FutureCare could introduce means testing in future phases, despite the initial pledge that it would be a health-care plan for all citizens over 65.

Permanent Secretary for the Ministry of Health, Warren Jones, said the Government is looking at a variety of options which will take into account Bermuda's growing elderly population for future phases of the health scheme, including means testing.

The admission came after Government announced it would allow seniors who found themselves ineligible for FutureCare and unable to pay private coverage fees to join the Government's basic health care insurance, known as HIP.

Health Minister Walter Roban said reopening HIP for seniors was an "interim solution" the Government wants to put in place to address the needs of seniors who have been left out in the cold because private health companies no longer offer a low-cost basic health coverage plan.

Approximately 30 percent of Bermuda's elderly population was enrolled in the first phase of FutureCare in April this year, and $10 million has been set aside by Government to pay for it. Participants pay $260 a month to be covered.

The second phase is expected to roll out in April 2010, though no details about who it will include or how much it will cost have been made public.

Several insurers The Royal Gazette has spoken with have questioned how Government will pay for the comprehensive health care plan, particularly as the ageing population is expected to grow. All of them have said they believed means testing would be necessary.

Currently, 13 percent of Bermuda's population are seniors the figure is expected to rise. By 2020, seniors will number around 11,129 or 17 percent of Bermuda's population, according to Department of Statistics projections. By 2025 seniors will represent one-fifth of the population, numbering more than 12,000.

When asked if Government had taken into account the growing ageing population and if they planned to implement a means test making those who earn over a certain amount ineligible for the programme or pay more to be involved in it, Permanent Secretary Warren Jones said: "There are a lot of things we will consider for phase two and forward.

"We have looked at a tiered system, certainly there are some that can afford more. We will be considering a number of options and one of those could be a tiered system. This does not relate to benefits but instead to the premium that would be paid."

And he noted that the current $260 monthly premium could be raised in future phases.

Mr. Jones' comments have shed more light on the complicated, and costly, issue of ensuring adequate care for seniors.

Many have applauded the Government for forging ahead with the election promise to provide quality health care to every Bermudian over 65 via their programme, FutureCare. Others have said the intentions are noble, but questioned where the money will come from to fulfill the ambitious plan.

Opposition MP Grant Gibbons, who is also a director of Colonial Insurance, has projected that without means testing and based on the current set up of FutureCare, the Bermuda Government, and tax payers, could be facing a health-care plan that costs hundreds of millions of dollars a year based on population trends and health-care cost inflation within the next decade.

"The big issue will be trying to find something that is obviously an improvement to seniors but doesn't cost the rest of the Country too much," he said.

One senior insurance provider, who asked to remain anonymous, said he was already concerned that the $10 million set aside for this phase of the programme was not enough. He calculated that it amounted to approximately $4,205 per person presently enrolled. He said a more realistic number would be $19 million, and that is just for a third of Bermuda's ageing population.

However, Health Minister Walter Roban said yesterday he was confident the $10 million budget would meet the needs of FutureCare users.

Another executive said he believed the Government would have to implement a means test because there would be too many seniors wanting to enter the programme.

"I just don't see it working as it is currently set up," he said. "They will have to raise taxes, make budget cuts or implement means testing. There is no way they can pay for it the way it is set up now and with the number of people coming on to the programme."

Claudette Flemming, Age Concern's director, said: "It is a legitimate question, should those that can afford to pay for private care get FutureCare? But then the question is how do you determine who can afford it?"

With 25 percent of seniors living off $30,000 or less there are many incidents of seniors being land rich but cash poor, she said.

But she urged Government to forge ahead and address the difficult questions: "It makes sense now to look at the issues as the senior population is getting bigger. If we start now we can work out some of the kinks before the population gets larger."

HIP reactivated to cover shortfall in health insurance for seniors

Government will bring back a basic health insurance plan for seniors ineligible for the first phase of FutureCare.

This will mean that seniors who were ineligible for the Government's new senior health care scheme, FutureCare, but unable to pay between $5,000 and $18,000 for private policies will now be able to access basic health care.

Health Minister Walter Roban said yesterday: "This Government cannot allow a situation to exist where there is no affordable health care coverage available for our seniors. It can be anticipated that the amendment to the Health Insurance Act will be passed in early November and seniors will be able to access HIP before the end of that month."

