Rim country seniors and disabled persons are avoiding most of the painful changes in Medicare HMO coverage that will go into effect today, Jan. 1 The alterations will target hundreds of thousands of such enrollees elsewhere in the state, according to several Payson health care experts.
The moment Dec. 31 rolls into 2002, those who participate in plans such as PacifiCare of Arizona will no longer be covered for brand-name or the more expensive prescriptions.
Also, for perhaps the first time ever, specific diseases have been singled out in some of the revamped plans. PacifiCare and Humana Net of Arizona, for instance, will abolish its $10 or $20 co-pay for chemotherapy and instead require cancer patients to pay 20percent of their bill, which can be as high as $2,000 per treatment.
Co-pays for dialysis patients, meantime, will triple for per-session visits from $25 to $75.
"Those changes are on Medicare-Plus Choice Products, which are a few HMOs that are left down in the Valley and in Tucson primarily," said Sandy Dinah, a Payson health care consultant, practice manager, registered nurse and patient advocate. "Most of them have pulled out of the rural counties and the last one in Gila County, Intergroup, pulled out a year ago."
Still, Dinah is aware of some Rim country residents who are enrolled in PacifiCare, she said, and for them "the changes that have been made are dramatic. In fact, in my opinion, those people would be better off with their own individual supplement than they are with their an HMO.
"For example, if you need outpatient surgery, several HMOs are charging the patients 50 percent for any outpatient services that are done, whereas if the patient had just straight Medicare with no supplement at all, they would be responsible for roughly 20 percent of that cost. And if they had a supplement, they would be responsible for and this is a worst-case scenario a $100 deductible per year."
Those in Gila County who are still enrolled in PacifiCare of Arizona, Dinah said, "are paying an enormous price for it. They're penalized because they live outside of Maricopa and Pima counties. They could get a supplement with full coverage and the ability to go to any doctor in the United States without xxxx