A series of novel insurance plans proposed by Blue Cross-Blue Shield of Maryland to reduce health costs for the elderly would eliminate many of the "deductibles" that patients now pay under Medicare and charge fixed insurance premiums instead, according to details of the plans disclosed today.
In the process, Blue Cross-Blue Shield officials said at a news conference, coverage for the state's 300,000 to 350,000 patients over age 65 in many cases would be more comprehensive and cheaper.
"These options start with the full range of Medicare benefits and build upon them," said Blue Cross-Blue Shield Executive Vice President Robert C. Heird.
Blue Cross-Blue Shield of Maryland, the private nonprofit insurance carrier that administers the $900 million Medicare program for all jurisdictions in the state, except Montgomery and Prince George's counties, unveiled details of four optional insurance plans proposed at the request of the federal Health Care Financing Administration (HCFA).
HCFA, the federal agency responsible for Medicare, is looking for ways to cut spiralling health costs nationwide. It is not expected to make any decisions on the proposal for several months.
The proposals have drawn criticism from the hospital industry, which complained of a "shroud of secrecy" under which they were formed, and statements of concern from state officials about the lack of competition in the plan.
Under the plans, elderly patients could opt to stay in the traditional Medicare program or join one of four existing Blue Cross-affiliated health care systems -- two so-called provider programs and two health maintenance organizations (HMOs). Patients would be free to switch from one plan to another.
Under all four private insurance options, federal Medicare funds would still provide the bulk of the money -- the "base premium" as Heird called it -- to pay the health costs of the elderly. But the insurance premiums paid by the patients would supplant various deductible items that Medicare patients now pay out of pocket.
In an example cited at the briefing, an elderly patient hospitalized for 13 days with a broken hip would incur costs totaling $8,070, including a $1,200 surgeon's fee and $500 a day for a hospital room. Medicare would pay $6,824 of the $8,070 total, leaving the patient responsible for the remaining $1,246.
Under the four private insurance options proposed by Blue Cross-Blue Shield, the same patient would receive about the same coverage by paying an annual premium ranging from $240 to $840, which would form a pool to help pay costs above what Medicare reimburses. The patient would also be responsible for $2 to $5 for each drug prescription or outpatient office visit. Doctors participating in the plans would accept Medicare and Blue Cross reimbursements as payments in full and would not bill the patient for the difference, if any, between the reimbursement and the usual fee.
One of the four plans is the Blue Cross-Blue Shield Participating Provider Program in which 90 percent of the state's physicians have agreed to accept Blue Cross-Blue Shield Medicare reimbursements as payments in full. In another, the Preferred Provider Program, 55 percent of the state's doctors have agreed to accept 10 percent less than the usual insurance payment.
The HMOs, both subsidiaries of Blue Cross-Blue Shield, are the Columbia Medical Plan with four centers in Howard and Anne Arundel counties, and the Free State Health Plan with 14 centers near Baltimore.