Ventura County Seniors Get Tips on Dealing With Medicare Shake-Up

At 86, F.M. Carlisle is not quite sure how to replace the health insurance benefits he will lose on Jan. 1.

One of more than 6,400 seniors in Ventura County to be dumped by Kaiser Permanente and Blue Cross of California, Carlisle and more than 100 others in the same boat jammed a Ventura meeting room Monday to learn about their alternatives.

Officials with an educational group called the Health Insurance Counseling and Advocacy Program told them not to panic. U.S. Rep. Lois Capps (D-Santa Barbara) urged them to join her in opposing a bill that she warned “would end Medicare as we know it today.”

The somber notes were similar to those that have sounded across the United States the last few years. Because of rising costs and what they view as inadequate federal reimbursements, Medicare health maintenance organizations dropped at least 1.7 million seniors from 1998 to 2001. In 2004, the rate will slow, according to government figures, but out-of-pocket costs to subscribers are expected to jump.

Carlisle, who retired as head of his own oilfield service company, was among 3,500 Ventura County residents who learned in September that they would be dropped by Kaiser’s Medicare Plus Choice plan in 2004. Both Kaiser and Blue Cross, which is dropping 2,937 county residents from a similar plan, said the move was prompted by too many expenses and too few customers.

“What are you going to do?” said Carlisle, a veteran of five HMOs. “You’ve got to roll with the punches.”

The actions by Kaiser and Blue Cross do not affect a senior’s right to Medicare. However, many Medicare HMOs offer additional benefits -- including, in some cases, prescription drug coverage.

Health officials reminded the worried crowd at Ventura’s senior center that some veterans and their widows do not know about all the benefits for which they may be eligible. They also ran through comparisons of benefits under Medicare and those available through supplemental insurance programs.

But unless Medicare is expanded to include payment for medications, Capps said the same anxiety would continue to grip seniors each autumn, when the HMOs’ one-year contracts are renegotiated.

“The lesson for me is that this is something we don’t want to repeat on a national scale,” said Capps, a member of Congress since 1998.

She said she had aggressively pursued higher reimbursements so HMOs like Kaiser and Blue Cross would continue to serve seniors outside major urban areas. Kaiser is keeping its Medicare Plus Choice Plan only in western Ventura County, while Blue Cross’ action affects the entire county.

“Their only response has been to cut your benefits, charge seniors more and finally pull out,” Capps said.

A bill in a congressional conference committee could make matters worse by “essentially privatizing Medicare,” she said.

Republicans in Congress favor encouraging competition between Medicare and private health plans, contending it would help keep costs down. However, many Democrats say such competition could end up increasing the burden on seniors and disabled people.