The Centers for Medicare & Medicaid Services (CMS) has approved a request by Sterling Life Insurance Co. to expand private fee-for-service health care coverage to Medicare beneficiaries in 28 counties in seven states, including the cities of Atlanta , Ga. , and Dallas , Texas .
Sterling Life Insurance Co., a Bellingham, Wash.-based subsidiary of Aon Corporation, will begin on June 1 serving beneficiaries through its private fee-for-service plan in counties in Georgia , Indiana , Montana , North Carolina , Oregon , South Carolina and Texas . About 900,000 beneficiaries live in the 28 counties. Beneficiaries can sign up for the plan during the current open enrollment in Medicare Advantage plans.
“We are pleased Sterling Life Insurance Co. has decided to offer this health plan in more areas around the country,” 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 newly approved counties in the plan in Georgia are - Bryan, Chatham including the city of Savannah, Cobb, Columbia, De Kalb, Effingham, Fulton including the city of Atlanta, McDuffie and Richmond including the city of Augusta; Indiana – Clark, Floyd and Harrison, all in the Louisville, Ky. area; Montana – Cascade; North Carolina – Buncombe, Henderson, Polk and Transylvania; Oregon – Douglas; South Carolina – Cherokee, Jasper, Laurens and Union; and Texas – Dallas including the city of Dallas, Henderson, Kaufman, Smith, Tarrant and Williamson.
Sterling Life Insurance Co. will offer its Medicare Advantage private fee-for-service plan as another health care option to beneficiaries in the 28 counties. The Medicare Advantage plans currently operating in at least one of these counties are Humana Inc., Kaiser Permanente Senior Advantage, Regence Blue Cross Blue Shield of Oregon, Scott and White Health Plans, Secure Horizons Medicare Advantage Plan, Unicare Life and Health Insurance Co. and United Health Insurance Co.
Sterling Life Insurance Co. was the first organization to be approved to offer a private fee-for-service plan, Sterling Option I, which is currently available in 23 states. Sterling Life Insurance Co. is wholly owned by Combined Insurance Company of America . Both companies are subsidiaries of Aon Corporation, based in Chicago .
A private fee-for-service plan is an insurance program that charges enrollees a premium and cost-sharing amounts and lets beneficiaries choose the providers they want to see, as long as these providers accept the private fee-for-service insurance program.
"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," CMS Administrator Mark McClellan, Ph.D., M.D., 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."
Since Dec. 8, 2003, when President Bush signed the Medicare Modernization Act into law, CMS has approved 68 new contracts with Medicare health plans and 91 service area expansions. There are currently 210 applications pending for new contracts and 91 service area expansions pending.
Medicare Advantage 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.
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