Beneficiaries in Kansas and Oklahoma will have access to health plans that
feature prescription drug benefits and low out-of-pockets, alternative to
Medicare supplement
KANSAS CITY, Kan., May 16 /PRNewswire/ -- Medicare beneficiaries in rural
America will soon have more than one option for health care coverage thanks to
the passing of the Medicare Modernization Act (MMA) in 2003. Up until
recently, Medicare beneficiaries in Kansas and Oklahoma had little, if any,
health care insurance options other that traditional Medicare, Medicare
supplement or a state-funded plan.
Beginning January 1, 2006, the 947,000 Medicare beneficiaries of Kansas
and Oklahoma will have access to a new type of Medicare health plan known as
regional preferred provider organizations (PPOs). Regional PPOs differ from
an HMO in that there is no referral necessary to see a physician or specialist
of choice. These plans also differ from traditional Medicare in that they
feature a prescription drug benefit, and are designed specifically by The
Centers for Medicare & Medicaid Services to ensure that Medicare beneficiaries
living in all areas of the country have ready access to affordable,
comprehensive health care -- especially those who live in underserved rural
areas.
"Humana intends to offer a Medicare Advantage regional PPO in up to 14 of
the nation's 26 regions," said Stefen Brueckner, Humana vice president, Senior
Segment. "We applaud Congress for taking this historical step forward to
modernize the Medicare program, and we are taking action to make healthcare
coverage more affordable and accessible by expanding our Medicare Advantage
product offering into regions such as Kansas and Oklahoma. The MMA has
enabled Humana to reduce out-of-pocket costs for Medicare beneficiaries and
enhance benefits, particularly the prescription drug benefit which previously
may not have been available to many beneficiaries living in rural areas."
Note to editors: Attached are Frequently Asked Questions that may be
useful to readers as they contemplate the new Medicare Advantage products for
2006.
About Humana
Humana Inc. (NYSE: HUM), headquartered in Louisville, Kentucky, is one of
the nation's largest publicly traded health benefits companies, with
approximately 7 million medical members located primarily in 15 states and
Puerto Rico. Humana offers a diversified portfolio of health insurance
products and related services -- through traditional and consumer-choice plans
-- to employer groups, government-sponsored plans, and individuals.
Over its 44-year history, Humana has consistently seized opportunities to
meet changing customer needs. Today, the company is a leader in consumer
engagement, providing guidance that leads to lower costs and a better health
plan experience throughout its diversified customer portfolio.
More information regarding Humana is available to investors via the
Investor Relations page of the company's web site at http://www.humana.com ,
including copies of:
- Annual report to stockholders;
- Securities and Exchange Commission filings;
- Most recent investor conference presentation;
- Quarterly earnings press releases;
- Audio archive of most recent earnings release conference call;
- Calendar of events (includes upcoming earnings conference call dates,
times, and access number, as well as planned interaction with
institutional investors);
- Corporate Governance Information.
FREQUENTLY ASKED QUESTIONS: HEALTH PLAN OPTIONS AVAILABLE TO MEDICARE
BENEFICIARIES
What is traditional Medicare?
Medicare is a federal health insurance program for people 65 years old or
over and for certain disabled people under 65 years of age and people with end
stage renal disease. A person is automatically enrolled in Medicare hospital
insurance (Part A) when he or she applies for Social Security benefits upon
reaching 65 years of age. Part A covers inpatient care in a hospital or
skilled nursing facility for a limited period of time. Part B covers
physician and outpatient hospital services, and is paid for out of the
enrollee's Social Security. Medicare does not pay full cost of some covered
services. For this reason, it is important to have a supplement plan.
Medicare pays for many health care services and supplies, but it doesn't
pay for all health care costs. Benefits have deductibles and no drug coverage
beyond Medicare-approved drugs. Additional member costs can include co-
insurance and co-payments in addition to any deductibles.
What is Medicare Advantage?
Medicare Advantage is the new name for Medicare + Choice plans. This type
of health plan is an alternative to traditional Medicare and is a direct
result of the Balanced Budget Act of 1997 and the Medicare Modernization Act
of 2003. Medicare Advantage plans include Medicare Health Maintenance
Organization plans (HMO), Medicare Preferred Provider Organization plans
(PPO), and Medicare Private Fee-For-Service plans (PFFS). Medicare Advantage
plans feature prescription drug benefits, fixed costs, limits on out-of-pocket
expenses, and worldwide coverage for emergency care and urgently needed care.
What is a Medicare Advantage HMO?
An HMO is an alternative to traditional Medicare and features restricted
networks that try to control health care costs through utilization management
and referral processes. HMOs often provide additional benefits not found in
traditional Medicare, including a drug benefit plan, wellness or fitness
programs.
What is a Medicare Advantage PPO?
Members can see any physician they want, but if they see a network doctor,
they will get a better benefit and lower co-payment than with a non-network
physician. Referrals aren't needed and there is no "gatekeeper" concept found
with HMOs -- members do not have to see a primary care physician first. In
addition to prescription drug benefits, Medicare Advantage PPOs may also offer
additional benefits such as dental, vision, cosmetic and nutritional
supplements.
What is a Medicare Advantage PFFS plan?
This type of Medicare Advantage plan differs from a traditional HMO in
that members have the freedom to select any doctor, hospital, or health care
provider of choice without the restrictions of a network or referral. PFFS
plans feature limits on out-of-pocket expenses, coverage for emergency care
and urgently needed care, and in some cases, a prescription drug benefit. It
is a full replacement for original Medicare.
What is the new Medicare Part D drug benefit?
New regulations, which go into effect January 1, 2006, will provide a
prescription drug benefit to anyone enrolled in Medicare, regardless of their
income. This benefit is available to anyone entitled to Medicare Part A or
enrolled in Medicare Part B and is designed to help beneficiaries with rising
out-of-pocket drug costs and access to prescription medications.
Beneficiaries who are enrolled in traditional Medicare can enroll in a
stand-alone prescription drug plan (PDP) for drug coverage either in lieu of a
Medicare supplement, or as additional coverage to offset expensive
prescription drug costs should catastrophic illness occur. If beneficiaries
are enrolled in a Medicare Advantage HMO, PPO or PFFS plan that offers
Medicare Part D coverage (MA-PD), they will automatically receive their drug
benefits as part of their coverage.
What questions should Medicare beneficiaries consider when choosing a
health plan?
- Do you already have a doctor you like?
- Are you choosing a new physician?
- How important is freedom-of-choice to you?
- Do you need a prescription drug plan?
- Do you have health problems that may recur over time?
- What drugs are covered by the plan's formulary?
- Does you doctor feel the plan allows him or her to provide appropriate
treatment?
SOURCE Humana Inc.
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CONTACT:
Barbara Kerr, Humana Corporate
Communications, +1-305-626-5736, or bkerr@humana.com
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