The Centers for Medicare & Medicaid Services (CMS) today approved a request by Coventry Health and Life Insurance Co. to offer a Medicare managed care plan to Medicare beneficiaries in three greater Kansas City area counties as part of a demonstration program announced by Health and Human Services Secretary Tommy G. Thompson. The health plans under this program are modeled after coverage offered by preferred provider organizations (PPOs) to most Americans under age 65.
Coventry Health and Life Insurance, a subsidiary of Coventry Health Care Inc., based in Bethesda, Md., can begin on Jan. 1, 2004, to serve Medicare beneficiaries. Coventry Health Care of Kansas Inc., another Coventry Health Care subsidiary, which currently offers Medicare+Choice coverage, will administer the PPO coverage offered by Coventry Health and Life Insurance.
About 162,000 beneficiaries live in the managed care organization’s newly approved service area of Cass and Jackson counties in Missouri, and Johnson County in Kansas. Beneficiaries can sign up for the plan during the current Medicare+Choice open enrollment.
“We are pleased Coventry Health Care decided to expand this plan to include more Medicare beneficiaries in the Kansas City area,“ Secretary Thompson said. “This demonstration program gives seniors new options for their Medicare coverage similar to that available in the private insurance market. Greater access and expanded options and choices in health care have been key goals of this Administration. These goals are being achieved by the new Medicare reform law signed by President Bush. The changes will modernize Medicare and provide a prescription drug benefit for the first time.”
Congress created Medicare+Choice in the Balanced Budget Act of 1997 to expand the types of health care options available to Medicare beneficiaries, enabling them to receive new preventive benefits and greater patient protections. Preferred provider type coverage was previously unavailable to Medicare beneficiaries.
The plan will give another health care choice to beneficiaries living in the three counties. The other Medicare+Choice plans currently operating in at least one of the counties are Coventry Health Care of Kansas Inc. and Humana.
"Whether beneficiaries enroll in a PPO or another Medicare+Choice plan, or fee-for-service Medicare, we are doing more to guarantee they understand the Medicare options available to them,” CMS Acting Administrator Dennis Smith said. “The under age 65 market is rapidly flocking toward PPO products, which give patients the flexibility they need. Seniors want the same options and this is the first big step in getting them there.”
Currently, Medicare+Choice health maintenance organizations (HMOs) are available where private companies choose to offer them. 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. Unlike traditional HMOs, the new options will allow beneficiaries who choose to enroll, access to services provided outside the contracted network of providers.
The demonstration program, announced in August 2002, includes new health plans that will ultimately be available in 22 states across the country, expanding health care options to approximately 11 million Medicare beneficiaries.
The demonstration plans are considered Medicare+Choice plans and must offer all of Medicare’s required benefits, but also have the flexibility to offer additional services, including prescription drugs. Most important, they offer beneficiaries a wider choice of health care providers than is currently offered in HMOs.
A number of resources with information regarding the plan offered by Coventry Health Care are available as part of various CMS consumer information sources, including a national toll-free phone number -- 1-800-MEDICARE (1-800-633-4227) or TTY/TDD, at 877-486-2048, and the CMS Internet site -- www.medicare.gov. In addition, a coalition of more than 200 national and local organizations is available to assist seniors in making informed decisions about their health care options.