The Centers for Medicare & Medicaid Services (CMS) has approved a request by Essence Inc. to expand managed care coverage to Medicare beneficiaries in St. Clair and Monroe counties in Illinois in the St. Louis , Mo. metro area.
Essence Inc., a physician-owned plan based in St. Louis , will begin serving beneficiaries in Illinois on June 1 in St. Clair County, including the city of East St. Louis , and Monroe County . Medicare beneficiaries can sign up for the plan during the current open enrollment for Medicare Advantage plans. About 40,000 beneficiaries live in St. Clair County and 4,400 in Monroe County , a total of about 44,400 beneficiaries in the two counties.
"We are pleased Essence Inc. decided to expand this health plan to include beneficiaries on the Illinois side of the St. Louis metro area,” 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.”
Essence now serves beneficiaries in the Missouri counties of St. Louis , St. Louis City , Jefferson and St. Charles .
The company, which does business as Essence Healthcare, will give beneficiaries on the Illinois side of the Mississippi River in the St. Louis area another health care option to select. The other Medicare Advantage plans currently operating in the two Illinois counties are Group Health Plan, Mercy Health Plans and United Healthcare.
“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 68 new contracts with Medicare health plans and 91 service area expansions. There are currently 210 applications pending for new contracts and 91 service area expansions pending.
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.