STANTON - Health Care Plus is proving to be more of a minus for Montcalm County’s budget.
Emergency Medical Services (EMS) Director David Feldpausch recently told the Board of Commissioners Health & Human Services Committee that he is predicting Health Care Plus will lose $5,000 or more this year due to a combination of more claims and greater claim amounts.
The plan has been losing money since 2008.
EMS began offering Health Care Plus in 1997. The goal was to give people on a fixed income or Medicare a co-pay option for ambulance transportation costs.
The standard Medicare co-pay is 20 percent. Health Care Plus covers all out-of-pocket expenses for “medically necessary” transportation provided by EMS for subscribers, their spouses and dependent children living in the same household.
Anyone is eligible to subscribe to the program, but EMS has focused its marketing efforts on low-income residents.
Health Care Plus currently has 327 participants. Last fiscal year, 83 claims were made, eight of which were more than $200.
“The largest effect on the program is the increase of uninsured or underinsured participants,” Feldpausch told The Daily News. “It is just another side effect of our struggling economy. Each year the payouts seem to get larger and even though enrollment is up, it is not enough to make the program self-sufficient.”
Feldpausch said one of the reasons the program is struggling is because he doesn’t specifically promote it to individuals who are not on a fixed income.
“I encourage everyone I speak to about it to find out what kind of coverage they have for ambulance transport to determine if it is something that would benefit them,” Feldpausch told The Daily News. “Co-pays and deductibles vary greatly among insurance plans. I am just not comfortable marketing a product to residents knowing that they have no need for it. So we are selling subscriptions to only those who are most likely to benefit from use of the program.”
Feldpausch is recommending limiting program payouts to 25 percent of the total cost for each ambulance transport. He said this would limit large claims while continuing to help people with recurring health issues.
“I just think we need to take some sort of action to cap expenditures,” Feldpausch told commissioners. “I don’t want to be back here next year saying I lost $12,000 on this program and you looking at me like I’m irresponsible or something.”
Commissioners asked Feldpausch to do some more research and report back.
“It would seem like we don’t need to be adding to the loss,” said District 1 Commissioner Lloyd Walker. “To me, it’s purely a social program and lots of social programs are being cut, which is unfortunate.”
District 5 Commissioner Carl Paepke said he has participated in the program since it began, even though he has a good insurance plan.
“Tough, economic times call for tough economic decisions,” Feldpausch said. “I don’t know what the answer is. Times have changed and if we want to keep the program viable and healthy we’ve got to figure out what the program’s vision is and whether we need to make changes.”