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Changes in Medicare HMO Out of Pocket Costs
Tue, 09/26/2000 - 11:00pm — Karen Stevenson
Changes in Out-Of-Pocket Requirements for HMOs in Illinois
Changes in Out-Of-Pocket Requirements for HMOs in Illinois
Description:
As reported earlier, many Medicare HMOs will no longer provide services in some or all of their service areas starting January 1, 2001. Although there has been speculation that the remaining plans would implement increases in premiums or co-payments or reduce benefits, there was no way to be sure until they announced pricing for 2001. Most of the new plan prices are now available, and it appears there is a definite increase in out-of-pocket costs. I analyzed plans available in Illinois to see what patterns seem to be emerging, using data from the Medicare.gov site.
14 plans will be discontinued in Illinois, including all of Aetna's plans, and 5 new plans will be implemented, leaving a total of 11 plans available in all of Illinois, most of which are only available in selected areas. Several plans with the highest premiums in 2000 were among the eliminated plans, which distorts the comparison of premiums in the two years. Even the companies that provided plans in both years have discontinued some plans and implemented others, making comparisons difficult. Four of the 14 remaining plans have no prescription drug coverage at all in 2001, including all of the plans that charge no premium. Of those that provide some prescription drug coverage, co-payments for generic/brand-name prescription drugs increased from $10/$10 or $5/$15 to $10/$35, and some plans have put caps on costs, as well. Some other comparisons drawn from the data:
Humana
The lowest cost Humana plan in 2000 has no premium, has no co-payments for physician or hospital stays, and requires $5/$15 co-payments for generic/brand-name prescription drugs. The lowest cost plan in 2001 still requires no premium, but has added a $15 co-payment for physician visits and no longer includes a prescription drug benefit.
The highest cost plan in 2000 has a $49 premium and calls for a $10 co-payment for a physician visit and $5/$15 co-payments for prescription drugs. The highest cost plan in 2001 has a $69 premium, keeps the physician visit co-payment at $10, but increases the co-payments for prescription drugs to $10/$35.
Mercy Health Plans
The lowest cost Mercy Health Plans HMO in 2000 has a $39 premium, and requires a $10 co-payment for physician visits and prescription drugs. The lowest cost plan in 2001 has a $69 premium, and requires a $15 co-payment for physician visits, has added a $200 co-payment for hospital stays, and requires a $10/$35 co-payment for generic/brand-name drugs.
The highest cost plan in 2000 has a $69 premium, and requires a $10 co-payment for physician visits and prescription drugs. The highest cost plan in 2001 has a $89 premium, and requires a $15 co-payment for physician visits, has added a $200 co-payment for hospital stays, and requires a $10/$35 co-payment for generic/brand-name drugs.
Changes in Out-Of-Pocket Requirements for HMOs in Illinois
From 2000 to 2001
|
Year 2000 |
|||||
| Company/Plan | Monthly
Premium (1) |
Physician Visit Co-Payment | Hospital Visit Co-Payment | Generic
Drugs Co-Payment (2) |
Brand
Name Drugs Co-Payment (2) |
| Aetna H1465 - 005 | $146 | $10 | $0 | $10 | $20 |
| Aetna H1465 - 004 | $95 | $10 | $0 | ? | ? |
| Aetna H1465 - 006 | $172 | $5 | $0 | $10 | $20 |
| Aetna H1465 - 002 | $61 | $10 | $0 | $10 | $20 |
| Aetna H1465 - 001 | $10 | $10 | $0 | ? | ? |
| Aetna H1465 - 003 | $87 | $5 | $0 | $10 | $20 |
