MANAGED CARE PLAN OFFERED IN NEW YORK CITY AND 2 SUBURBAN COUNTIES TO BENEFICIARIES ELIGIBLE FOR MEDICARE AND MEDICAID
The Centers for Medicare & Medicaid Services (CMS) has approved a request by Group Health Inc. to offer a health plan in New York City and the suburban New York counties of Rockland and Westchester for beneficiaries who are eligible for Medicare and Medicaid.
Group Health Inc. (GHI), based in New York City , is now serving beneficiaries, known as dual eligibles, who qualify for Medicare and Medicaid. The plan serves beneficiaries throughout the five boroughs of New York City and the two suburban counties, north of New York.
The Medicare Modernization Act of 2003 (MMA) established a Medicare Advantage option for private plans that exclusively or primarily enroll “special needs” individuals. They can sign up for the plan during the current open enrollment for Medicare Advantage, formerly known as Medicare+Choice.
GHI has offered a preferred provider organization (PPO) health plan for Medicare beneficiaries, as part of a demonstration program, since April 2003. That plan covers the same service area. About 1.23 million Medicare beneficiaries live in New York City and Rockland and Westchester counties.
"We are pleased GHI decided to offer this Medicare Advantage Special Needs option plan to beneficiaries in New York City and two suburban counties,” HHS Secretary Mike Leavitt 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 special needs plan is designed specifically to meet the requirements of these beneficiaries. That includes helping members access community resources, as well as ensuring that dual eligible beneficiaries benefit from disease management programs, resulting from health risk assessments administered by the plan.
Eligible beneficiaries can enroll in GHI’s program offered through its new Medicare Advantage contract with CMS. To qualify for the plan, a beneficiary must be enrolled in Medicare Part B and the New York state Medicaid program, and be entitled to Medicare Part A.
GHI, which does business as GHI Medicare Choice PPO Plan, has provided health care to New York residents since 1937. The new plan, to be called GHI Medicare PPO Value, will give another health care option to beneficiaries in the newly approved service area. The Medicare Advantage plans currently operating in this area are Aetna Health Inc., Americhoice of N.Y., Elderplan Inc., Empire HealthChoice, HealthNet of N.Y., HIP of Greater N.Y., Managed Health Inc., Oxford Health Plans (N.Y.) Inc., United Healthcare of N.Y. and WellCare of N.Y.
"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."
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 57 service area expansions. There are currently 38 applications pending for new contracts and 26 service area expansions pending.
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 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.