The Centers for Medicare and Medicaid Services (CMS) has approved a request by United HealthCare Insurance Co. to expand a Medicare managed care plan to include beneficiaries in three counties in southwestern Ohio 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.
United HealthCare Insurance is now serving beneficiaries in Clark, Montgomery and Warren counties in the Cincinnati and Dayton areas under its Medicare Complete Choice (PPO) product. Medicare beneficiaries can sign up now for the plan and throughout the current Medicare+Choice open enrollment. About 141,000 beneficiaries live in the three counties.
In January 2003, the company began to serve beneficiaries in four Ohio counties under Medicare Complete Choice (PPO). The counties are Butler, Hamilton, Cuyahoga and Mahoning, including the cities of Cincinnati, Cleveland and Youngstown.
“We are pleased United HealthCare Insurance decided to expand this plan to include more Medicare beneficiaries in southwestern Ohio,“ 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 are key goals of this Administration.”
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.
“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 Administrator Tom Scully 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 big first step in getting them there.”
United HealthCare Insurance is a subsidiary of UnitedHealth Group, based in Minnetonka, Minn. The PPO demonstration plan gives another health care choice to Medicare beneficiaries in the three counties. The other choices currently are UnitedHealthcare of Ohio and Community Insurance Co.
Currently, Medicare+Choice health maintenance organizations (HMOs) are 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 Aug. 27, 2002, includes new health plans that will ultimately be available in 23 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 United HealthCare Insurance 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.