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MANAGED CARE PLAN EXPANDS TO MEDICARE BENEFICIARIES IN SYRACUSE, BINGHAMTON, ELMIRA AND OSWEGO, N.Y.
MANAGED CARE PLAN EXPANDS TO MEDICARE BENEFICIARIES IN SYRACUSE, BINGHAMTON, ELMIRA AND OSWEGO, N.Y.
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Excellus Health Plan Inc. to expand its managed care plan to Medicare beneficiaries in the central and southern part of upstate New York, including Syracuse, Binghamton, Elmira and Oswego.
Excellus Health Plan, based in Rochester, N.Y., operates a preferred provider organization (PPO) health plan that is now serving beneficiaries in six counties - Broome, Chemung, Madison, Onondaga, Otsego and Oswego. Medicare beneficiaries can sign up for the plan during the current open enrollment for Medicare Advantage, formerly known as Medicare+Choice.
About 160,000 beneficiaries live the six counties which include Binghamton and Elmira in the southern part of upstate New York, the Syracuse area in central New York and Oswego near Lake Ontario. Excellus Health Plan does business as the Medicare Blue PPO plan in the six counties.
"We are pleased Excellus Health Plan decided to expand its PPO plan to include more Medicare beneficiaries in upstate New York,” HHS Secretary Tommy G. Thompson said. "Under the Medicare reform law signed by President Bush, Medicare will provide all seniors - no matter where they live - with better health insurance options, including prescription drug coverage and preventive care. The law is achieving the President's goals of strengthening and modernizing Medicare.”
PPO plans are modeled after coverage offered by PPOs to most Americans under age 65. Unlike traditional HMOs, PPOs allow beneficiaries who choose to enroll, access to services provided outside the contracted network of providers.
Excellus Health Plan began serving beneficiaries in 1986 in the Buffalo, N.Y. area, through Univera Healthcare, an Excellus company.
The PPO plan will give beneficiaries in the newly approved service area another health care choice. The only other Medicare Advantage plan currently operating in all six counties is American Progressive Life and Health Insurance Co.’s Private Fee-for-Service Plan. A United Healthcare plan is only available in Onondaga County.
“We want to make sure all Medicare beneficiaries, whether in a PPO or another Medicare Advantage plan or fee-for-service, are receiving the highest quality health care," said CMS Administrator Mark McClellan, M.D., Ph.D. "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."
Since Dec. 8, when President Bush signed the Medicare Modernization Act into law, CMS has approved 10 new contracts with Medicare health plans and 27 service area expansions. There are currently 28 applications pending for new contracts and 22 service area expansions pending.
Medicare Advantage HMOs, PPOs 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 managed care plans. 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.