The Centers for Medicare and Medicaid Services (CMS) has approved a request by Coventry Health and Life Insurance Co. to offer a Medicare managed care plan in the city of St. Louis, Mo., three surrounding Missouri counties and two Illinois counties as part of a demonstration program recently 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.
Coventry Health and Life Insurance is a subsidiary of Coventry Health Care Inc., based in Bethesda, Md. Group Health Plan Inc., another Coventry Health Care subsidiary, which currently offers Medicare+Choice coverage, will administer the PPO coverage offered by Coventry Health and Life Insurance.
Group Health Plan, with an office in Earth City, Mo., is now serving Medicare beneficiaries in the city and county of St. Louis, Jefferson and St. Charles counties in Missouri, and Madison and St. Clair counties in Illinois. Beneficiaries can sign up for the plan during the current Medicare+Choice open enrollment.
"This program gives seniors new options for their Medicare coverage similar to that available in the private insurance market," Secretary Thompson said. "Greater access and expanded options and choices in health care are key goals of this Administration."
About 357,000 Medicare beneficiaries live in the city and county of St. Louis and the four surrounding Missouri and Illinois counties. These beneficiaries already may also choose among other Medicare+Choice plans – Group Health Plan’s existing Advantra and Gold Advantage HMO plans, Mercy Health Plans of Missouri Inc., Sterling Life Insurance Co. and United Healthcare of the Midwest Inc.
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 Administrator Tom Scully 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."
Currently, Medicare+Choice health maintenance organizations (HMOs) are available 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, available to all beneficiaries, is currently chosen by more than 35 million 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 23 states across the country, expanding health care options to approximately 11 million Medicare beneficiaries.
The demonstration plans will be considered Medicare+Choice plans and must offer all of Medicare’s required benefits, but will also have the flexibility to offer additional services. Most important, they will 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 Group Health Plan 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.