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Carriers Announce 2003 Medicare HMO Decisions

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NU Online News Service, Sept. 9, 6:33 p.m. – Aetna Inc., Hartford, and several other big managed care companies say they will continue to trim their Medicare health maintenance organization plans in 2003.

But several smaller companies, such as Oxford Health Plans Inc., Trumbull, Conn., and Health Net Inc., Los Angeles, say they will be holding the size of their plans steady, or even expanding their Medicare HMOs.

The Medicare HMO program was popular with private carriers when it started, in the mid-1990s, but the carriers began to flee in the late 1990s, after Congress decided to hold the typical reimbursement increase to less than 5% per year.

The federal Centers for Medicare and Medicaid Services gave the carriers until today to decide where they will sell Medicare HMO coverage in 2003.

Aetna, for example, says it will stop offering individual Medicare HMO coverage in five relatively small markets: Ocean County and Monmouth County in New Jersey, and Allegheny County, Fayette County and Westmoreland County in Pennsylvania.

But Aetna says it will continue to run Medicare HMOs in 26 counties in the Los Angeles, New York and Philadelphia metropolitan areas.

Aetna will be keeping Medicare HMOs in:

  • Los Angeles, Orange, San Bernardino and Riverside counties in California.
  • Bergen, Essex, Hudson, Passaic, Sussex, Union and Camden counties in New Jersey.
  • Queens, Kings, Richmond, New York, Bronx, Rockland and Westchester counties in New York.
  • Philadelphia, Chester and Delaware counties in Pennsylvania.

And Aetna notes that it will be participating in the new Medicare preferred provider organization test program.

Aetna will be setting up Medicare PPO plans in 21 counties:

  • Anne Arundel, Calvert, Charles, Baltimore, Harford and Baltimore City counties in Maryland.
  • Bergen, Essex, Hudson, Mercer, Middlesex, Monmouth, Ocean, Passaic and Union counties in New Jersey.
  • Monroe, Schuylkill, Lehigh, Northampton, Montgomery and Bucks counties in Pennsylvania.

Blue Cross and Blue Shield of Florida, Jacksonville, Fla, is another example of a carrier that has decided to retrench: it will be keeping Medicare HMOs in three South Florida counties, but killing Medicare HMOs in three other counties, including the county where its main office is located.

On the other hand, Oxford, a large player in the New York City metropolitan market, says it will keep Medicare HMOs in seven counties in New York, New Jersey and Connecticut. The plans serve about 70,000 members.

Health Net, another large regional player, says it will keep Medicare HMOs in 27 counties:

  • Maricopa, Pima, Pinal and Santa Cruz counties in Arizona.
  • Alameda, Contra Costa, Kern, Los Angeles, Orange, Placer, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Mateo, Santa Barbara, Santa Clara and Yolo counties in California.
  • Fairfield, Hartford and New Haven counties in Connecticut.
  • Bronx, Kings, Queens and Richmond counties in New York.
  • Philadelphia County in Pennsylvania.

Health Net will stop offering Medicare HMOs in parts of Alameda and Santa Barbara counties, but those two withdrawals will affect fewer than 1,000 Medicare beneficiaries, Health Net says.

Health Net reports that will resume signing up new members in 10 counties in Arizona, California and Connecticut, and that it will set up Medicare PPO plans in 21 counties.

The Health Net PPO plans will be in:

  • Cochise, Coconino, Gila, Maricopa, Mohave, Pima and Pinal counties in Arizona.
  • Benton, Clackamas, Columbia, Hood River, Jackson, Josephine, Lane, Linn, Marion, Mutnomah, Polk, Washington and Yamhill counties in Oregon.
  • Clark County in Washington.