The news ends uncertainly for many seniors who fell between the gap and found themselves unable to afford basic coverage.

In April approximately 30 percent of Bermuda's seniors were enrolled in FutureCare. At that same time HIP Government's basic health care plan was closed to anyone over 64.

At a fee of $241 per month, HIP enables participants to visit a doctor once a year and covers hospital visits. Persons enrolled in FutureCare pay $260 a month and are entitled to overseas health care, unlimited doctor visits, vision benefits, $2,000 a year towards prescription costs as well as other benefits.

When FutureCare was rolled out there were private sector options for low-cost basic health care, but in the last few months the companies discontinued the policies.

The next phase is not due to be implemented until April 2010. This meant that seniors not enrolled in HIP prior to April were left uncertain about their future if they were unable to pay higher premiums to private companies.

"I am pleased to report that the Auditor General's chambers is presently drafting an amendment to the Health Insurance Act 1970 that will permit seniors to access HIP," Mr. Roban said.

"This will serve as an interim solution whilst we move towards addressing the wider issue of affordability of health care in Bermuda and the second phase of implementation of FutureCare."

Because both HIP and FutureCare are Government programmes Mr. Roban said they were unable to open HIP to seniors until an amendment went through Parliament, which reconvenes on November 6.

The Health Minister said the Government was reopening HIP, but keeping the first phase of FutureCare closed to additional people, because the funding is not there to expand it.

He added: "[FutureCare] will not support unplanned growth during the course of this fiscal year.

"Secondly, we are building the claims experience in FutureCare to help inform our planning for this programme in the future.

"The reopening of HIP to seniors represents a response to a real need that has come about through actions outside the influence of Government."

The second phase of FutureCare will be implemented in April 2010, it is not yet known the eligibility requirements to enter the scheme at that time or how many additional people will be enrolled in it.

FutureCare timeline

• December 9, 2007 — Premier Ewart Brown says during a PLP pre-election press conference that FutureCare will "make the dreaded prospect of health care insecurity a thing of the past for our senior citizens".

• February 15, 2008 — Health Minister Nelson Bascome says: "FutureCare will be a health plan for all citizens of Bermuda aged 65 and over and will ensure access to effective, safe, coordinated, and patient-centred health care."

• February 20, 2009 — Mr. Bascome says during a Budget day press conference that the first phase of FutureCare will launch on April 1 for elderly people already enrolled in the basic state Health Insurance Plan (HIP) before January 1, 2009.

• March 11, 2009 — The Minister describes the launch of FutureCare as a "historic landmark for this country" and says in its first year it will be restricted to those 65 and over presently in HIP, anyone turning 65 after January 1, 2009 and persons 65 and over deemed to be "indigent".

• April 1, 2009 — HIP for seniors is replaced by FutureCare.

• April 2, 2009 — Health permanent secretary Warren Jones tells The Royal Gazette that seniors could still join HIP and qualify for FutureCare after January 1, 2009. He says the programme was only closed to newcomers after the Minister's March 11 announcement and an influx of calls from pensioners wanting to sign up.

Asked if the Island's seniors were informed before the March 11 speech that HIP would become closed to them from a certain date, he replies: "No, they were not informed as phase one of the programme was being designed for persons presently on HIP."

He tells us that the requirement that seniors be in HIP in order to qualify for FutureCare "was not communicated to the public". He adds: "Nor was it our intent to do so."

• June 18, 2009 — Opposition Senator Michael Dunkley suggests $10 million spent on 'dolphin mitigation' (at the new cruise ship pier in Dockyard) could have been better spent on social programmes such as FutureCare.

• September 10, 2009 — Government flags up that private insurers who had provided a HIP equivalent, low cost, health package had ceased doing so. Newly appointed Health Minister Walter Roban said: "We have taken steps to fill this gap. Our Government programmes are established through legislation and therefore, the solutions will also have to be legislated."

• September 15, 2009 — A spokesperson for the Ministry of Health said: "When the Government initiated FutureCare there were private sector options. They no longer exist. The Government is presently reviewing a proposal to address this issue."

• September 23 — Government announces it is reintroducing HIP for people over 65 as a result of private health insurers taking an equivalent low cost plan from their books. People over 65 who do not qualify for the first phase of FutureCare, and now find themself unable to afford the private options, should be able to enrol in HIP by late November.