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Medicare News

For Immediate Release: Contact:
Thursday, January 22, 2004 CMS Office of Public Affairs
202-690-6145

For questions about Medicare please call 1-800-MEDICARE or visit www.medicare.gov.

AETNA EXPANDS POINT-OF-SERVICE MEDICARE MANAGED CARE PLAN TO ROCKLAND AND WESTCHESTER COUNTIES, N.Y.

The Centers for Medicare and Medicaid Services (CMS) has approved a request by Aetna to expand a point-of-service (POS) Medicare managed care plan to include beneficiaries in Rockland and Westchester counties, N.Y., 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.  These plans offer access to out-of-network providers.

 

Aetna, based in Hartford, Conn., is now serving beneficiaries in suburban Rockland and Westchester counties north of New York City, including the Westchester cities of Mount Vernon, New Rochelle, Yonkers and White Plans.  About 217,000 beneficiaries live in the two counties.

 

The plan, known as Aetna Golden Choice Plan, is open for enrollment to Medicare beneficiaries.  A year ago, Aetna began to serve beneficiaries in 21 counties in Maryland, New Jersey and Pennsylvania through the plan.

 

“We are pleased Aetna decided to expand this plan to include Medicare beneficiaries in Westchester and Rockland counties,“ 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 have been key goals of this Administration.  These goals are being achieved by the new Medicare reform law signed by President Bush.  The changes will modernize Medicare and provide a prescription drug benefit for the first time.”

 

Congress created Medicare Advantage, formerly known as 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, a POS, another Medicare Advantage plan or fee-for-service Medicare, we are doing more to guarantee they understand the Medicare options available to them,” Acting CMS Administrator Dennis Smith said.  “The under age 65 market is rapidly flocking toward PPO-type products, which give patients the flexibility they need.  Seniors want the same options and this is the big first step in getting them there.”

 

Aetna’s demonstration plan will give another health care choice to Medicare beneficiaries in Rockland and Westchester counties. They already may choose among other Medicare Advantage plans – Empire HealthChoice HMO, GHI Medicare Choice PPO, WellCare Choice of New York and HIP Health Plan of Greater New York.   Aetna also is operating an HMO product, Aetna Golden Medicare Plan, in those counties and New York City.         

 

Currently, Medicare Advantage 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 22 states across the country, expanding health care options to approximately 11 million Medicare beneficiaries.

 

The demonstration plans are considered Medicare Advantage 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 Aetna 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.

      

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