Medicare :: CMS terminates America’s health choice medical plan

As of midnight July_19, 2007, the Medicare Advantage contract between the Centers for Medicare and Medicaid Services (CMS) and America?s Health Choice, Inc. (AHC) of Vero Beach, Florida is terminated.

CMS has taken this action because of AHC?s failure to meet the terms of its contract.

Specifically, AHC failed to make services available to the extent that it posed an imminent and serious to the health of AHC enrollees. AHC?s Medicare Advantage plan had an enrollment of approximately 12,000 members. This action by CMS does not affect AHC?s stand-alone prescription drug (PDP) contract, which has approximately 500 members enrolled.

In order to avoid any lapse in coverage, AHC?s Medicare Advantage members living in Florida?s Treasure Coast area have been enrolled retroactively into United Health Care?s Secure Horizons, a Medicare regional preferred provider product, effective on July 1, 2007. The Secure Horizons plan was selected because it is the only Medicare Advantage plan that covers the entire AHC service area and it offers a similar benefits package. In addition, the vast majority will have a zero dollar premium. Secure Horizons will immediately provide all former AHC enrollees with Medicare health benefits and prescription drug coverage. Beneficiaries can continue to see their current providers whether they are in or outside of the Secure Horizons network.

Beneficiaries receiving services from providers outside of the Secure Horizons network, will pay only the in-network cost sharing amount until September 29, 2007. Beneficiaries being treated for serious acute illness on July 20, 2007 will continue to receive already prescribed AHC benefits at the Secure Horizon?s in-network cost sharing amounts for up to 90 days. Similarly, beneficiaries receiving services such as chemotherapy and radiation therapy will continue to receive already prescribed AHC benefits at Secure Horizon in-network cost sharing amounts until December 31, 2007.

Beneficiaries and providers looking for more information about the Secure Horizons plan may contact Secure Horizons at 1-888-507-9352 (TTY users may call 1-888-685-8480). Secure Horizons is ready to help beneficiaries and providers make this a smooth transition.

Beneficiaries who choose not to remain in the Secure Horizons plan have a special election period until September 30, 2007 to make changes in their Medicare health care and prescription drug coverage. Many Medicare Advantage and stand alone prescription drug plans are available in the Treasure Coast area. In addition, beneficiaries have the option of returning to Original Medicare and, if they wish, purchasing a Medicare Supplement plan (Medigap) within 63 days from the loss of coverage under AHC. More information about Medicare plan options can be found at Medicare?s website www.medicare.gov or by calling 1-800 Medicare (1-800-633-4227). TTY users may call 1-877-486-2048. Information may also be found by calling or visiting the local office of the state counseling center, Serving Health Insurance Needs of Elders (SHINE).

CMS is working closely with its partners in the State of Florida government including the Florida SHINE to ensure that beneficiary rights are protected and that they are aware of the Medicare coverage available to them. Beneficiaries may contact SHINE at 1-800-96-ELDER (1-800-963-5337). CMS also is working with Secure Horizons to contact affected providers. Provider outreach, mailings, and meetings are planned so that providers are well informed about these changes.

It is important for Medicare beneficiaries formerly enrolled in AHC?s Medicare Advantage plan to keep five things in mind:

Coverage with AHC ended at midnight July 19, 2007.

All AHC enrollees have been enrolled in Secure Horizons? regional preferred provider product with coverage retroactive to July 1, 2007.

The Secure Horizons plan benefits are similar to the benefits beneficiaries were receiving under AHC and Secure Horizons will work with beneficiaries and providers for a smooth transition.

(4) Beneficiaries looking for more information about the Secure Horizons plan may contact Secure Horizons at 1-888-507-9352 (TTY users may phone 1-888-685-8480). Secure Horizons is ready to help beneficiaries and providers make this a smooth transition.

(5) Medicare beneficiaries with any questions may always contact 1-800- MEDICARE (1-800-633-4227; TTY users phone: 1-877-486-2048) or their local SHINE office at 1-800-963-5337.

CMS and UHC will provide members of America?s Health Choice with additional information.

Sub-editor

Medicare :: CMS terminates America’s health choice medical plan
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Posted on at 6:13 am.
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