Kaiser increasing seniors’ rates

About 15,000 Kaiser Permanente Hawaii Medicare plan members will see an increase in their monthly out-of-pocket premiums on Jan. 1.

The state’s largest health maintenance organization — both a medical provider and health insurer — notified Medicare members of the increases this week. Premiums will rise from zero to $38 for the Senior Advantage Basic plan; $144 to $180 for the Senior Advantage Enhanced; $39 to $63 for the Senior Advantage Essential policy; and $160 to $202 for the Senior Advantage Essential Plus.

That’s on top of the $104.90 price most seniors (with an income of $85,000 or less) pay for Medicare Part B medical coverage, which goes up to $121.80 in 2016. It is also in addition to co-pays and co-insurance for prescription drugs.

The premium rise “varies from individual to individual based on the plan selected and where they live,” said Kaiser spokeswoman Laura Lott.

“Currently the cost of high-quality health care needed by Medicare beneficiaries is not adequately covered by member premiums, co-payments and co-insurance, and government reimbursements,” she said. “This adjustment will help us improve the financial sustainability of our Medicare plan. We want to continue providing high-quality care and service for our members and future Medicare beneficiaries for many years to come. We are taking this action only because it is absolutely necessary.”

The increases will help Kaiser, which has provided Medicare coverage in Hawaii for more than 40 years, “continue to offer plans with care and service that our members need to be healthy at a cost that enables our Medicare plans to be financially sustainable into the future,” Lott said. “To do that, we had to make the difficult decision to adjust rates for 2016.”

Meanwhile, Hawaii Medical Service Association notified 5,000 senior members that they will have to pay an additional fee as of Jan. 1 when seeing a doctor at a medical facility or hospital-based clinic, though premiums for its Medicare policies are virtually unchanged next year. HMSA said it used to cover 100 percent of the facility fee, but next year will cover only 80 percent. The portion members pay could range from $20 to $50 per doctor visit.

“It’s so unfair for us seniors,” said Makiki resident Mary Yamakawa, 83, who pays $252 a month in HMSA premiums for herself and her 90-year-old husband, who lives in a skilled-nursing facility that costs $11,000 a month. “We are on a limited budget. Social Security did not increase anything for us. For us seniors with limited income, that’s a lot to be charged — a facility fee on top of the co-pays. The cost of living is going up. This is everyday living. This is life.”