MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN NEW YORK CITY AND FOUR NEW YORK SUBURBAN COUNTIES
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Empire Blue Cross Blue Shield to offer a managed care option to Medicare beneficiaries throughout New York City and in four suburban New York counties.
Empire Blue Cross Blue Shield is now operating a preferred provider organization (PPO) health plan serving beneficiaries in the five New York City counties (called boroughs), Nassau and Suffolk counties on Long Island, and Rockland and Westchester counties, north of New York City. Medicare beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage plans. About 1.53 million beneficiaries live in the newly approved service area, including about 300,000 in Brooklyn, 290,000 in Queens, 230,000 in Manhattan , 225,000 in Nassau and 145,000 in Westchester .
Empire, which does business as Senior Plan Direct PPO, is based in New York City and has been a health insurer for more than 70 years. It began offering a Medicare managed care plan to beneficiaries in 1996 with its Medicare HMO in the same nine-county area.
CMS has approved 143 new Medicare Advantage plans to provide services in 2005, far exceeding the highest number of plans that had been previously available. These new plans are providing significant monthly out-of-pocket savings for Medicare beneficiaries, particularly those with chronic illnesses. The availability of these plans in 49 states, along with their enhanced benefits and increased savings, are the results of the Medicare Modernization Act of 2003.
“This is great news for seniors who are getting more choices and better benefits as the new Medicare law kicks in,” HHS Secretary Mike Leavitt said. "We have created a market for plans to compete in providing the best deal for seniors.”
Empire Blue Cross Blue Shield will give another health care option to beneficiaries in New York City and the four suburban counties. Currently, 21 other Medicare Advantage plans are operating in at least one of the counties.
“We are seeing broader health plan participation than ever before, with a greater potential for savings for people with Medicare,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “Medicare Advantage plans help beneficiaries save by better coordinating their care and offering preventive benefits that help them stay healthy and keep their costs down, reflecting the steps we are taking to help make Medicare more up-to-date.”
These Medicare Advantage plans also offer more extensive benefits or lower cost sharing compared to the original Medicare program, providing greater cost-savings to people with Medicare in 2005 than in previous years. On average, beneficiaries can save just over $100 a month compared to the original Medicare plan, either with paying for individual Medigap coverage or with paying for the co-payments and other coverage limits in the original Medicare plan. Those average savings include $29 in extra benefits, $2 in Part B premium reduction and $70 in reduced average out-of-pocket expenses for Medicare-covered services compared to the national actuarial value.
With the addition of these new plans, Medicare beneficiaries in 49 states will have access to 428 health plans across the nation. Those include 41 plans completely new to the Medicare program and 66 new local PPOs. Some 90 current providers plan to increase their service areas this year. Many of these plans have already begun offering services in these areas.
With these expansions, 73 percent of Medicare beneficiaries will have access to HMO plans, 52 percent will have access to PPO plans and 80 percent will have access to private fee-for-service plans. The vast majority of beneficiaries in rural areas will have access to private fee-for-service plans, and nearly 20 percent of beneficiaries in rural areas will have access to coordinated care plans (HMOs or PPOs). Altogether there are more than 5 million beneficiaries currently enrolled in Medicare Advantage health plans, with an average of 50,000 beneficiaries per month joining the plans since last year.
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.
Medicare Advantage HMOs, PPOs and private fee-for-service plans are available where private companies choose to offer them, while original fee-for-service Medicare, with about 37 million beneficiaries, is available to all beneficiaries. Currently, about 42 million aged and disabled Americans are enrolled in Medicare.
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.