| Humana H1406 - 008 | $0 | $0 | $0 | $5 | $15 |
| Humana H1406 - 009 | $39 | $0 | $0 | $5 | $15 |
| Humana H1406 - 015 | Not Available | ||||
| Humana H1406 - 014 | Not Available | ||||
| Humana H1406 - 006 | $19 | $10 | $0 | $5 | $15 |
| Humana H1406 - 013 | $49 | $10 | $0 | $5 | $15 |
| John Deere H1472 - 001 | $109 | $10 | $250 |
Not covered |
|
| John Deere H1472 - 002 | $150 | $10 | $0 | $7 | $7 |
| Mercy Health Plans H2668 - 002 | $39 | $10 | $0 | $10 | $10 |
| Mercy Health Plans H2668 - 003 | $69 | $10 | $0 | $10 | $10 |
| Mercy Health Plans H2667 - 005 | Not Available | ||||
| Mercy Health Plans H2667 - 006 | Not Available | ||||
| OSF Health Plans H1468 - 001 | $0 | $10 | $150 |
Not covered |
|
| Rush Prudential H1449 - 001 | $79 | $0 | $0 |
Not covered |
|
| Rush Prudential H1449 - 002 | $116 | $0 | $0 | * | * |
| United Healthcare H9045 - 003 | $0 | $10 | $0 | $10 | $40 |
| United Healthcare H2654 - 005 |
Not Available |
||||
| United Healthcare H9045 - 004 | $40 | $0 | $0 |
Not covered |
|
| United Healthcare H2654 - 003 | $0 | $10 | $0 | $5 | $35 |
| Overall Average | $64 | $7 | $20 | $8 | $19 |
| Overall High | $172 | $10 | $250 | $10 | $40 |
| Overall Low | $0 | $0 | $0 | $5 | $7 |
|
Year 2001 |
|||||
| Monthly
Premium (1) |
Physician Visit Co-Payment | Hospital Visit Co-Payment | Generic
Drugs Co-Payment (2) |
Brand
Name Drugs Co-Payment (2) |
|
| Aetna H1465 - 005 | Discontinued | ||||
| Aetna H1465 - 004 | Discontinued | ||||
| Aetna H1465 - 006 | Discontinued | ||||
| Aetna H1465 - 002 | Discontinued | ||||
| Aetna H1465 - 001 | Discontinued | ||||
| Aetna H1465 - 003 | Discontinued | ||||
| Humana H1406 - 008 | Discontinued | ||||
| Humana H1406 - 009 | Discontinued | ||||
| Humana H1406 - 015 | $19 | $15 | $0 |
Not covered |
|
| Humana H1406 - 014 | $69 | $10 |
$0 |
$10 | $35 |
| Humana H1406 - 006 | $39 | $10 | $0 | $10 | $35 |
| Humana H1406 - 013 | $0 | $15 | $0 |
Not covered |
|
| John Deere H1472 - 001 | ? | ? | ? | ? | ? |
| John Deere H1472 - 002 | ? | ? | ? | ? | ? |
| Mercy Health Plans H2668 - 002 | Discontinued | ||||
| Mercy Health Plans H2668 - 003 | Discontinued | ||||
| Mercy Health Plans H2667 - 005 | $69 | $15 | $200 | $10 | $35 |
| Mercy Health Plans H2667 - 006 | $89 | $15 | $200 | $10 | $35 |
| OSF Health Plans H1468 - 001 | $50 | $10 | $150 |
Not covered |
|
| Rush Prudential H1449 - 001 | Discontinued | ||||
| Rush Prudential H1449 - 002 | Discontinued | ||||
| United Healthcare H9045 - 003 | $0 | $20 | $250 | Not covered | |
| United Healthcare H2654 - 005 | $0 | $15 | $275 | Not covered | |
| United Healthcare H9045 - 004 | Discontinued | ||||
| United Healthcare H2654 - 003 | Discontinued | ||||
| Overall Average | $37 | $14 | $119 | $10 | $35 |
| Overall High | $89 | $20 | $275 | $10 | $35 |
| Overall Low | $0 | $10 | $0 | $10 | $35 |
| (1) Premium over and above the Part B premium all HMO beneficiaries are required to pay ($45.50 in 2000) | |||||
| (2) Other limitations and caps apply to some of these | |||||
| * 50% covered, no fixed dollar co-payment | |||||
As reported earlier, many Medicare HMOs will no longer provide services in some or all of their service areas starting January 1, 2001. Although there has been speculation that the remaining plans would implement increases in premiums or co-payments or reduce benefits, there was no way to be sure until they announced pricing for 2001. Most of the new plan prices are now available, and it appears there is a definite increase in out-of-pocket costs. I analyzed plans available in Illinois to see what patterns seem to be emerging, using data from the Medicare.gov site.
