The Centers for Medicare & Medicaid Services (CMS) today approved a request by Highmark Inc. to offer a managed care-preferred provider organization (PPO) plan to Medicare beneficiaries in 17 western Pennsylvania counties including the city of Pittsburgh.
Highmark Inc., an independent licensee of the Blue Cross Blue Shield Association based in Pittsburgh, can begin serving Medicare beneficiaries in the 17 counties on May 1, 2003.
About 650,000 beneficiaries live in the 17 counties, which include the cities of Altoona, Erie and Johnstown. The counties are Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Crawford, Erie, Fayette, Greene, Indiana, Lawrence, Mercer, Somerset, Washington and Westmoreland. Beneficiaries can sign up for the plan during the current Medicare+Choice open enrollment period.
"We are pleased that Highmark has decided to offer this new PPO option to Medicare beneficiaries in western Pennsylvania," HHS Secretary Tommy G. Thompson said. "The reality is, Medicare should provide all seniors - no matter where they live - with better health insurance options, including prescription drug coverage and preventive care. The President's goals for strengthening and modernizing Medicare will move us closer to that goal."
Highmark, which operates as FreedomBlue, will give another health care choice to beneficiaries living in Pittsburgh and the surrounding area. Beneficiaries living in these counties already can choose among several Medicare+Choice plans. In addition, the United Mine Workers operate a health care prepayment plan in the area as well.
"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 Administrator Tom 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."
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.
Congress created Medicare+Choice in the Balanced Budget Act of 1997 to expand the types of health care options available to Medicare beneficiaries, who in addition can now receive new preventive benefits and patient protections. There also is 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.