You asked why Medicare managed care is not available in Litchfield County and whether it will be in the future.

According to Margaret Gerundo-Murkett of the CHOICES program, a state-operated program that counsels seniors on health insurance options), Medicare managed care (now called Medicare Advantage) has not been available in Litchfield County since late 2001. (Just one year earlier, the county had five Medicare HMOs from which to choose—Aetna US Healthcare, PHS (now Health Net), Anthem Blue Cross/ Blue Shield, Cigna, and MedSpan. ) The main reason that the HMOs pulled out was financial—serving Medicare recipients was not profitable enough. This phenomenon occurred throughout the country where it is reported that 2. 9 million seniors lost HMO coverage between 1999 and 2003. As of January 1, 2004, two Medicare HMOs (Oxford and Health Net) were operating in Connecticut and served only Fairfield, Hartford, and New Haven counties.

But this trend could be reversed. According to a September 15, 2004 Hartford Courant article, Health Net, which has the most exposure in Connecticut (it serves all three counties), is planning to re-enter the additional counties as of January 1, 2005, including launching some new, lower-priced plans (although nothing was definite as of December 1, 2004). In addition, the new federal Medicare Modernization Act seeks to enhance the role of Medicare HMOs, in part through increased payments to them.

One source, www. therubins. com, a website devoted exclusively to senior issues, reports that the Bush administration increased Medicare payments to HMOs and other private health plans in 2004 by 10. 6% to persuade them to enter or re-enter the Medicare market. It also quotes a Mathematica Policy Research, Inc. study that asserts that the new law gives HMOs 7% more, on average, than the per capita spending for traditional Medicare, which is provided on a fee-for-service basis. And in October 2004, the federal Centers for Medicare and Medicaid Services (the federal Medicare agency) announced that 35 managed care plans had made new applications and 22 had applied for service area expansions for the 2005 contract year.

RC: ts