About a year before the scheduled opening of its north Modesto hospital, Kaiser Permanente said it's slashing the premium for its Senior Advantage Medicare health plan by 25 percent.
The 2008 premium will be $74 a month, down from $99 this year. Kaiser also is offering unlimited coverage for generic prescription drugs, sales representative Greg Friesen said.
Changes to Senior Advantage and other health plans available to Medicare beneficiaries in Stanislaus County were discussed Thursday at the Modesto Senior Center. The Health Insurance Counseling and Advocacy Program held the meeting to help Medicare beneficiaries compare the various plans.
Friesen told the 150 people attending the meeting that Kaiser's north Modesto hospital would open in January, but Kaiser officials cor- rected the information after the meeting. The Kaiser hospital at Dale Road, near Bangs Avenue, is slated to open in October 2008.
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Other plans such as Secure Horizons and Health Net Seniority Plus announced few premium and benefit changes for 2008.
The government created Medicare in 1965 as a national health program for Americans age 65 and older. In 1972, adults with certain disabilities became eligible for Medicare and the government allowed the first Medicare health main-tenance organization plans as demos.
Today, millions of beneficiaries receive primary care, hospitalization, surgical, emergency services, prescription drug and other benefits through Medicare HMOs. Choosing a plan that meets a person's needs isn't easy, so Stanislaus County's Health Insurance Counseling and Advocacy Program holds an annual meeting in October to provide information.
The Kaiser plan will have the lowest premium of the three HMOs available in Stanislaus County, although the $275-per- day copayment for hospital- izations is higher than other plans. The copayment applies to hospitalization stays of one to eight days.
Other copayments are $30 for seeing a physician or specialist, $225 for outpatient surgery, $300 for ambulance service and $20 for clinical diagnostics. The limit on copayments is $4,000 a year.
The copays are $12 for a 30-day supply of generic drugs and $45 for brand drugs. For generic drugs, Kaiser is eliminating the coverage gap that often requires Medicare patients to pay full price for medicines when their drug costs are $2,510 to $4,050 for a year.
Name change coming
The primary change next year for PacifiCare Secure Horizons HMO members is the name. Because of corporate mergers involving PacifiCare, UnitedHealth Group and the American Association of Retired People, the popular plan has changed its name to AARP Medicare-Complete SecureHorizons.
The monthly premium for 2008 is $79. The copayment for a hospitalization is $200, regardless of whether the patient stays one day or 20 days, said Sandra Stevens, a Secure Horizons representative.
Other copays are $10 for physician visits, $25 for emergency ambulance service, up to $7 for lab services, zero to 20 percent for X-rays, $5 for a 30-day supply of generic drugs and $29 for brand drugs. Copays may be higher for certain medications and coverage is suspended when drugs costs are $2,510 to $4,050.
The Health Net Seniority Plus HMO will charge $80 a month. The copays are $100 per day for hospitalizations lasting one to four days, $10 for physician visits, $150 for outpatient surgery, $125 for emergency ambulance, zero to $250 for lab tests, and zero for X-rays. The copayment for a 30-day supply of ge-neric drugs is $5 and for brand drugs on the formulary it is $30. Copayments may be higher for certain drugs and there is a coverage gap.
Some plans offer dental and vision benefits at an additional charge.
Seniors opting for a Medicare HMO pay the premiums on top of the $96.40 monthly charge that most beneficiaries pay for Medicare Part B benefits, which cover physician and surgeon fees, lab and other services.
The HMO plans are a hedge against a lengthy hospital stay. Those opting for original Medicare coverage (with Part B) are expected to pay $1,024 for the first 60 days of hospitalization, $256 per day for the 61st to 90th day in the hospital and $512 per day if the hospital stay is more than three months.
Surgery copays vary
With original Medicare, patients pay 20 percent for physician visits, emergency ambulance service, X-rays and lab tests, and copayments vary for different surgeries. Beneficiaries have a choice of Medicare Part D drug plans ranging in price from $14.60 to $103 a month.
Frank Dotson, director of the Stanislaus County Health Insurance Counseling and Advocacy Program, said Medicare officials are monitoring the marketing tactics of insurance agents selling what are known as private fee-for-service plans. The plans offer various medical benefits for seniors, but clients need to make sure their doctors and specialists accept the terms and conditions of those plans.
For example, physicians in the Modesto-based Sutter Gould Medical Foundation do not accept fee-for-service plans that were being marketed to Stanislaus County residents this year.
Details of Medicare health plans are available at www.medicare.gov. Counseling is offered by the Health Insurance Counseling and Advocacy Program: 800-434-0222.
Bee staff writer Ken Carlson can be reached at firstname.lastname@example.org or 578-2321.