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Hot Off The Press

National Enrollment Survey Identifies Top Medicare Providers

Manasquan, N.J. -- With the Medicare crisis continuing in Washington, D.C., industry observers are still waiting to assess what the federal government will do for the nation's Medicare program.

Regardless of what the federal government will do with Medicare, growth in Medicare managed care is expected to continue, according to Melanie A. Jenkins, an analyst with The Managed Care Information Center, Wall Township, N.J.

Medicare managed care has seen substantial growth in the past few years, said Jenkins, as the Health Care Financing Administration has turned to these types of plans to control rising Medicare costs.

PacifiCare, with its 481,365 subscribers in the West, Northwest and Southwest, is the largest provider of Medicare prepaid health plans in the United States, according to an enrollment study conducted by The Managed Care Information Center.

The other four MCOs among the top five Medicare enrollers are: California-based FHP Inc., with 369,305 subscribers and seven Medicare contracts; Kaiser Foundation HP Inc., with 353,455 covered lives represented by nine contracts; Kentucky-based Humana Group Health Plan Inc., with 307,155 members represented by nine Medicare contracts; and U.S. Healthcare Inc., representing 72,192 subscribers covered by nine contracts.

The unprecedented population increases in the Southwest, Northwest and West, clearly account for the premier positions of PacifiCare, FHP, Kaiser and Humana. Fifty-seven percent, or 277,148 of PacifiCare's 481,365 subscribers reside in the Los Angeles market area; similarly, Southern California represents FHP's most strategic market, accounting for 56.3 percent, or 208,002 of its 369,305 subscribers.

Kaiser Foundation's market strongholds include both Northern and Southern California: its Oakland contract covers 103,024 lives, while its Los Angeles provider organization represents 151,222 subscribers, for a combined enrollment of 254,246, representing 71.9 percent of Kaiser's 353,455 covered lives.

Chief among Humana's regional markets is Dade County, Fla.; its enrollment in that market is 212,814 covered lives, representing 69.2 percent of Humana's nationwide 307,155 Medicare subscribers.

Those five premier healthcare providers account for 1,583,472 subscribers of the Medicare MCO population.

The second tier of the largest Medicare healthcare providers includes: Av-Med Health Plan Inc., covering 58,316 lives with five contracts; New Jersey-based Sanus Health Plan Inc., with 50,549 covered lives represented by three contracts; PCA Health Plans, with 46,735 subscribers with five contracts; CIGNA Healthcare, representing 38,411 covered lives under four contracts; and Hartford, Conn.-based Aetna Health Plans, with 31,452 subscribers represented by three contracts.

Enrollment growth patterns among these providers remain modest because their larger competitors have already achieved market penetration in particularly crucial regional markets such as Miami; Orange County, Calif.; and Seattle.

Yet the enrollment advantages of niche marketing remain appealing. For example, all five of Av-Med's contracts are in strategic Florida markets, yet Miami and Tampa account for 60.9 percent or 35,566 of Av-Med's 58,316 Florida subscribers. Similarly, 26,249 subscribers, or 68.3 percent of CIGNA Healthcare's nationwide enrollment of 38,411 belong to its Arizona provider.

For more information contact The Managed Care Information Center, 1913 Atlantic Avenue, Suite F4, Manasquan, NJ, 08736, toll-free telephone 1-888-THE-MCIC (1-888-843-6242), fax 1-888-FAX-MCIC (1-888-329-6242), e-mail or online at

For more information contact The Managed Care Information Center, 1913 Atlantic Avenue, Suite F4, Manasquan, NJ, 08736, toll-free telephone 1-888-THE-MCIC (1-888-843-6242), fax 1-888-FAX-MCIC (1-888-329-6242), e-mail or online at

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