MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN PARTS OF NEW YORK STATE AND PA.
The Centers for Medicare & Medicaid Services (CMS) has approved a request by American Progressive Life and Health Insurance Co. of New York to offer private fee-for-service health care coverage to Medicare beneficiaries in parts of upstate New York and Pennsylvania.
American Progressive Life and Health Insurance of New York will begin on May 1 serving beneficiaries in 33 New York counties, including the cities of Albany, Binghamton, Ithaca, Schenectady, Syracuse and Utica, and in 15 Pennsylvania counties, including the cities of Lewisburg and Williamsport. Beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage, formerly known as Medicare+Choice. Nearly 1 million beneficiaries live in these counties. (A list of the 48 New York and Pennsylvania counties served by the company is attached.)
“We are pleased American Progressive Life and Health Insurance Co. has decided to serve beneficiaries in New York and Pennsylvania," 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 company, a subsidiary of Universal American Financial Corp. based in Rye Brook, N.Y., is offering the private fee-for-service plan under the Medicare Advantage program. The plan will give another health care option to beneficiaries in the 48 counties. In the New York counties, other Medicare choices in the service area are CDHP, Health Now, Senior Blue and WellCare. In the 15 Pennsylvania counties, the other choices are Health Assurance, Keystone West, Geisinger, Health America, UPMC and Sterling PFFS.
A private fee-for-service plan is an insurance program that charges enrollees a premium and cost-sharing amounts and lets beneficiaries choose the providers they want to see, as long as these providers accept the private fee-for-service insurance program.
"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," CMS
Administrator Mark McClellan, Ph.D., M.D., said. "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 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.
The following 33 counties in New York and 15 counties in Pennsylvania are included in American Progressive Life and Health Insurance’s coverage area for its private fee-for-service health care plan for Medicare beneficiaries:
New York: Albany, Broome, Cayuga, Chemung, Chenango, Clinton, Columbia, Cortland, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Herkimer, Jefferson, Lewis, Madison, Montgomery, Oneida, Onondaga, Otsego, Oswego, Rensselaer, Saratoga, Schenectady, Schoharie, Steuben, St. Lawrence, Tioga, Tompkins, Warren and Washington.
Pennsylvania: Bradford, Cameron, Centre, Clinton, Columbia, Franklin, Huntingdon, Lycoming, Mifflin, Montour, Potter, Sullivan, Susquehanna, Tioga and Union.