Insurance woes hit seniors

Published 12:00 am Saturday, April 21, 2001


PHOTO: ELODIA STEIN, a St. John resident, reviews health care options with Sean Roussel of River Parishes Hospital in LaPlace. Members of the senior population met at the Hampton Inn in LaPlace Thursday morning for a discussion on options. (Staff Photo by Amy Szpara) LAPLACE – Seniors in the tri-parish area are being faced with some difficult decisions, now that the Medicare HMO contracted with River Parishes Hospital is pulling out. The elderly will either be left with no coverage other than Medicare or the option to sign up with a group that doesn’t cover local doctors, if they don’t purchase supplemental insurance. Nearly 2,000 local seniors are going to be affected by the recent news that GulfSouth Option 65 is leaving town, as of May 1. The company contacted River Parishes Hospital about two weeks ago, giving patients one month to decide what they want to do. “It’s very confusing and very frustrating,” said Sean Roussel, spokesperson for River Parishes Hospital. “Picture being in their positions. You’re 70 years old, and you don’t know what to do.” After GulfSouth Option 65 closes in the area, patients will go back to their regular Medicare. They can also purchase supplemental insurance to cover deductibles and co-insurance without being denied, as long as they do that within 63 days after GulfSouth Option 65 expires. If the patient chooses supplemental insurance during that time, no medical screenings will take place. If a patient opts to wait until after the deadline, medical screenings can cause the patient to be denied. With supplemental insurance, patients are required to pay from $90 and up a month for premiums, depending on their age and health, but the supplement will pay the costs that Medicare does not cover. That includes 20 percent of expenses, a $792 deductible for hospital stays and the regular deductible. Neither Medicare or supplemental insurance covers prescription drugs, however. The other option that current GulfSouth Option 65 holders have is to purchase a plan with the Oath for SmartPlan 65, a Medicare HMO plan, which does not have a monthly premium. The plan does, however, require co-pays and is not currently under contract with River Parishes Hospital. The holder would not be allowed to use the local hospital, except in an emergency, and the patient would have to change from a local doctor to one in the Metairie area. According to Roussel, the Medicare HMO insurance plans come and go in the area. In four years, there have been four different companies to service the senior population. Community 65, United HeathCare, Etna Gold and now GulfSouth Option 65 have all left the area after finding that it is not as profitable as they had estimated, said Roussel. According to Bruce Naremore, chief operations officer at River Parishes, it is a yearly problem. The elderly become afraid when they lose their plans, and independent insurance companies come in and try to get the seniors to sign on with them. For example, companies that carry many different insurance companies will offer SmartPlan 65 to patients losing benefits, and in desperation to remain covered, the elderly sign up for the insurance. River Parishes, though attempting negotiations to get a contract with SmartPlan 65, does not have one in place at this time. If a patient signs on with that plan, he or she most likely will have to change doctors, as the insurance does not cover those in the LaPlace area. Some patients have been using their doctors for decades, though. Naremore said that the independent companies will give the seniors a false sense of security sometimes. One plan that is closing will give the names of those enrolled to another plan, and the latter plan will target those people. “The thought of not having medical insurance is as frightening as anything,” said Roussel. There are many Medicare supplements available to the elderly, which will cover what Medicare does not pay. The thing that keeps a lot of people from purchasing the supplements are premium costs, but Naremore said that supplemental insurance is often the best bet. Though supplements do not cover prescriptions, they do cover deductibles and co-pays. SmartPlan 65 will cover $600 a year toward prescription drugs, though the patients still have to pay a $30 or $50 co-pay, and after the $600 runs out for the year, the patient has to pay full costs. If the patient spends $600 by May, he or she has to pay drug costs out-of-pocket for half a year. Because Medicare pays the contracted Medicare HMO companies so much a month, the companies come into the area. However, they soon learn that the amount paid is not enough for the company to make money, said Roussel. That is when they leave town. “It’s just disappointing. They come in and sign them up in the masses, then they don’t do as well as they thought, and they leave,” said Roussel. Naremore recommends that patients get a supplemental insurance plan now, during the 63 days allowed, and switch over to the contracted plan if the hospital gets one in the future. “If they sign on with the Oath right now, they lose the ability to get supplemental insurance without screening later,” said Naremore. “Get a supplement and live with it for a little while and then switch it if we sign with the Oath later.” “If they are not sure what to do,” Naremore said of seniors, “I’d rather them check with us or with their physicians.” “There is no rosy picture for prescriptions,” Roussel added. “We just want people to make the best decision for them about what they need to do about insurance. They need to know the truth going into the game.” At a meeting held Thursday at the Hampton Inn in LaPlace, River Parishes residents listened to Matthew A. Scoggins of Louisiana Health Care Options explain all of their new options. An insurance agent that Naremore believes is providing accurate information to the public, Scoggins answered questions of the crowd. “Medicare has not been paying HMOs enough money, so they bail out of the market. They are losing money. If you go with another HMO, you might be looking for coverage in a year. I can’t promise that you won’t,” said Scoggins. Scoggins added that with the supplement, “you pay now,” and with the HMO, “You pay later. You have to decide what you want to do.” To reserve a seat at the next options seminar with Scroggins, call 652-3022.