Blue Cross Blue Shield drops HMO plans in 11 counties

Sept. 27--DURHAM -- Blue Cross and Blue Shield of North Carolina will drop its Blue Medicare HMO standard and Blue Medicare HMO Enhanced plan products in 11 North Carolina counties in 2015, affecting 50,000 beneficiaries statewide.

The counties include: Alamance, Davidson, Forsyth, Iredell, Rowan, Stokes, Surry, Wake, Wilkes and Yadkin, which makes up about one-third of BCBSNC's Medicare Advantage population, said Michelle Douglas, public relations manager for BCBSNC.

Under HMO plans, beneficiaries generally must get care from within the plan's network as opposed to PPO plans, which contracts with a network of preferred providers to which the beneficiary can choose.

Mary Snider, a BCBSNC customer who lives in Davidson County, said she received a letter this week that said her Blue Medicare HMO enhanced coverage would no longer be available.

According to the letter, if Snider does not take action before Dec. 31 on selecting a new plan, she will lose prescription drug coverage and only have Original Medicare beginning Jan. 1.

"This is a shock to everybody," Snider said. "We wish they still offered (the old plans.)"

Snider said her monthly premium for Blue Medicare HMO Enhanced was $18.90 per month, which is confirmed by Centers for Medicare and Medicaid Services (CMS) data.

The BCBSNC letter does not outline the new plan offerings or specifics because they are not made public until Oct. 1.

However, according to CMS data that shows approved plan premiums for 2015, the only available HMO plan with drug coverage from BCBSNC in Davidson County is set to increase by just over three times Snider's current premium, to $63.50 per month.

"There are some people out here who choose between health care and food," she said about potential price increases. "If you're caught in the middle, there's nothing you can do."

The changes do not affect BCBSNC's provider network and only affect individual members, not employers, Douglas said.

According to the letter, those affected have the option to join another Medicare health plan or change to Original Medicare, which may require a separate Medicare subscription drug plan to cover prescription drugs.

Original Medicare is fee-for-service managed by the federal government.

Geographically, nine of the 11 counties border each other in the northwestern part of the state.

According to calculations based on government data from 2012, about 20 percent of the population across the 11 counties is enrolled in Medicare.

Douglas said in an email that BCBSNC made the decision to drop the plans based on the overall performance of the plans in these areas as well as changes in CMS reimbursements for Medicare Advantage plans.

"I can tell you that the 11 counties where we will no longer offer the Blue Medicare HMO Enhanced/Select plans are the counties with most significant federal government reimbursement impact," she said.

Kerry Hall, of the N.C. Department of Insurance, said that Medicare Advantage (private company health plans that contract with Medicare) products are not subject to the department's regulation and are approved by the CMS.

But Hall said the Insurance Department does offer assistance, called The Seniors' Health Insurance Information Program (SHIIP), for beneficiaries in selecting a plan.

"The SHIIP program is very helpful," Snider said.

On Thursday, the CMS released a report that said the average premium submitted by health plans would increase by $2.94 next year, to $33.90 per month.

The report also highlights that the average premium for a basic Medicare prescription drug plan is expected to be $32 per month.

"Because of the Affordable Care Act, people with Medicare are seeing reduced costs through both savings on covered brand-name and generic drug and having access to certain preventative services at no cost sharing," the report said. "Since the passage of the Affordable Care Act, more than 8.3 million people with Medicare have saved over $12 billion on prescription drugs through July 2014, an average of $1,443 per beneficiary."

The report projects that enrollment in Medicare Advantage plans is expected to increase 42 percent and premiums will have decreased by 6 percent between the enacting of the ACA in 2010 and 2015.

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