Payers continue to leave

Sunday, September 21, 2003

September 22, 2003

Medicare + Choice
WASHINGTON - For 2004, 16 health plans have announced their decision to either leave the Medicare+Choice program or reduce their service area, affecting 41,000 beneficiaries. Last year, 217,000 enrollees were affected by non-renewal activity, according to CMS.

About 38,000 of the 41,000 beneficiaries will be able to choose from another Medicare coordinated care plan (36,991 enrollees) or a private fee for service plan (1,021). Additionally, nearly 1,500 beneficiaries will be eligible to enroll in one of the preferred provider demonstration options (PPO). Approximately 3,100 will lose a private plan option, requiring them to return to fee-for-service Medicare, CMS stated in a release issued Sept. 22.

Despite the expected departure of 16 health plans, CMS expects a net increase of beneficiaries into the Medicare+Choice program this year.

"We are encouraged by the requests by health plans to bring more choices to Medicare beneficiaries by expanding their service areas and even offering new programs,"stated CMS Administrator Tom Scully. "Since January 1, 2003, we have approved eight new Medicare + Choice contracts and expansion of service areas for 23 plans. As of September 1, we had 9 new plans pending and 22 service area expansions. So, this year, we expect a net increase in the number of covered lives once these service area expansions are approved.

Recent reports show that overall, 55% of all Medicare + Choice enrollees live in households with less than $20,000 in income, CMS stated.