MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN CINCINNATI, OHIO AND EIGHT COUNTIES IN OHIO, KY.
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Humana Insurance Co. to offer managed care coverage to Medicare beneficiaries in eight counties in Ohio and Kentucky including the cities of Cincinnati and Middletown , Ohio .
Humana Insurance, based in Louisville , Ky. , will operate a preferred provider organization (PPO) health plan that will begin serving beneficiaries on Jan. 1 in five southwestern Ohio counties - Hamilton including Cincinnati , Brown, Butler , Clermont and Warren - and Boone, Campbell and Kenton counties in northern Kentucky . Medicare beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage, formerly known as Medicare+Choice. About 235,000 beneficiaries live in the eight counties.
"We are pleased Humana Insurance decided to offer this PPO health plan to beneficiaries in southwestern Ohio and northern Kentucky ,” 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.”
Humana Insurance is a subsidiary of Humana Inc., based in Louisville . The company will give another health care option to beneficiaries living in southwestern Ohio and northern Kentucky . The Medicare Advantage plans currently operating in the Ohio counties are Community Insurance Co., C&O Employees Hospital Association and United Healthcare. In the Kentucky counties, the Medicare Advantage plans now operating are Blue Cross Blue Shield, Sterling Life Insurance Co., Unicare Life and Health Insurance Co. and United Healthcare.
"We want to make sure all Medicare beneficiaries, whether in a Medicare Advantage plan, fee-for-service or PPO, 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 41 new contracts with Medicare health plans and 56 service area expansions. There are currently 20 applications pending for new contracts and 21 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.