14 plans will be discontinued in Illinois, including all of Aetna's plans, and 5 new plans will be implemented, leaving a total of 11 plans available in all of Illinois, most of which are only available in selected areas. Several plans with the highest premiums in 2000 were among the eliminated plans, which distorts the comparison of premiums in the two years. Even the companies that provided plans in both years have discontinued some plans and implemented others, making comparisons difficult. Four of the 14 remaining plans have no prescription drug coverage at all in 2001, including all of the plans that charge no premium. Of those that provide some prescription drug coverage, co-payments for generic/brand-name prescription drugs increased from $10/$10 or $5/$15 to $10/$35, and some plans have put caps on costs, as well. Some other comparisons drawn from the data:
Humana
The lowest cost Humana plan in 2000 has no premium, has no co-payments for physician or hospital stays, and requires $5/$15 co-payments for generic/brand-name prescription drugs. The lowest cost plan in 2001 still requires no premium, but has added a $15 co-payment for physician visits and no longer includes a prescription drug benefit.
The highest cost plan in 2000 has a $49 premium and calls for a $10 co-payment for a physician visit and $5/$15 co-payments for prescription drugs. The highest cost plan in 2001 has a $69 premium, keeps the physician visit co-payment at $10, but increases the co-payments for prescription drugs to $10/$35.
Mercy Health Plans
The lowest cost Mercy Health Plans HMO in 2000 has a $39 premium, and requires a $10 co-payment for physician visits and prescription drugs. The lowest cost plan in 2001 has a $69 premium, and requires a $15 co-payment for physician visits, has added a $200 co-payment for hospital stays, and requires a $10/$35 co-payment for generic/brand-name drugs.
The highest cost plan in 2000 has a $69 premium, and requires a $10 co-payment for physician visits and prescription drugs. The highest cost plan in 2001 has a $89 premium, and requires a $15 co-payment for physician visits, has added a $200 co-payment for hospital stays, and requires a $10/$35 co-payment for generic/brand-name drugs.
Changes in Out-Of-Pocket Requirements for HMOs in Illinois
From 2000 to 2001
|
Year 2000 |
|||||
| Company/Plan | Monthly
Premium (1) |
Physician Visit Co-Payment | Hospital Visit Co-Payment | Generic
Drugs Co-Payment (2) |
Brand
Name Drugs Co-Payment (2) |
| Aetna H1465 - 005 | $146 | $10 | $0 | $10 | $20 |
| Aetna H1465 - 004 | $95 | $10 | $0 | ? | ? |
| Aetna H1465 - 006 | $172 | $5 | $0 | $10 | $20 |
| Aetna H1465 - 002 | $61 | $10 | $0 | $10 | $20 |
| Aetna H1465 - 001 | $10 | $10 | $0 | ? | ? |
| Aetna H1465 - 003 | $87 | $5 | $0 | $10 | $20 |
| Humana H1406 - 008 | $0 | $0 | $0 | $5 | $15 |
| Humana H1406 - 009 | $39 | $0 | $0 | $5 | $15 |
| Humana H1406 - 015 | Not Available | ||||
