Press Releases

MANAGED CARE PLAN OFFERED TO MEDICARE BENEFICIARIES IN SAN JUAN, P.R. METRO AREA

The Centers for Medicare & Medicaid Services (CMS) has approved a request by SDM Healthcare Management Inc. to offer managed care coverage to Medicare beneficiaries in six municipalities in the San Juan  metropolitan area in Puerto Rico .  

SDM Healthcare Management, based in Bayamon  , P.R., is now serving beneficiaries in San Juan and the other neighboring municipalities of Bayamon , Caguas , Carolina , Guaynabo and Trujillo Alto. Beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage plans. About 189,000 beneficiaries live in the six municipalities.      

CMS has approved 143 new Medicare Advantage plans to provide services in 2005, far exceeding the highest number of plans that had been previously available. These new plans are providing significant monthly out-of-pocket savings for Medicare beneficiaries, particularly those with chronic illnesses. The availability of these plans in 49 states, along with their enhanced benefits and increased savings, are the results of the Medicare Modernization Act of 2003.

“This is great news for seniors who are getting more choices and better benefits as the new Medicare law kicks in,” HHS Secretary Mike Leavitt said.  "We have created a market for plans to compete in providing the best deal for seniors.”

The plan, which does business as Medicare Supreme, Medicare Prime and Medicare Excel, gives beneficiaries another health care option to select.   The other Medicare Advantage plans currently operating in greater metropolitan San Juan are Humana Health Plans of Puerto Rico, an HMO plan; Humana Insurance of Puerto Rico Inc., a preferred provider organization (PPO) plan; MMM Healthcare Inc.; Preferred Medicare Choice Inc., an HMO plan; Triple-S Inc., HMO and PPO plans; and MCS Life Insurance Co., an HMO plan.    

“We are seeing broader health plan participation than ever before, with a greater potential for savings for people with Medicare,” said CMS Administrator Mark B. McClellan, M.D., Ph.D. “Medicare Advantage plans help beneficiaries save by better coordinating their care and offering preventive benefits that help them stay healthy and keep their costs down, reflecting the steps we are taking to help make Medicare more up-to-date.”

These Medicare Advantage plans also offer more extensive benefits or lower cost sharing compared to the original Medicare program, providing greater cost-savings to people with Medicare in 2005 than in previous years. On average, beneficiaries can save just over $100 a month compared to the original Medicare plan, either with paying for individual Medigap coverage or with paying for the co-payments and other coverage limits in the original Medicare plan. Those average savings include $29 in extra benefits, $2 in Part B premium reduction and $70 in reduced average out-of-pocket expenses for Medicare-covered services compared to the national actuarial value.    

With the addition of these new plans, Medicare beneficiaries in 49 states will have access to 428 health plans across the nation. Those include 41 plans completely new to the Medicare program and 66 new local PPOs. Some 90 current providers plan to increase their service areas this year. Many of these plans have already begun offering services in these areas.

With these expansions, 73 percent of Medicare beneficiaries will have access to HMO plans, 52 percent will have access to PPO plans and 80 percent will have access to private fee-for-service plans. The vast majority of beneficiaries in rural areas will have access to private fee-for-service plans, and nearly 20 percent of beneficiaries in rural areas will have access to coordinated care plans (HMOs or PPOs). Altogether there are more than 5 million beneficiaries currently enrolled in Medicare Advantage health plans, with an average of 50,000 beneficiaries per month joining the plans since last year.

Medicare Advantage HMOs and private fee-for-service plans are available where private companies choose to offer them, while original fee-for-service Medicare, with about 37 million beneficiaries, is available to all beneficiaries. Currently, about 42 million aged and disabled Americans are enrolled in Medicare.

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.