CHAMPAIGN — With just weeks remaining for state of Illinois retirees to enroll in new Medicare Advantage health plans, the single insurer available to thousands of Carle Physician Group patients who want to keep their doctors is better known in areas outside East Central Illinois, a company executive says.
But possibly not for long.
"We hope to enroll as many individuals who allow us to be their insurance carrier," says Frank Mancuso, regional vice president of Medicare and Retirement for UnitedHealthcare.
The state is moving its Medicare-eligible retirees to Medicare Advantage plans, offering a choice of four plans — though not all are available in every county — for new coverage starting Feb. 1, 2014.
Most of the retirees in East Central Illinois have a choice of two Medicare Advantage plans, the UnitedHealthcare PPO, and Aetna Life Insurance Co.'s Coventry Advantra HMO.
Health Alliance Medical Plans, which wasn't awarded a state Medicare Advantage contract, said about 6,000 of its current state retiree group members are Carle patients.
Carle doctors are out of network for both UnitedHealthcare and Coventry, but the UnitedHealthcare PPO will work at Carle because it's a "passive PPO" making member cost-sharing the same both in and out of network, according to Mancuso.
Members have "total freedom of choice" to seek care both in and out of network, and providers are reimbursed the same, he said.
"About 98 percent of our out-of-network providers accept our members on the group retiree PPO basis," Mancuso said.
Under the Medicare Advantage HMO plans, members must largely see in-network providers for covered services other than emergency care.
UnitedHealthcare is more well-known in other Illinois markets, such as Chicago, Peoria, Moline and counties around St. Louis, Mancuso says. But the company's Medicare Advantage PPO for state retirees is available statewide, he said.
UnitedHealthcare Medicare and Retirement is part of UnitedHealth Group, a Minnesota-based diversified health care company that processes 900 million claims a year. It serves 84 million people through UnitedHealthcare and its Optum health services businesses, according to UnitedHealth Group's 2012 annual report.
In terms of Medicare business, UnitedHealthcare says it currently serves 385,000 Medicare beneficiaries in Illinois. Nationally, the company server nearly one in five Medicare beneficiaries, with just under 3 million people enrolled in Medicare Advantage plans and about 4.9 million people enrolled in stand-alone Medicare Part D drug plans, Mancuso said.
The company hopes to make the transition to a new insurer as seamless as possible for state retirees, he said.
Meanwhile, Mancuso advises those state retirees still considering their options to take time to make an educated decision and look at the additional benefits the plan choices offer.
"We'll make ourselves as accessible as possible, and we're really looking forward to Feb. 1," he said.