The Centers for Medicare & Medicaid Services (CMS) has approved a request by New West Health Services to offer managed care coverage to Medicare beneficiaries in 20 Montana counties, including the state’s major cities.
New West Health Services, based in Helena , Mont. , will operate a preferred provider organization (PPO) health plan that will begin serving beneficiaries on June 1 in the 20 counties. The cities in those counties include Billings , Butte , Great Falls , Helena and Missoula . Medicare beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage plans. About 107,000 beneficiaries live in the 20 counties.
"We are pleased New West Health Services decided to offer this health plan to beneficiaries in the largest cities in Montana and elsewhere in the state,” 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.”
The counties in the plan are Beaverhead, Big Horn, Broadwater, Carbon, Cascade, Flathead, Gallatin , Jefferson, Lake, Lewis and Clark, Mineral, Missoula , Park, Powell, Ravalli, Stillwater , Sweet Grass, Yellowstone and parts of Granite and Sanders.
New West Health Services will give another health care option to beneficiaries in the 20 counties. The only Medicare Advantage plan currently operating in Montana is Sterling Insurance Co., which offers a private fee-for-service plan.
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 71 new contracts with Medicare health plans and 97 service area expansions. There are currently 218 applications pending for new contracts and 85 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.