Press Releases

MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN 13 WISCONSIN COUNTIES

The Centers for Medicare & Medicaid Services (CMS) has approved a request by Network Health Insurance Corp. Inc. to offer managed care coverage to Medicare beneficiaries in 13 counties in eastern and central Wisconsin.   

Network Health Insurance Corp., based in Menasha, Wis., is operating a preferred provider organization (PPO) health plan that is now serving beneficiaries in the 13 counties. The counties are Brown, Calumet, Dodge, Fond du Lac , Green Lake, Manitowoc, Marquette, Outagamie, Portage, Sheboygan, Waupaca, Waushara, and Winnebago.  Included in these counties are the cities of Appleton, Fond du Lac, Green Bay, Oshkosh, Sheboygan and Stevens Point.

Medicare beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage, formerly known as Medicare+Choice. About 173,000 beneficiaries live in the 13 counties.   

"We are pleased Network Health Insurance Corp. decided to offer this health plan to beneficiaries in 13 Wisconsin counties,” HHS Secretary Tommy G. Thompson 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.”

Network Health Insurance Corp. is a subsidiary of. Network Health Plan, a cost HMO that has served Medicare beneficiaries in Wisconsin for nearly a decade.   The company’s new PPO plan, called Network PlatinumPlus, will give another health care option to beneficiaries in the 13 counties.  The Medicare Advantage plans currently operating in these counties are Security Health Plan (HMO), United Healthcare of Wisconsin and three private fee-for-service plans, Humana Insurance Co., Unicare Life and Health Insurance Co. and United Healthcare Insurance Co.   

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.

"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 41 new contracts with Medicare health plans and 57 service area expansions.   There are currently 38 applications pending for new contracts and 26 service area expansions pending.

Medicare Advantage HMOs, PPOs 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.