New policies trigger sticker shock six months after end of Pa. low-cost insurance

In the six months since Pennsylvania ended its adultBasic health insurance program for low-income residents, fewer than half of the enrollees have signed up for alternative insurance options.

In the final hours of adultBasic’s funding, enrollees were encouraged to apply for Medicaid, or change their coverage to a product called Special Care that is subsidized by Pennsylvania’s Blue Cross and Blue Shield plans.

So far, just 38 percent of the enrollees who were with adultBasic to the end have signed up for either of those products.

One former enrollee, Jerry Kaufman, a self-employed trash collector, says he hasn’t been happy with his new Special Care insurance plan. It limits him to four doctors’ visits a year.

“So I’m limited to, even if I’m not feeling good, to try and not to go to the doctor,” he said. “I have prostate cancer, and I’m trying to use just those four office visits a year to my urologist, which I have to go every three months to be monitored.”

Kaufman said he’s also upset about the higher premium. Under adultBasic, he paid $36 a month; now, with Special Care, he pays $162 a month.

Rosanne Placey, a spokeswoman for the state Insurance Department, said those suffering sticker shock from coverage costs must remember how expensive subsidizing the program is.

“The issue is cost; $36 a month versus $140 a month, that’s a significant jump,” she said. “But $36 was heavily subsidized. The product itself cost $600 per person, per month.”

The Blues are involved in negotiations with the state Insurance Department to raise that rate by about 5 percent.

Former adultBasic enrollees would also be eligible for PA Fair Care, a temporary program that started this month to cover those with pre-existing conditions. Its monthly premium is just under $300.

A Highmark/Blue Shield spokesman says the real driver of rate increases is rising health-care costs across the board.