The Hawaii Medical Service Association has notified 5,000 senior members that they will have to pay an additional fee — which could range from $20 to $50 per doctor visit — as of Jan. 1 when seeing a doctor at a medical facility or hospital-based clinic.

“This fee is in addition to the usual co-payment for a visit to the doctor,” Wendy Nakasone, HMSA vice president of Medicare programs, told members in the Akamai Advantage plan in a letter dated Dec. 1. “In the past, HMSA paid the facility fee, but we’re unable to continue doing so because of rising medical costs.”

HMSA said it used to cover 100 percent of the facility fee, but next year will cover only 80 percent. The patient will have to pay the other 20 percent.

In the letter, HMSA lists nine hospitals that have charged a “facility fee” in the past, including Hawaii Pacific Health — parent company of Kapiolani Medical Center for Women & Children, Pali Momi Medical Center, Straub Clinic & Hospital and Wilcox Memorial Hospital — the Queen’s Medical Center, Kauai Veterans Memorial Hospital, Kona Community Hospital, Kuakini Medical Center and Maui Memorial Medical Center.

The letter tells patients to contact their medical facility to confirm how much their facility fee is.

Of the nine hospitals mentioned in the letter, only the Queen’s Medical Center responded to the Honolulu Star-Advertiser’s request for information about the fees by late Tuesday afternoon.

Facility fees at Queen’s range from $127 to $246 per visit, said Robert Nobriga, Queen’s executive vice president and chief financial officer. A patient’s 20 percent would range from $25.40 to $49.20.

“This is what we would charge any patient (not just Medicare),” Nobriga said. “It depends on their insurance coverage in terms of what percentage of the fee they would normally pay.”

All hospital-based clinics charge facility fees, both for inpatient and outpatient services owned and operated by the medical center, he added. The fee does not apply to stand-alone providers not associated with a hospital.

“In the interest of transparency, we believe it’s very important that our members understand what they’re paying for when they choose a provider. We want our members to know that they can get the same quality of care from a different provider without paying for this fee,” said Elisa Yadao, HMSA senior vice president of consumer experience, in a statement.

“If an HMSA member chooses to visit a provider that charges a facility fee, we will still cover 80 percent of the facility fee as a benefit of their Akamai Advantage plan. What we’re asking members to do, which they do for every other fee, is to cover their portion, which in most cases will be approximately $20,” Yadao said.

HMSA Akamai Advantage is a preferred provider organization plan that has a contract with Medicare, the government health insurance program for seniors. All Medicare members, regardless of what plan they have, could be subject to facility fees, HMSA said. There are about 246,000 Hawaii residents who are eligible for Medicare.

“Other facilities may start charging this fee in 2016, so it’s best to inquire when making an appointment,” Nakasone said.

Members can call HMSA at 948-6000 for questions about the change.