The Centers for Medicare & Medicaid Services (CMS) has approved a request by Colorado Access to offer a health plan in seven counties in the Denver metro area for beneficiaries with special needs who are eligible for Medicare and Medicaid. This plan will be available for the first time in Colorado .
Colorado Access, a company based in Denver , will begin on Feb. 1 serving beneficiaries, known as dual eligibles, who qualify for Medicare and Medicaid. The plan’s seven counties are Denver including the city of Denver, Adams, Arapahoe, Boulder, Broomfield, Douglas and Jefferson .
The Medicare Modernization Act of 2003 (MMA) established a Medicare Advantage option for private plans that exclusively or primarily enroll “special needs” individuals. They can sign up for the plan during the current open enrollment for Medicare Advantage, formerly known as Medicare+Choice.
“We are pleased Colorado Access decided to offer this Medicare Advantage Special Needs option plan to beneficiaries in the Denver area,” HHS Secretary Tommy G. Thompson said. "Under the Medicare reform law signed by President Bush, Medicare will provide 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.”
About 100,000 beneficiaries eligible for both Medicare and Medicaid live in the seven counties. The special needs plan is designed specifically to meet the requirements of these beneficiaries. That includes helping members access community resources, as well as ensuring that dual eligible beneficiaries benefit from disease management programs, resulting from health risk assessments administered by the plan.
Beneficiaries with special needs can enroll in the company’s program offered through its new Medicare Advantage contract with CMS. Medicare Advantage Special Needs Plans are available under MMA. To qualify for the plan, a beneficiary must be enrolled in Medicare Part B and the Colorado state Medicaid program, and be entitled to Medicare Part A.
"We want to make sure beneficiaries are receiving the highest quality health care," said CMS Administrator Mark McClellan, M.D., Ph.D. "We are doing more to guarantee that beneficiaries understand the 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 MMA into law, CMS has approved 41 new contracts with Medicare health plans and 56 service area expansions. There are currently 20 applications pending for new contracts and 21 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.