Medicare HMO to drop 15,500 in Md.

UnitedHealthcare becomes 2nd insurer to quit state this year

Federal payments too low

700,000 U.S. seniors are expected to lose coverage by Dec. 31

Health care crisis

July 01, 2000|By M. William Salganik | M. William Salganik,SUN STAFF

UnitedHealthcare became the latest to exit the Medicare HMO market in Maryland yesterday, leaving about 15,500 seniors to look for new coverage by Jan. 1.

Nationally, United is leaving 21 counties, where it has 56,000 Medicare HMO members, while remaining in 61 counties, where it has about 350,000 members.

Like other major health insurers, United blames the pullouts on federal reimbursements that it contends are too low.

The exit of United is a further narrowing of choices for seniors in the state and is part of a national trend by health insurers who are expected to drop 700,000 elderly from Medicare HMOs by the end of the year.

United has the largest number of Medicare HMO members in Baltimore (4,400) and Baltimore County (4,300), plus about 600 members in Carroll County, where the only other current Medicare HMO insurer, CIGNA, also is leaving.

CIGNA, with 8,100 members in Maryland, said in early June that it would be leaving the market Jan. 1.

The other two Medicare HMOs operating in Maryland, CareFirst BlueCross BlueShield (32,000 members) and Kaiser Permanente (17,000), have yet to announce their plans for next year.

The rural counties of Western Maryland, the Eastern Shore and Southern Maryland lost their last HMO option at the beginning of this year, when CareFirst limited coverage to urban and suburban counties, where federal payments are higher.

In another development yesterday, Humana Inc. announced that it will drop Medicare HMO coverage for 84,000 seniors. On Thursday, Foundation Health Systems and Aetna U.S. Healthcare announced similar cutbacks affecting more than 350,000 seniors. Aetna left the Maryland market at the beginning of 1999 and Foundation and Humana do not insure in Maryland.

Altogether, the trade group American Association of Health Plans (AAHP) estimated this week that about 700,000 of the more than 6 million seniors in Medicare HMOs would lose their coverage through pullouts at the end of the year. That's about as many as were dropped by the HMOs in the previous two years combined.

Karen Ignagni, AAHP's president, said the HMO program, called Medicare+Choice, had been "overregulated and underpaid." She added, "The magnitude of these [pullout] numbers demonstrates that the Medicare+Choice funding crisis is an urgent matter."

Some critics say the problem is not that Medicare isn't paying enough, but that HMOs haven't managed well.

"Their promise was that they would be able to control costs by imposing restrictions," said Joe Baker, associate director of the Medicare Rights Center, an advocacy group in New York. "We get all the restrictions, and we still have to pay top dollar."

When a Medicare HMO leaves a market, some seniors switch to other HMOs. Others return to traditional Medicare coverage, but lose some benefits, particularly prescription drug coverage. Some of those benefits are also provided by supplemental Medigap insurance, but Medigap premiums are much higher than those charged by HMOs.

Roger Cruzan, United's vice president for public relations, said the key factor in the Minneapolis insurer's decision to cut back was that "costs are rising 8 percent a year, against a 2 percent increase in reimbursement. It's a difficult environment to operate in."

In deciding which markets to leave, Cruzan said, United also evaluated the number of doctors willing to participate.

Allan Hanssen, chief operating officer for UnitedHealthcare of the Mid-Atlantic, with offices in Woodlawn, said fewer doctors in the Baltimore area were willing to remain in the program. "In the local market, we've seen many [physician groups] either declare bankruptcy or go out of business."

He declined to provide specific financial figures for the Medicare HMO in the region, but said, "Historically, the profitability of this product has been a challenge."

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