HMO customers may get some relief

January 28, 1998|By GUY FLETCHER

HMO customers may get some relief

ANNAPOLIS - Many managed-care customers in Washington County whose premiums recently jumped from zero to $75 a month could get some relief from legislation being drafted in the Maryland General Assembly.

The legislation would prohibit Blue Cross and Blue Shield of Maryland from charging rural residents a premium for Medicare-replacement benefits, while others living in the metropolitan areas pay nothing.

"It's got to be the same everywhere," said Del. John P. Donoghue, D-Washington, co-sponsor of the bill and chairman of the House of Delegates' subcommittee on health care.


Donoghue and other lawmakers have heard complaints over the past few months from Medicare customers who had switched in recent years from purchasing "Medigap" coverage to the Blue Cross "zero-premium" Medi-CareFirst HMO.

Under a contract with the federal government, Blue Cross is paid a monthly premium from Medicare for each member and, in turn, is responsible for providing the member's health care benefits.

Late last year several county residents were told that beginning on Jan. 1, they would have to pay monthly premiums of $75. Some people said they were on fixed incomes and would be hard hit by the expense.

The change affected about 2,450 Western Maryland residents, including about 925 in Washington County, according to Blue Cross.

Blue Cross said it had to charge a premium to those in rural areas of the state because it has been receiving a lower reimbursement from the federal government in those areas. The company said it cannot start charging people for the plan in the areas where the Medicare premium is covering costs.

"It's a tough situation, but we really didn't have any other choice," said Fran Tracy, a lobbyist for Blue Cross.

Tracy said the only other option Blue Cross had was to remove the plan from the rural areas - something that would hurt those able to pay the $75.

"I'm not minimizing the financial hardship, but there are still people for whom this would still be a wonderful deal," she said.

The legislation would require Medicare-replacement services and premiums to be uniform throughout the state. Although Blue Cross has not yet taken a formal position on the legislation, supporters of the bill expect it will generate strong opposition.

"It will be controversial, for sure," said Del. Adelaide C. Eckardt, R-Talbot, the bill's chief sponsor.

Donoghue said the legislation will "send a strong message to all the HMO carriers" that they should not promise attractive packages to lure customers to their plans and then hike premiums.

Because the legislation would be in effect for only seven months, it would be a temporary solution. Eckardt said the answer would be for state lawmakers and others to convince the federal government that its reimbursement formula is flawed and needs to be corrected.

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