| Humana H1406 - 014 | Not Available | ||||
| Humana H1406 - 006 | $19 | $10 | $0 | $5 | $15 |
| Humana H1406 - 013 | $49 | $10 | $0 | $5 | $15 |
| John Deere H1472 - 001 | $109 | $10 | $250 |
Not covered |
|
| John Deere H1472 - 002 | $150 | $10 | $0 | $7 | $7 |
| Mercy Health Plans H2668 - 002 | $39 | $10 | $0 | $10 | $10 |
| Mercy Health Plans H2668 - 003 | $69 | $10 | $0 | $10 | $10 |
| Mercy Health Plans H2667 - 005 | Not Available | ||||
| Mercy Health Plans H2667 - 006 | Not Available | ||||
| OSF Health Plans H1468 - 001 | $0 | $10 | $150 |
Not covered |
|
| Rush Prudential H1449 - 001 | $79 | $0 | $0 |
Not covered |
|
| Rush Prudential H1449 - 002 | $116 | $0 | $0 | * | * |
| United Healthcare H9045 - 003 | $0 | $10 | $0 | $10 | $40 |
| United Healthcare H2654 - 005 |
Not Available |
||||
| United Healthcare H9045 - 004 | $40 | $0 | $0 |
Not covered |
|
| United Healthcare H2654 - 003 | $0 | $10 | $0 | $5 | $35 |
| Overall Average | $64 | $7 | $20 | $8 | $19 |
| Overall High | $172 | $10 | $250 | $10 | $40 |
| Overall Low | $0 | $0 | $0 | $5 | $7 |
|
Year 2001 |
|||||
| Monthly
Premium (1) |
Physician Visit Co-Payment | Hospital Visit Co-Payment | Generic
Drugs Co-Payment (2) |
Brand
Name Drugs Co-Payment (2) |
|
| Aetna H1465 - 005 | Discontinued | ||||
| Aetna H1465 - 004 | Discontinued | ||||
| Aetna H1465 - 006 | Discontinued | ||||
| Aetna H1465 - 002 | Discontinued | ||||
| Aetna H1465 - 001 | Discontinued | ||||
| Aetna H1465 - 003 | Discontinued | ||||
| Humana H1406 - 008 | Discontinued | ||||
| Humana H1406 - 009 | Discontinued | ||||
| Humana H1406 - 015 | $19 | $15 | $0 |
Not covered |
|
| Humana H1406 - 014 | $69 | $10 |
$0 |
$10 | $35 |
| Humana H1406 - 006 | $39 | $10 | $0 | $10 | $35 |
| Humana H1406 - 013 | $0 | $15 | $0 |
Not covered |
|
| John Deere H1472 - 001 | ? | ? | ? | ? | ? |
| John Deere H1472 - 002 | ? | ? | ? | ? | ? |
| Mercy Health Plans H2668 - 002 | Discontinued | ||||
| Mercy Health Plans H2668 - 003 | Discontinued | ||||
| Mercy Health Plans H2667 - 005 | $69 | $15 | $200 | $10 | $35 |
| Mercy Health Plans H2667 - 006 | $89 | $15 | $200 | $10 | $35 |
| OSF Health Plans H1468 - 001 | $50 | $10 | $150 |
Not covered |
|
| Rush Prudential H1449 - 001 | Discontinued | ||||
| Rush Prudential H1449 - 002 | Discontinued | ||||
| United Healthcare H9045 - 003 | $0 | $20 | $250 | Not covered | |
| United Healthcare H2654 - 005 | $0 | $15 | $275 | Not covered | |
| United Healthcare H9045 - 004 | Discontinued | ||||
| United Healthcare H2654 - 003 | Discontinued | ||||
| Overall Average | $37 | $14 | $119 | $10 | $35 |
| Overall High | $89 | $20 | $275 | $10 | $35 |
| Overall Low | $0 | $10 | $0 | $10 | $35 |
| (1) Premium over and above the Part B premium all HMO beneficiaries are required to pay ($45.50 in 2000) | |||||
| (2) Other limitations and caps apply to some of these | |||||
| * 50% covered, no fixed dollar co-payment | |||||
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