LAKE COUNTY ? For Mark and Cathi Demasck, good health insurance coverage is not a just ideal, it”s essential. Cathi deals with five chronic health conditions, and to pay for her hospital bills, she needs a low co-pay plan.
That”s why when she heard that her Blue Shield/CalPERS coverage would switch Jan. 1 to a new PPO plan that requires a higher co-pay, she knew it would be a great hardship to pay those bills.
To remain on her plan and receive high quality, convenient care, she and her husband Mark have decided to sell their Main Street Gifts business in Lakeport and Kelseyville home. They plan to relocate to Redwood City where Mark works, and where the Demasck”s can get coverage.
“We don”t want to leave. But because of the health insurance change and restrictions, we have to. We”re leaving our friends, our home, our business that we”ve built for the past two years?The Bay Area is a very stressful place, and I”ll have to sacrifice my comfort level,” Demasck said as she worked at Main Street Gifts Wednesday.
The gargantuan California Public Employee Retirement System Blue Shield health care benefit provider quit Lake County on Jan.1, leaving county and state employees, retirees and their spouses digging deeper into their pockets.
Leaving Lake County cuts costs for Blue Shield, which cited higher costs of providing services. “In Lake County, overall costs were 89 percent higher than statewide,” CalPERS representative Karen Perkins said. Napa, Plumas and El Dorado counties are also taking the hit.
“The change in Lake County impacted about 2,000 CalPERS members. As of Jan. 1, CalPERS continues to serve more than 3,000 total members in Lake County,” Perkins said.
Kathy Ferguson, human resources director for the County of Lake, said of approximately 825 active county employees, including the Lake County Sheriff”s Office, at least 90 percent were enrolled in the Blue Shield health plan offered through CalPERS.
“Certainly people are experiencing a higher share of cost, but it depends on the individual. Every person”s health situation is different?there”s a 20 percent co-pay, preventative lab work is covered at 100 percent, so for some people who are only going to the doctor annually, they may not notice at all. But someone with a chronic health problem is going to notice a big difference,” Ferguson said.
So far, Ferguson estimates the transition to the new CalPERS PPO plan has been smooth for county employees. “But we”re only a few weeks into it. We haven”t heard yet of anyone needing to move out of the county, but it could happen. They have to look at their total compensation package when they look at accepting an offer elsewhere?the cost of gas and commuting?factor all of those things into their decisions,” Ferguson said.
Perkins said there are still three CalPERS PPO plans offered in Lake County. “They could also enroll in a health plan using a work Zip code. Members choosing to do this must receive all covered services?except emergency and urgent care?within the health plan”s service area, even if they do not live in that service area. For instance, a member living in Lake County and working in San Mateo County could enroll in a health plan offered in San Mateo County. That would include Blue Shield Access+ HMO, Kaiser Permanente and the three PPO plans.”
Perkins said that for some preventative care services, there is no co-payment under the CalPERS PPO plan, including periodic health exams, gynecological exams and well-baby care.
“How many retired people are having babies?” Demasck asked. “Lake County has many retirees living on a fixed income who can”t afford the 20 to 40 percent more for the premium. It”s forcing them out of the county. And now the county is losing a resident and a store. What about the employees who work here? What happens to them? I know my friend Susan is also moving out of the county because of CalPERS, I wonder how many other people are affected.”
Contact Elizabeth Wilson at ewilson@record-bee.com
