KNOXVILLE, Tenn. — Knoxville-based Cariten Senior Health is one of two health plans in Tennessee and among 33 nationwide selected by the federal government to offer a new Medicare+Choice Preferred Provider Organization (PPO) option to seniors.
The 33 plans, including Cariten's, in 23 states will begin to serve Medicare beneficiaries in January as part of a demonstration program modeled after PPOs available to the vast majority of Americans under 65, Health and Human Services Secretary Tommy G. Thompson announced in late August.
Cariten Senior Health, which has offered a Medicare+Choice HMO product since 1998, is one of only two plans in the state of Tennessee of offer this new Medicare+Choice PPO option. PPO coverage through Cariten Senior Health will be available to residents of 35 East Tennessee Counties and 11 counties in southwestern Virginia. Cariten Senior Health currently serves more than 11,000 members.
"We are pleased to offer yet another choice in health care coverage to Medicare-eligible individuals in East Tennessee and southwestern Virginia," said Don Schmidt, Cariten Healthcare's vice president of Medicare and provider relations. "As a local, provider-owned plan, Cariten Senior Health is uniquely positioned to offer our community's seniors and disabled persons an affordable alternative to original Medicare or Medicare supplements."
"This demonstration gives seniors new options for their Medicare coverage similar to that available in the private insurance market," Secretary Thompson said. "That's a key goal of the Bush administration's plan proposals to improve and strengthen Medicare. President Bush and I are committed to giving seniors additional, better benefit options as well as access to affordable prescription drugs. Our plan will make that possible for an increased number of Americans."
Enrollees will have more flexibility than is available through existing Medicare HMOs, but will still enjoy richer benefits than those available in the original Medicare program. Beneficiaries will be able to enroll in these new plans beginning in November, the Medicare health plan open enrollment period, with coverage beginning Jan. 1, 2003.
The new PPO option will be available to about 11 million Medicare beneficiaries — 30 percent of all seniors — in parts or all of 23 states: Alabama, Arizona, California, Florida, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maryland, Missouri, North Carolina, Nevada, New Jersey, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Tennessee, Virginia, West Virginia and Washington.
Until now, Medicare beneficiaries generally could only choose between two models of care — fee-for-service coverage or a closed network HMO — while many Americans under 65 are choosing PPOs, which blend the two approaches.
The demonstration plans will be considered Medicare+Choice plans and must offer all of Medicare's required benefits, but will also have the flexibility to offer greater access to drug benefits and disease management services. Most important, they will offer beneficiaries a wider choice of health care providers than is currently offered in HMOs.
"The administration is driving to improve Medicare any way we can, by developing new and better health plan options, including prescription drug coverage," Centers for Medicare & Medicaid Services Administrator Tom Scully said. "The under age 65 market is rapidly flocking toward PPO products, which give patients the flexibility they need. Seniors want the same options and this is a big first step in getting them there."
Cariten Senior Health is one of many health care plans and services offered by Cariten Healthcare. Other plans and services include HMO (Health Maintenance Organization), PPO (Preferred Provider Organization) and POS (Point of Service), as well as TPS (Third Party Administrator) services. It also offers Business Health Solutions, a comprehensive approach to business behavioral and workplace needs including a workers' compensation managed care product, an employee assistance program, workplace consulting services and vocational rehabilitation services.
Founded in 1985 as a provider-owned managed care organization, Cariten Healthcare has almost 500,000 health plan members. The company is majority owned by Covenant Health, one of the largest and most respected health care institutions in East Tennessee.