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Subscribers' Medicare rates increase depending on locality



Published: Tue, September 25, 2001 @ 12:00 a.m.



Lawrence County rates are much lower because it is part of an urban region under federal guidelines.

By HAROLD GWIN

VINDICATOR SHARON BUREAU

SHARON, Pa. -- Mercer and Crawford County subscribers to Security Blue Medicare HMO insurance will see their basic coverage rate jump 130 percent next year.

Highmark Blue Cross/Blue Shield said the increase is necessary to offset rising costs.

Federal reimbursements aren't keeping up costs, said spokeswoman Vanessa Paris, noting that reimbursements average 2 percent per year but costs are going up 8 percent.

"We're committed to staying in the market," Paris said, but that will require a change in rates and benefits.

Despite the increases, Security Blue is still the most affordable Medicare supplemental insurance available in this area, she said.

Mercer County has 5,000 subscribers, and Crawford has about 1,100.

Monthly cost: Cost for basic service, which includes vision and hearing insurance, will rise from $43 to $99 per month in January, provided the federal Health Care Financing Administration (HCFA) approves the changes.

Standard coverage, which includes everything provided under basic service plus up to $150 per quarter in prescription drug costs, will rise from $73 to $134 per month.

The current $43 and $73 rates were artificially lowered in March thanks to a $6 billion federal appropriations bill designed to aid Medicare HMOs like Security Blue.

Before that additional funding, the basic and standard rates in Mercer and Crawford stood at $77 and $102 per month, respectively.

Some co-payments are also being imposed on subscribers in 2002, pending HCFA approval.

They include a $100 co-payment for each inpatient hospitalization with a maximum of $500 per year, a $25 co-payment for any outpatient surgery, a $25 ambulance co-payment for each one-way ride and a $50 emergency room co-payment for each visit.

Informational meetings: Highmark will hold public information sessions at Howard Johnson's at Interstate 80 and U.S. Route 19 from 10 a.m. to noon and 1 to 3 p.m.. both Nov. 1 and Nov. 6 to inform its subscribers of the changes.

Security Blue has 4,650 subscribers in Lawrence County, but the rates there are much lower because that county is considered part of the urban Allegheny County region, Paris said.

Lawrence residents will pay $12 for basic service and $65 for standard coverage. Their quarterly maximum on prescription drugs is also higher at $350.

The difference is caused by HCFA's reimbursing differently for urban versus rural regions. Security Blue gets $664 for each Lawrence county subscriber but $538 for each Mercer and Crawford County rural subscriber, Paris said.




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