MANAGED CARE PLAN EXPANDS TO INCLUDE MEDICARE BENEFICIARIES IN INDIANAPOLIS AND 7 INDIANA COUNTIES
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Advantage Health Solutions Inc. to expand its Medicare managed care plan to seven central Indiana counties, including the city of Indianapolis, as part of a demonstration program announced by Health and Human Services Secretary Tommy G. Thompson. The health plans under this program are modeled after coverage offered by preferred provider organizations (PPOs) to most Americans under age 65.
Advantage Health Solutions, based in Indianapolis, can now enroll and serve Medicare beneficiaries in the seven counties. The counties are Boone, Hamilton, Hendricks, Johnson, Marion, Morgan and Shelby, which include the cities of Indianapolis, Carmel and Greenwood. Beneficiaries can sign up for the plan, known as Advantage Preferred Plus, during the current Medicare+Choice open enrollment period.
About 180,000 Medicare beneficiaries live in the seven counties. These beneficiaries currently have no other Medicare+Choice plans to choose from in those counties. The plan began serving beneficiaries on Jan. 1, 2003, in Allen and St. Joseph counties in Indiana, including the cities of Fort Wayne and South Bend.
“This program gives seniors new options for their Medicare coverage similar to that available in the private insurance market,” Secretary Thompson said. “Greater access and expanded options and choices in health care are key goals of this Administration.”
Congress created Medicare+Choice in the Balanced Budget Act of 1997 to expand the types of health care options available to Medicare beneficiaries, enabling them to receive new preventive benefits and greater patient protections. Preferred provider type coverage was previously unavailable to Medicare beneficiaries.
“Whether beneficiaries enroll in a PPO or another Medicare+Choice plan, or fee-for-service Medicare, we are doing more to guarantee they understand the Medicare options available to them,” CMS Administrator Tom Scully said. “The under age 65 market is rapidly flocking toward PPO products, which give patients the flexibility they need. Seniors want the same options and this is the big first step in getting them there.”
Currently, Medicare+Choice health maintenance organizations (HMOs) are available where private companies choose to offer them. 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, available to all beneficiaries, is currently chosen by more than 35 million beneficiaries. Unlike traditional HMOs, the new options will allow beneficiaries who choose to enroll, access to services provided outside the contracted network of providers.
The demonstration program, announced Aug. 27, 2002, includes new health plans that will ultimately be available in 23 states across the country, expanding health care options to approximately 11 million Medicare beneficiaries.
The demonstration plans will be considered Medicare+Choice plans and must offer all of Medicare’s required benefits, but will also have the flexibility to offer additional services, including prescription drugs. Most important, they will offer beneficiaries a wider choice of health care providers than is currently offered in HMOs.
A number of resources with information regarding the plan offered by Advantage Health Solutions are available as part of various CMS consumer information sources, including a national toll-free phone number -- 1-800-MEDICARE (1-800-633-4227), or TTY/TDD, at 877-486-2048, and the CMS Internet site -- www.medicare.gov. In addition, a coalition of more than 200 national and local organizations is available to assist seniors in making informed decisions about their health care options.