ATLANTA - About a million Georgia Medicare recipients will soon be able to choose alternatives to the program's regular insurance.
Prompted by higher federal payments to insurance companies, Humana and Blue Cross and Blue Shield of Georgia will begin offering extra benefits, including free gym memberships and some prescription drug coverage.
But seniors generally will pay more for those added benefits.
The new Medicare choices will reverse the trend of health plans in Georgia closing their Medicare HMOs, which forced most patients into regular Medicare.
Nationally, ``2005 will be a year of expansion,'' said Mohit Ghose, a spokesman for America's Health Insurance Plans, an industry trade group. ``More seniors are expected to have more choices and benefits available to them.''
Currently, Georgia seniors only have one alternative to regular fee-for-service Medicare. Kaiser Permanente offers an HMO that is limited to the Atlanta area and covers 14,800 people a mere 1.5 percent of the Medicare recipients in the state.
The changes come in the wake of the 2003 law that created the new prescription drug benefit under Medicare.
Later this month, Louisville, Ky.-based Humana plans to offer a private fee-for-service plan in Georgia with extra benefits, including some prescription drug coverage, physicals and free gym memberships. Medicare members who choose this plan will pay a $5 copay for a primary-care doctor visit, rather than paying 20 percent of the bill, Humana said.
The drug benefits include a $12 copay for generic drugs and a $10 allowance for brand-name drugs, plus a discount if Humana network pharmacies are used.
Humana intends to extend its Medicare option statewide.
``It works well in rural areas, where you can't have HMOs,'' said Fred Borho, director of private fee-for-service in the southeast for Humana. In some areas of the state, seniors will not be charged any premium beyond the regular Medicare premium, Humana said.
Next year, Blue Cross and Blue Shield of Georgia, the state's largest health insurer, plans to offer a managed care plan similar to an HMO that will provide vision, dental and generic-drug benefits and gym memberships.
Like Humana, Blue Cross intends to provide a private fee-for-service plan with copays for doctor visits, and vision and hearing benefits.
``We expect that other plans will enter the Georgia market over the next 12 months,'' said Charlie Harman, a Blue Cross vice president.
But for many seniors, the insurance companies may first have to regain their trust. Over the past five years, six health plans in Georgia, including Blue Cross, eliminated their Medicare programs, citing low federal payments. Those pullouts may make some Georgia seniors wary about trying something other than regular Medicare.
``Folks have gotten a little leery about the stability of these plans,'' said Ken Mitchell, state director of AARP. The organization supports wider choices but warns that much education is needed.
Wednesday
July 2nd, 2025
2:43AM
