MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN BUFFALO, NIAGARA FALLS AND UTICA, N.Y.
The Centers for Medicare & Medicaid Services (CMS) today approved a request by Excellus Health Plan Inc. to offer a managed care plan to Medicare beneficiaries in western and upstate New York, including Buffalo, Niagara Falls and Utica.
Excellus Health Plan, based in Rochester, N.Y., will operate a preferred provider organization (PPO) health plan that will begin serving beneficiaries on July 1 in 10 counties, eight in western New York, and Herkimer and Oneida counties, including the city of Utica, in upstate New York. Erie and Niagara counties include the cities of Buffalo and Niagara Falls.
Excellus Health Plan, which does business as Univera Healthcare in the eight western New York counties, will offer the Univera PPO plan in that area. Besides Erie and Niagara, the other western counties the PPO plan will serve are Alleghany, Cattaraugus, Chautauqua, Genesee, Orleans and Wyoming. In Herkimer and Oneida counties, Excellus Health Plan, which does business as Excellus BlueCross BlueShield in that region, will offer a plan to beneficiaries called Medicare Blue PPO.
Medicare beneficiaries can sign up for the plan during the current open enrollment for Medicare Advantage, formerly known as Medicare+Choice. About 330,000 beneficiaries live in the managed care organization’s newly approved service area.
"We are pleased Excellus Health Plan decided to offer a PPO plan to Medicare beneficiaries in western and 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 area, through Univera Healthcare, an Excellus company.
The two PPO plans give beneficiaries in the 10 counties another health care choice. Other Medicare Advantage plans currently available in at least one of the 10 counties are Fidelis Care New York, Healthnow/Blue Cross Blue Shield of Western New York, Independent Health Association, Rochester Area HMO which does business as Preferred Care and United Healthcare of New York.
“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."
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.