Limited Expansion Of Managed Care In US Medicare

The Clinton Administration has approved the limited pilot expansion ofmanaged care in the US Medicare program.

From January 1, Medicare beneficiaries in Orlando, Philadelphia, Houston and rural southern Virginia can choose among several managed care options, including a preferred provider organization and provider-sponsored networks. A hybrid plan, where one plan offers a health maintenance organization, a PPO and a point-of-service plan with limited out-of-network services with higher penalties, will be available in southern Virginia only. Medicare payments will be readjusted to the health status of beneficiaries instead of only demographic factors, notes the Health Care Financing Administration.

Later this year, the pilot should include 19 plans in Florida, California, Georgia, Illinois, Louisiana, Montana, New York, Ohio, Pennsylvania and Texas.