MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN AUSTIN, CORPUS CHRISTI, HOUSTON, SAN ANTONIO IN TEXAS
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Humana Insurance Co. to offer managed care coverage to Medicare beneficiaries in Austin , Corpus Christi , Houston and San Antonio in Texas .
Humana Insurance, based in Louisville , Ky. , will operate a preferred provider organization (PPO) health plan that will begin serving beneficiaries on Jan. 1 in 16 Texas counties in which the cities or their metro areas are located. Medicare beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage, formerly known as Medicare+Choice. About 330,000 beneficiaries live in the 16 counties.
"We are pleased Humana Insurance decided to offer this health plan to beneficiaries in several major cities in Texas and surrounding areas,” 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.”
The 16 counties are Aransas, Bastrop , Bexar including the city of San Antonio , Caldwell , Comal, Guadalupe, Fort Bend , Hays, Harris including Houston , Kendall, Medina , Montgomery , Nueces including Corpus Christi , San Patricio, Travis including Austin and Williamson.
Included in the Houston metro area are Fort Bend , Harris and Montgomery counties. The counties in Austin ’s metro area are Bastrop , Caldwell , Hays, Travis and Williamson. The San Antonio area counties are Bexar, Comal, Guadalupe, Kendall and Medina . The Corpus Christi counties are Aransas, Nueces and San Patricio.
Humana Insurance is a subsidiary of Humana Inc., based in Louisville . The company will give another health care option to beneficiaries living in or close to Austin ,Corpus Christi , Houston or San Antonio . Each of these plans - Evercare, SelectCare of Texas, Sterling Life Insurance Co. and Texas HealthSpring LLC.- currently operates in at least one of the counties in the plan.
"We want to make sure all Medicare beneficiaries, whether in a 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."
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.
Since Dec. 8, 2003, when President Bush signed the Medicare Modernization Act into law, CMS has approved 37 new contracts with Medicare health plans and 51 service area expansions. There are currently 23 applications pending for new contracts and 26 service area expansions pending.
Medicare Advantage 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.