Rep. Kennedy must use his position on the House Appropriations Committee and the Subcommittee on Labor, Health and Human Services and Education to address the rising out-of-pocket health care costs for Medicare HMO enrollees.  As the Congressional elections approach, seniors will want to see concrete congressional action, leading to meaningful Medicare reform.