2 Health Plans Cut Back on Coverage

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2 Health Plans Cut Back on Coverage

By Ronald D. White, The Los Angeles Times September 24, 2003

Blue Cross of California and Kaiser Permanente will drop Medicare Plus Choice plan coverage for more than 7,500 people in Ventura and Santa Clara counties next year in what the companies described as regrettable but unavoidable decisions.

The change will affect 2,937 Blue Cross members and 3,500 Kaiser members in Ventura County, according to the federal Centers for Medicare and Medicaid Services.

Medicare Plus is a supplemental health insurance program for seniors aged 65 and older and for some younger disabled people. The plans typically provide coverage for medical treatment that is not fully paid for by Medicare.

Many of the people losing Medicare Plus coverage from Blue Cross and Kaiser will still be able to get it through other companies, said Tom Scully, administrator for the federal Centers for Medicare and Medicaid Services. They also will be eligible for basic Medicare coverage.

The Centers for Medicare and Medicaid Services approved the elimination of service in limited areas of Ventura and Santa Clara counties, effective Jan. 1, 2004. Both Blue Cross and Kaiser said there were not enough customers in these areas to justify coverage, especially with low reimbursements and rising medical costs.

The Medicare Plus Choice program was created by Congress in 1997 to provide the option of additional coverage through private managed-care plans. But the program has been struggling in recent years as managed-care companies pulled out of the program.

Nationwide, 40,000 people will lose Medicare Plus coverage from their current provider next year, although many will be able to obtain coverage from other companies, Scully said.

By comparison, 217,000 people across the country were forced to find other supplemental coverage last year. "The trend is heading in the right direction," Scully said.

Rep. Lois Capps (D-Santa Barbara), whose district includes part of Ventura County, said the change is nonetheless traumatic for many elderly people. She urged those faced with the loss of coverage to call groups such as the Ventura County Area Agency on Aging for advice on obtaining new health insurance.