New chronic illness plans in Tucson
There’s a new Medicare Advantage company in Tucson with a different way of managing chronic illnesses and patients under its care. CareMore Health Plan Inc, is setting up shop in Tucson with Medicare Advantage plans for people with diabetes and chronic pulmonary illnesses such as Asthma, COPD and chronic bronchitis.
CareMore’s Medicare Advantage plans are known as special needs plans focusing on people with particular illnesses. The key to these plans is “coordinated care” which closely manages treatment in an effort to prevent patients from “bouncing around from specialist to specialist and physician to physician, test to test,”according to Chief Executive Leeba Lessin. “When a patient goes into the hospital, we consider it a failure.”
According to a study by the Johns Hopkins University, CareMore patients, despite having chronic illnesses, are readmitted 27% less often than those on traditional Medicare.
Starting in January 2010, CareMore will have two Care Centers in Tucson where people who enroll in their plans can be treated for routine needs that are associated with diabetes and pulmonary disease. These include podiatry services and wound care for diabetics. The Care Centers will also have a full gym so members can participate in training for balance, strength, and general fitness. One Care Center will be located on the east side at the corner of Kolb and Speedway. The second will be in south Tucson. A third Center is planned for Green Valley.
According to a recent story in the Los Angeles Times, Medicare Advantage plans have been criticized because they cost the government on average 14% more than traditional Medicare. CareMore delivers its services for 86% of the cost of traditional Medicare. CareMore’s plans have a zero-premium and include vision and dental benefits.
Being new to Tucson, CareMore’s biggest challenge could be building its network of doctors, particularly specialists. People who enroll in their Medicare Advantage plans will use the Carondolet network of primary care physicians and hospitals (St. Josephs, St Marys, Tucson Heart Hospital). But the plan benefits may outweigh the limited network, with co-payments for a hospital stay at $100 per day for days 1-5; outpatient surgery at $75; $0 for x-rays and lab services; and $0 for cardiac rehab services. Managing members’ health is the most important benefit in these plans.
CareMore is based in California where it has 34,000 people enrolled in its Medicare Advantage plans which are HMO networks of physicians, clinics and hospitals. They specialize in chronic illness plans.
Would you recommend a Medicare Advantage Plan for a person who gets his health care from VA exclusively, while also enrolled in Medicare and a Federal Health Benefits Plan as a retiree. Thank you.
I’m not familiar with the Federal Health Benefits Plan, but I would assume that it is pretty good. Your drug plan probably has no “donut hole” – and it sounds like you can get your Rx from the VA anyway. You may be paying a premium for your FHBP, but you probably have better coverage than with Medicare Advantage plans.
State retirees with state plans, and people like yourself, may see Medicare Advantage plans with no premium and think it sound like a good deal. But it’s probably not as good as what you have. Some veterans, who can use the VA, do join a Medicare Advantage plan as a backup – in case they get sick somewhere and can’t get to a VA facility. Paying “zero premium” for a Medicare Advantage plan is fine for someone who can use the VA – but once the plans start charging premiums, I think these Vets will start dropping the plans.
But you sound like you have benefits that are much better than Medicare Advantage. You may be paying something for your coverage, but remember – You get what you pay for!
I hope this helps.