The Centers for Medicare and Medicaid Services (CMS) has approved a request by Humana Insurance Co., a subsidiary of Humana Inc., to offer private fee-for-service health care coverage to Medicare beneficiaries throughout Iowa, Minnesota and Wisconsin and parts of North and South Dakota.
Humana, based in Louisville, Ky., is now serving beneficiaries in the five states. Beneficiaries can sign up for the plan during the current Medicare+Choice open enrollment. About 1.55 million Medicare beneficiaries live in the company’s newly approved service area.
The plan is open to beneficiaries in 22 counties in eastern North Dakota, including the cities of Grand Forks and Fargo, and 30 counties in eastern South Dakota, including the city of Sioux Falls. In Iowa, Minnesota and Wisconsin, where the entire state is covered, the plan is available in such cities as Cedar Rapids, Des Moines, Iowa City and Sioux City, Iowa; Minneapolis-St. Paul, Duluth, Moorhead, Rochester and St. Cloud, Minn.; and Milwaukee, Madison and Green Bay, Wis.
"We are pleased that Humana has decided to offer this new option to Medicare beneficiaries in the Midwest," HHS Secretary Tommy G. Thompson said. "The reality is, Medicare should provide all seniors - no matter where they live - with better health insurance options, including prescription drug coverage and preventive care. The President's principles for strengthening and modernizing Medicare will move us closer to that goal."
Humana is offering the private fee-for-service plan under the Medicare+Choice program. In addition to Humana, another organization, Sterling Life Insurance Co., offers this type of plan to beneficiaries in 25 states across the country. A private fee-for-service plan is a private insurance program that charges enrollees a premium and cost-sharing amounts and lets beneficiaries choose the providers they want to see.
"We want to make sure all Medicare beneficiaries, whether in a Medicare+Choice plan or fee-for-service, are receiving the highest quality health care," CMS Administrator Tom Scully 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."
The North Dakota counties under the Humana plan are Barnes, Cass, Cavalier, Dickey, Eddy, Foster, Grand Forks, Griggs, Kidder, LaMoure, Logan, McIntosh, Nelson, Pembina, Ramsey, Ransom, Richland, Sargent, Steele, Stutsman, Traill and Walsh.
The South Dakota counties under the plan are Aurora, Beadle, Bon Homme, Brookings, Charles Mix, Clark, Clay, Codington, Davison, Day, Deuel, Douglas, Grant, Hamlin, Hanson, Hutchinson, Jerauld, Kingsbury, Lake, Lincoln, McCook, Marshall, Miner, Minnehaha, Moody, Roberts, Sanborn, Turner, Union and Yankton.
In his budget proposal for fiscal year 2003, President Bush said the current Medicare+Choice system for paying private plans is not giving beneficiaries the health care options they deserve. Annual increases in Medicare+Choice funding have failed to reflect rising health care costs, leading to unreliable options and reduced benefits for seniors. Under the President's proposal, all Medicare+Choice plans would receive payment increases.
Medicare+Choice HMOs and fee-for-service plans are available where private companies choose to offer them. Currently, about 5.6 million Medicare beneficiaries -- out of a total of nearly 40 million aged and disabled Americans -- have enrolled in Medicare HMOs. Original fee-for-service Medicare, currently chosen by more than 34 million beneficiaries, is available to all beneficiaries.
Congress created Medicare+Choice in the Balanced Budget Act of 1997 to expand the types of health care options available to Medicare beneficiaries, who in addition can now receive new preventive benefits and patient protections. There also is 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 is available to provide seniors more information about their health care options.
CMS Public Affairs Office
Director of Media Relations