The Centers for Medicare and Medicaid Services (CMS) has approved a request by Healthspring Inc. to expand a Medicare managed care plan to include beneficiaries in seven counties in middle Tennessee as part of a demonstration program announced by Health and Human Services Secretary Tommy G. Thompson. The health plans under this program are modeled after coverage offered by preferred provider organizations (PPOs) to most Americans under age 65.
Healthspring, based in Nashville, Tenn., began to serve Medicare beneficiaries in 1997 in 13 Nashville area counties - Cannon, Cheatham, Davidson, De Kalb, Macon, Marshall, Robertson, Rutherford, Smith, Sumner, Trousdale, Williamson and Wilson. In January 2003, after CMS approval, Healthspring began to offer the Medicare+Choice PPO demonstration plan to the beneficiaries in these 13 counties, including the city of Nashville.
The company can begin on Jan. 1, 2004, to serve beneficiaries in the seven Tennessee counties of Bedford, Coffee, Dickson, Hickman, Maury, Montgomery and Warren, including the cities of Clarksville and Columbia. Medicare beneficiaries can sign up for the plan, during the current Medicare+Choice open enrollment. About 57,000 beneficiaries live in the seven counties.
“We are pleased Healthspring decided to expand this plan to include more Medicare beneficiaries in middle Tennessee,“ Secretary Thompson said. “This demonstration program gives seniors new options for their Medicare coverage similar to that available in the private insurance market. Greater access and expanded options and choices in health care have been key goals of this Administration. These goals are being achieved by the new Medicare reform law signed by President Bush. The changes will modernize Medicare and provide a prescription drug benefit for the first time.”
Congress created Medicare+Choice in the Balanced Budget Act of 1997 to expand the types of health care options available to Medicare beneficiaries, enabling them to receive new preventive benefits and greater patient protections. Preferred provider type coverage was previously unavailable to Medicare beneficiaries.
“Whether beneficiaries enroll in a PPO or another Medicare+Choice plan, or fee-for-service Medicare, we are doing more to guarantee they understand the Medicare options available to them,” CMS Acting Administrator Dennis G. Smith said. “The under age 65 market is rapidly flocking toward PPO products, which give patients the flexibility they need. Seniors want the same options and this is the big first step in getting them there.”
The Healthspring demonstration plan will give another health care choice to Medicare beneficiaries in the seven counties. No other Medicare+Choice plans are currently available in these counties.
Currently, Medicare+Choice health maintenance organizations (HMOs) are where private companies choose to offer them. 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. Unlike traditional HMOs, the new options will allow beneficiaries who choose to enroll, access to services provided outside the contracted network of providers.
The demonstration program, announced Aug. 27, 2002, includes new health plans that will ultimately be available in 22 states across the country, expanding health care options to approximately 11 million Medicare beneficiaries.
The demonstration plans are considered Medicare+Choice plans and must offer all of Medicare’s required benefits, but also have the flexibility to offer additional services, including prescription drugs. Most important, they offer beneficiaries a wider choice of health care providers than is currently offered in HMOs.
A number of resources with information regarding the plan offered by Healthspring are available as part of various CMS consumer information sources, including a national toll-free phone number -- 1-800-MEDICARE (1-800-633-4227), or TTY/TDD, at 877-486-2048, and the CMS Internet site -- www.medicare.gov. In addition, a coalition of more than 200 national and local organizations is available to assist seniors in making informed decisions about their health care options.