2002.08.27: HHS EXPANDS HEALTH PLAN OPTIONS IN MEDICARE+CHOICE (Attachment)

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FOR IMMEDIATE RELEASE
Tuesday, August 27, 2002

Contact:

CMS Public Affairs
(202) 690-6145

HHS EXPANDS HEALTH PLAN OPTIONS IN MEDICARE+CHOICE
New Demonstration Program to Feature PPO Option in 23 States
(Attachment)

ALABAMA
United Healthcare
Blount, Chilton, Jefferson, Mobile, St. Clair, Shelby

ARIZONA
Health Net
Conchise, Coconino, Gila, Maricopa, Mohave, Pima, Pinal, Yavapai

PacifiCare (Secure Horizons)
Maricopa, Pima, Pinal (partial)

CALIFORNIA
PacifiCare (Secure Horizons)
Los Angeles, Orange

FLORIDA
United Healthcare
Broward, Hernando, Hillsborough, Lee, Palm Beach, Pasco, Pinellas

Humana
Pinellas

ILLINOIS
Order of St. Francis
Boone, Knox, Livingston, McLean, Marshall, Peoria, Stark, Tazewell, Winnebago, Woodford

United Healthcare
Madison, Monroe, St. Clair

Coventry
Madison, St. Clair

INDIANA
Advantage
Allen, Boone, Hamilton, Hendricks, Johnson, Marion, Morgan, St. Joseph, Shelby

KANSAS
Coventry
Johnson, Miami, Wyandotte

KENTUCKY (beginning June 2003)
Anthem BCBS*
Boone, Campbell, Kenton

LOUISIANA
Tenet Choices
Jefferson, Orleans, Plaquemines, St. Tammany (partial)

MARYLAND
Aetna
Anne Arundel, Baltimore, Baltimore City, Calvert, Charles, Harford

MISSOURI
Coventry
Cass, Clay, Jackson, Jefferson, Platte, St. Charles, St. Louis, St. Louis City

United Healthcare
Crawford, Franklin, Jefferson, St. Charles, St. Louis, St. Louis City, Warren

NEVADA
PacifiCare (Secure Horizons)
Clark

NEW JERSEY
Aetna
Bergen, Essex, Hudson, Morris, Passaic, Union

Horizon Healthcare of NJ, Inc.
All Counties

NEW YORK
Blue Cross Blue Shield of Western NY (HealthNow)
Albany, Allegany, Cattaraugus, Chautauqua, Columbia, Erie, Fulton, Genesee, Greene, Montgomery, Niagara, Orleans, Rensselaer, Saratoga, Schenectady, Warren, Washington, Wyoming

Group Health Inc.
Bronx, Kings, New York, Queens, Richmond, Rockland, Westchester

Managed Health/Health First
Bronx, Kings, New York, Queens, Richmond

United Healthcare
Bronx, Kings, New York, Queens, Richmond

NORTH CAROLINA
United Healthcare
Alamance, Chatham, Durham, Forsyth, Guilford, Mecklenburg, Orange, Randolph, Rockingham, Wake

PENNSYLVANIA
Aetna
Bucks, Lehigh, Monroe, Montgomery, Northampton, Schuylkill

Coventry
Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Lawrence, Washington, Westmoreland

University of Pittsburgh Medical Center
Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Crawford, Fayette, Huntington, Indiana, Lawrence, Mercer, Somerset, Venango, Washington, Westmoreland

RHODE ISLAND
United Healthcare
Kent, Providence, Washington

TENNESSEE
Cariten
Anderson, Bledsoe, Blount, Bradley, Campbell, Carter, Claiborne, Cocke, Franklin, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hawkins, Jefferson, Johnson, Knox, Loudon, McMinn, Marion, Meigs, Monroe, Morgan, Polk, Rhea, Roane, Scott, Sequatchie, Sevier, Sullivan, Unicoi, Union, Washington

Health Spring
Cannon, Cheatham, Davidson, De Kalb, Macon, Marshall, Robertson, Rutherford, Smith, Sumner, Trousdale, Williamson, Wilson

OHIO
Anthem BCBS *
Butler, Clermont, Greene, Hamilton, Montgomery, Warren

Coventry
Belmont, Jefferson

United Healthcare
Butler, Cuyahoga, Hamilton, Mahoning

OREGON
Health Net
Benton, Clackamas, Columbia, Hood River, Jackson, Josephine, Lane, Linn, Marion, Multnomah, Polk, Washington, Yamhill

VIRGINIA
Cariten
Bristol, Buchanan, Dichenson, Lee, Norton City, Russell, Scott, Smyth, Tazewell, Washington, Wise

WASHINGTON
Health Net
Clark

WEST VIRGINIA
Coventry
Brooke, Hancock, Marshall, Ohio

* Plan service begins June 2003.

Medicare Preferred Provider Organization (PPO) Demonstrations

Beginning January 1, 2003, health care organizations will offer people with Medicare new Preferred Provider Organization health plans (PPOs) in 23 states as part of a Medicare demonstration project. Although the PPO model is popular with Americans under age 65 it is not generally available to those over 65. Benefits will vary depending upon what each individual PPOs offers from in each market, but some of the common features of PPOs are:

Networks of preferred providers (hospitals, physicians and other providers) who provide all of the basic Medicare benefits, plus additional benefits such as annual physicals, other preventive services, disease management, and prescription drugs.
Access to providers outside the network. (This distinguishes a PPO from an HMO where the HMO must provide all the services.)
A balance of monthly premiums and some cost sharing amounts paid by the plan enrollees. For in-network services, the cost sharing amounts are lower than those for out-of-network services. In some cases, there are out-of-pocket maximums so when a maximum limit is reached, there is no more cost sharing.
Fees paid to out-of-network providers will be no more than they would get in fee-for-service Medicare.
Premiums vary but will be priced between existing HMO premiums and premiums charged by Medigap or Medicare supplemental insurance products.

Participating Health Plans:

Advantage
Aetna
Anthem BCBS*
Blue Cross Blue Shield of Western NY (HealthNow)
Cariten
Coventry Group Health Inc.
Health Net
Health Spring
Horizon Healthcare of NJ, Inc.
Humana
Managed Health/Health First Order of St. Francis
PacifiCare (Secure Horizons)
Tenet Choices
University of Pittsburgh Medical Center
United Healthcare

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Note: All HHS press releases, fact sheets and other press materials are available at www.hhs.gov/news.

HHS EXPANDS HEALTH PLAN OPTIONS IN MEDICARE+CHOICENew Demonstration Program to Feature PPO Option in 23 States(Attachment)

HHS EXPANDS HEALTH PLAN OPTIONS IN MEDICARE+CHOICE
New Demonstration Program to Feature PPO Option in 23 States
(Attachment)