BY TIM BONFIELD
The Cincinnati Enquirer
About 47,000 Ohio seniors -- including people in Hamilton, Butler and Warren counties -- will pay more for weaker health coverage to prevent Anthem Blue Cross and Blue Shield from dropping about 7,000 people from its Medicare HMO.
It's part of a compromise approved Thursday by the Health Care Financing Administration (HCFA), the agency that runs Medicare, to soothe the sting of Anthem's original plan to drop 20,000 seniors in 19 counties and parts of three others.
After taking heat from enrollees and politicians, Anthem agreed to continue offering its Senior Advantage Medicare HMO to about 7,000 people in six counties (Brown, Darke, Greene, Miami, Preble and Shelby) and parts of three others (Warren, Madison and Columbiana). Anthem will still drop 13 counties as of Jan. 1.
But because HCFA refused to increase Anthem's reimbursement rate -- the reason for the pullout -- the company is charging more to enrollees and cutting some benefits.
Letters informing enrollees of their benefit changes go out in the next few days.
Seniors in Warren and Butler counties will become part of a new Dayton region. They will be charged $39 monthly premiums (up from no charge); $300 co-payments for hospital stays (up from no co-payment); $10 for doctor visits instead of $5; and $50 for emergency room visits instead $25. Prescription benefits will be cut to $500 a year, down from $1,000.
This may be a shock for Butler residents because they were not affected by the original pullout decision but have been moved into Anthem's Dayton region, where the benefits are lower and costs are much higher than in Cincinnati.
In the Cincinnati region, including Hamilton, Clermont and Brown counties, seniors will keep their $0 premium and $5 office visits, but their drug benefit drops to $900 a year and their emergency room visits bump to $50.