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MANAGED CARE PLAN EXPANDS TO INCLUDE MEDICARE BENEFICIARIES IN 44 MUNICIPALITIES IN PUERTO RICO

The Centers for Medicare & Medicaid Services (CMS) has approved a request by Preferred Medicare Choice to expand managed care coverage to Medicare beneficiaries in 44 municipalities in Puerto Rico .

Preferred Medicare Choice, a subsidiary of Preferred Health Management based in San Juan , Puerto Rico , is now serving beneficiaries in the 44 municipalities (see attached list of these municipalities).   Medicare beneficiaries can sign up for the plan during the current open enrollment for Medicare Advantage plans. About 250,000 beneficiaries live in the 44 municipalities.   

Preferred Medicare Choice began serving beneficiaries in 2004 in Puerto Rico . The plan had previously served 34 municipalities before the current expansion.

CMS has approved 143 new Medicare Advantage plans to provide services in 2005, far exceeding the highest number of plans that had been previously available. These new plans are providing significant monthly out-of-pocket savings for Medicare beneficiaries, particularly those with chronic illnesses. The availability of these plans in 49 states, along with their enhanced benefits and increased savings, are the results of the Medicare Modernization Act of 2003.

“This is great news for seniors who are getting more choices and better benefits as the new Medicare law kicks in,” HHS Secretary Mike Leavitt said.  "We have created a market for plans to compete in providing the best deal for seniors.”

Preferred Medicare Choice gives beneficiaries another health care option to select. The other Medicare Advantage plans currently operating in Puerto Rico  are First Plus, Humana, Medicare y Mucho Mas, MCS, SDM Healthcare Management Inc.   and Triple S. 

“We are seeing broader health plan participation than ever before, with a greater potential for savings for people with Medicare,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “Medicare Advantage plans help beneficiaries save by better coordinating their care and offering preventive benefits that help them stay healthy and keep their costs down, reflecting the steps we are taking to help make Medicare more up-to-date.”

These Medicare Advantage plans also offer more extensive benefits or lower cost sharing compared to the original Medicare program, providing greater cost-savings to people with Medicare in 2005 than in previous years. On average, beneficiaries can save just over $100 a month compared to the original Medicare plan, either with paying for individual Medigap coverage or with paying for the co-payments and other coverage limits in the original Medicare plan. Those average savings include $29 in extra benefits, $2 in Part B premium reduction and $70 in reduced average out-of-pocket expenses for Medicare-covered services compared to the national actuarial value.    

With the addition of these new plans, Medicare beneficiaries in 49 states will have access to 428 health plans across the nation. Those include 41 plans completely new to the Medicare program and 66 new local preferred provider organizations (PPOs). Some 90 current providers plan to increase their service areas this year. Many of these plans have already begun offering services in these areas.

With these expansions, 73 percent of Medicare beneficiaries will have access to HMO plans, 52 percent will have access to PPO plans and 80 percent will have access to private fee-for-service plans. The vast majority of beneficiaries in rural areas will have access to private fee-for-service plans, and nearly 20 percent of beneficiaries in rural areas will have access to coordinated care plans (HMOs or PPOs). Altogether there are more than 5 million beneficiaries currently enrolled in Medicare Advantage health plans, with an average of 50,000 beneficiaries per month joining the plans since last year.

PPO plans are modeled after coverage offered by PPOs to most Americans under age 65. Unlike traditional HMOs, PPOs allow beneficiaries who choose to enroll, access to services provided outside the contracted network of providers.

Medicare Advantage HMOs, PPOs and private fee-for-service plans are available where private companies choose to offer them, while original fee-for-service Medicare, with about 37 million beneficiaries, is available to all beneficiaries. Currently, about 42 million aged and disabled Americans are enrolled in Medicare.

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.

ATTACHMENT

Following are the 44 municipalities in Puerto Rico that Preferred Medicare Choice is now serving:

Adjuntas, Aguas Buenas, Aibonito, Arroyo, Barranquitas, Caguas, Canovanas, Cayey, Ceiba, Cidra, Coamo, Comerio, Corozal, Culebra, Fajardo, Florida, Guayama, Guayanilla, Gurabo, Guanica, Humacao, Jayuya, Juana Diaz, Juncos, Las Piedras, Loiza, Luquillo, Maunabo, Naguabo, Naranjito, Orocovis, Patillas, Penuelas, Ponce, Rio Grande, Salinas, San Lorenzo, Santa Isabel, Toa Alta, Utuado, Vieques, Villalba, Yabucoa, Yauco.