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MERCER COUNTY Session to explain cost rise for insurance attracts few



Published: Fri, November 2, 2001 @ 12:00 a.m.



A company official said another rate increase is likely for 2003 as well.

By HAROLD GWIN

VINDICATOR SHARON BUREAU

MERCER, Pa. -- Representatives of Security Blue Medicare HMO insurance seemed surprised when only a handful of Mercer County subscribers showed up to hear an explanation of rising insurance premiums.

The Security Blue team set up shop at Howard Johnson's at the Mercer exit on Interstate 80 and had seats for more than 50 people but only seven came to the 10 a.m. meeting Thursday.

Ronald Ortiz, sales manager for Highmark Blue cross/Blue Shield's senior insurance products, ran the meeting and said later that the low turnout might have been anticipated because this is the fourth year in a row the insurance carrier has been forced to raise rates.

Comments: Those who did come expressed concern about rising costs.

"It's going to cost us $1,000 a quarter [for health insurance]," said Margaret Thompson of Mercer, who attended with her husband, William.

"We can't afford that. I bet there's a lot of people in the same boat," she said.

"We've got to eat. We've got other bills to pay."

Ortiz could offer little comfort.

Rates are rising because health-care costs are rising and federal Medicare isn't reimbursing insurance carriers enough to keep premiums low, he said, adding that Security Blue is just trying to break even.

Costs are rising at 8 percent per year but Medicare is giving only 2 percent increases in reimbursement, he said, predicting the same scenario is likely for 2003 as well.

Increases: The company announced in September that rates for its basic coverage, which includes vision and hearing insurance, will rise from $43 per month to $99 per month beginning in January, provided the federal Centers of Medicare and Medicaid Services (CMMS) approves the rate change.

The cost of the company's standard package, which includes everything offered under the basic service plus $150 per quarter in prescription drug costs, will rise from $73 to $134 per month.

CMMS is expected to approve the higher rates as early as today.

The current rates of $43 and $73 were artificially lowered in March when Congress passed a $6 billion appropriations bill as a one-time aid to Medicare HMOs like Security Blue, resulting in savings' being passed directly to subscribers, Ortiz said.

Similar congressional action this year appears unlikely, he said.

Security Blue has 5,000 subscribers in Mercer County and 4,650 in Lawrence County, but Lawrence subscribers will be paying only $12 per month for basic service and $65 per month for standard service, and their quarterly prescription allowance will be $350.

The difference is that the federal government views Lawrence County as part of the Pittsburgh urban market, which gets a higher reimbursement rate of $664 per subscriber, and Mercer County is considered a rural area and gets a reimbursement rate of $538 per subscriber. Crawford County's 1,100 subscribers pay the same rates as Mercer County.

The company is imposing some new co-payments on subscribers to help keep premiums as low as possible.

They include first-time charges of $25 for an ambulance, $25 for outpatient surgery and $100 for inpatient admissions (up to a maximum of $500 per year).

Emergency room co-payments will rise from $45 to $50 per visit and prescription drugs co-payment will rise from $10 to $12 for a 34-day supply of a generic drug and from $15 to $20 for a brand-name drug for the same period.




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