Tuesday, October 15, 2013

Aetna Announces Major Expansion Of Medicare Advantage Network

Aetna is expanding its network of doctors to treat Medicare Advantage customers into new territory, growing its geographic reach and physician base in 22 states, including Connecticut.
The expansion applies to more than 450,000 people in the U.S. who have Aetna’s employer-sponsored Medicare Advantage group health plans, which some businesses offer to their retirees. Aetna also has about 480,000 customers in its individually sold Medicare Advantage plans, for which there will be a network change announced in the near future, the company said.
Aetna and other health insurers have made major investments in recent years to bolster their services for Baby Boomers, who are increasingly reaching the Medicare eligibility age of 65.
The announcement Monday comes less than two weeks after one of Aetna’s major competitors, UnitedHealthcare, sent notices to Connecticut doctors saying they have been cut from the company’s Medicare Advantage network for next year. A UnitedHealthcare spokesman on Friday said the network cuts will “ultimately provide better outcomes for people in Connecticut while we and others manage through the severe government funding cuts in Medicare Advantage.”
Aetna said it is growing its network of doctors by 59 percent next year and expanding its territory from 442 counties to 703.
The expanded territory includes 87 additional counties in Texas — about one third of the state’s total. Aetna is broadening its Medicare Advantage reach by 49 counties in Indiana; 43 counties in Georgia; and 22 counties in Illinois.
The Hartford health insurer also is adding doctors to its networks in Arizona, Connecticut, Kentucky, Maine, Maryland, Michigan, Missouri, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, Tennessee, Virginia, Washington and Wisconsin.
“We’re very excited about this network expansion, which is one of our biggest ever,” Nancy Cocozza, president of Medicare Business for Aetna, said in a prepared statement. “Strengthening our network in group Medicare is important as it enables nationwide coverage for large, national employers, and it lets retirees continue receiving care from doctors they used and trusted while they were employed.”
The open enrollment period for Medicare plans starts Tuesday and ends Dec. 7. In addition to Medicare Advantage, Aetna has about 341,000 customers of its Medicare Supplement plans. Separately, the insurer also sells stand-alone prescription drug plans to Medicare-aged customers.
Medicare is federal government-funded health insurance primarily for people 65 and older. Medicare Advantage is a version of Medicare Parts A and B, hospital and medical coverage, administered by private insurers. The insurers are paid by the federal government to provide coverage. Often, private insurers compete for market share by offering additional benefits, such as discounts on dental coverage, eyewear or hearing-aid services, in addition to exercise programs or gym memberships.
UnitedHealthcare Cuts Back
Last week, the Fairfield County Medical Association said doctors were calling the organization to say they received letters notifying they had been cut from UnitedHealthcare’s network. The association says UnitedHealthcare is cutting 810 primary care physicians and 1,440 specialists. The insurer declined to say how many doctors have been cut, but UnitedHealthcare has said it will have an adequate network that includes more than 1,500 primary care physicians and more than 4,000 specialists.
UnitedHealthcare’s decision drew criticism from the Connecticut State Medical Society, American Medical Association, U.S. Sen. Richard Blumenthal, D-CT, and U.S. Rep. Joe Courtney, D-2ndDistrict. State Attorney General George Jepsen inquired on Friday about the matter, though Jepsen’s  spokeswoman said Medicare Advantage is a federally regulated matter.
Many of the questions about UnitedHealthcare’s decision to cut its network can only be answered by the federal Centers for Medicare & Medicaid Services, which manages Medicare Advantage. However, a federal government shutdown has left most of the federal Medicare employees furloughed.

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