MANAGED CARE PLAN EXPANDS TO INCLUDE MEDICARE BENEFICIARIES IN 12 COUNTIES IN EASTERN NORTH DAKOTA
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Medica Health Plans to expand managed care coverage to Medicare beneficiaries in 12 counties in eastern North Dakota, including the cities of Fargo, Grand Forks and Jamestown.
Medica Health Plans, based in Minneapolis, Minn., can begin enrolling and serving beneficiaries on June 1, 2003, in the North Dakota counties of Barnes, Cass, Dickey, Grand Forks, Griggs, LaMoure, Ransom, Richland, Sargent, Steele, Stutsman and Traill. About 35,700 beneficiaries live in the 12 counties.
Of Minnesota’s 87 counties, Medica Health Plans already serves Medicare beneficiaries in 62 full counties and three partial counties, The 12 counties in the newly approved service area will be the first North Dakota counties served by Medica Health Plans.
"We are pleased Medica Health Plans decided to expand this plan to include more Medicare beneficiaries in eastern North Dakota," HHS Secretary Tommy G. Thompson said. "The reality is, Medicare should provide all seniors - no matter where they live - with better health insurance options like those available to federal workers. The President's goals for strengthening and modernizing Medicare will move us closer to that goal."
The plan will give beneficiaries in the 12 North Dakota counties another health-care choice. Humana Insurance Company’s Medicare+Choice, private fee-for-service plan is currently operating in these counties.
Medica Health Plans is a cost HMO, which means that if members use the plan’s providers they will have no or low co-payments. However, members may also obtain services outside of the plan’s network and pay the standard Medicare deductibles and coinsurance.
"We want to make sure all Medicare beneficiaries, whether in a cost HMO, Medicare+Choice plan or fee-for-service, are receiving the highest quality health care," CMS Administrator Tom Scully said. "We are doing more to guarantee that beneficiaries understand the Medicare coverage options available to them. We also are reminding beneficiaries of the need to work closely with the doctors and other health care providers that give them medical care."
Cost HMOs, Medicare+Choice HMOs and fee-for-service plans are available where private companies choose to offer them. Currently, about 4.6 million Medicare beneficiaries -- out of a total of about 40 million aged and disabled Americans – have enrolled in Medicare HMOs. Original fee-for-service Medicare, currently chosen by more than 35 million beneficiaries, is available to all beneficiaries.
Medicare has a far-reaching consumer information program that includes a national toll-free phone number -- 1-800-MEDICARE (1-800-633-4227) or TTY/TDD, at 877-486-2048 -- an Internet site -- www.medicare.gov -- and a coalition of more than 200 national and local organizations to provide seniors more information.