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."