Senior citizens get look at new, higher cost health plan

Greg Harman

Friday, Oct. 27, 2000 | 11:29 a.m.

Seniors covered by one of Southern Nevada's larger HMO's got a chance this week to find out why their health coverage costs are going up.

PacifiCare, representing 31,000 residents in Southern Nevada, held an open meeting at the Henderson Convention Center this week to explain to more than 100 of its customers how and why their rates are going up next year.

The company announced it will no longer offer two separate policies for seniors.

Instead, it will offer a "classic plan" that raises the costs for prescription medicines for members while reducing their yearly allowance for brand-name prescription drug coverage from $2,000 and $3,000 under current programs to a flat $1,500.

Costs for emergency care increased significantly, including a $50 charge for every emergency room admission -- free under the current policies.

And urgent care co-payments doubled from $10 to $20.

Bard Coats, president of Secure Horizons of Nevada, PacifiCare's seniors HMO program, blamed rising medical costs and insufficient federal funding of Medicare programs for the change.

But the strain of the current system isn't limited to Nevada.

"This is everywhere," he said.

PacifiCare terminated service to a dozen counties in Ohio, Washington, Oregon and California last year.

Humana Inc. canceled its senior health care plan, Gold Medicare HMO, last year, citing substandard federal reimbursement policies for its decision.

"They just couldn't make it work," Coats said.

Members of Gold Medicare flocked to the only two remaining senior HMO programs in Clark County: PacifiCare of Nevada and Sierra Health Services Inc.

Richard Ewing, a Henderson senior and PacifiCare member who attended PacifiCare's presentation on Wednesday, said he reviewed all the numbers before coming to the meeting and was not concerned with the cost increases.

"I feel it's within reason," he said.

But Barbara Thomas was incensed by the increase, estimating it will cost her and her husband more than $50 every month. And she blamed the company's policy of not allowing primary care physicians to attend to their patients when they are in the hospital for a recent reaction that left her liver swollen.

But most of the meeting was devoted to matters other than cost, even stepping into the realm of the November elections.

When asked for his medical opinion of the presidential race, Coats demurred, saying that much of the information being presented by the candidates is questionable.

"The rhetoric that's out there for the presidential and Senate races is just amazing," Coats said.