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MANAGED CARE PLAN EXPANDS TO INCLUDE MEDICARE BENEFICIARIES IN SIX COUNTIES IN ROCHESTER, N.Y. AREA

The Centers for Medicare & Medicaid Services (CMS) today approved a request by Excellus Health Plan Inc. of New York to expand its managed care plan to Medicare beneficiaries in six counties in the Rochester, N.Y., area.

Excellus Health Plan, based in Rochester, can begin serving beneficiaries on Sept. 1, 2003, in the counties of Livingston, Monroe, Ontario, Seneca, Wayne and Yates, including the city of Rochester. About 167,300 beneficiaries live in the plan's newly approved service area.

Excellus Health Plan, which does business as Excellus Blue Cross Blue Shield, Rochester Region, will offer two versions of the Medicare+Choice HMO plan, under the name Medicare Blue Choice. In one version, members pay a coinsurance percentage with an annual out-of-pocket maximum. In the other version, members pay a straight copayment amount. Beneficiaries can sign up for either product during the current Medicare+Choice open enrollment.

The company began serving beneficiaries in 1986 in the Buffalo, N.Y. area, through Univera Healthcare, an Excellus company. In the Buffalo service area, the Medicare+Choice HMO plan is named SeniorChoice, which has members in eight counties around Buffalo.

"We are pleased Excellus Health Plan has decided to expand this health plan to include more Medicare beneficiaries in upstate New York," HHS Secretary Tommy G. Thompson said. "The reality is, Medicare should provide all seniors - no matter where they live - with better health insurance options like those available to federal workers. The President's goals for strengthening and modernizing Medicare will move us closer to that goal."

The plan gives Medicare beneficiaries in the six-county Rochester area another health care choice. The counties are currently served by one other Medicare+Choice HMO plan, Preferred Care.

"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 AdministratorTom 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."

Some differences exist between Buffalo-area SeniorChoice and Rochester-area Medicare Blue Choice. However, Medicare beneficiaries may only join the plan that covers the county where they live.

Excellus Health Plan also has another Medicare managed care product in the Rochester area called Blue Choice Senior. However, CMS is requiring the company to close the older product to new enrollments when the new product, Medicare Blue Choice, becomes available on Sept. 1, 2003. Members already enrolled in Blue Choice Senior can continue in that plan.

Under the older product, Medicare pays for actual cost of services. Under the new Medicare Blue Cross product, Medicare will pay a pre-determined amount for each Medicare member. CMS will permit employer groups currently offering the older cost-based plan to continue enrolling new retirees into it for up to one year.

Medicare+Choice 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.