Medicare: Many HMOs Experience High Rates of Beneficiary Disenrollment
(Letter Report, 04/30/98, GAO/HEHS-98-142).
Pursuant to a congressional request, GAO reviewed the feasibility of
computing health maintenance organizations' (HMO) voluntary
disenrollment rates from readily available data and analyzed the extent
to which these rates varied among plans, focusing on: (1) disenrollment
rates for all Medicare HMOs operating in 1996; (2) the disenrollment
rates of plans operating in the same markets; (3) disenrollment rates of
relatively new plans; and (4) the percentage of disenrollees who
switched to fee-for-service.
GAO noted that: (1) annual disenrollment rates exceeded 20 percent of
plans' average monthly membership at more than 40 Medicare HMOs in 1996;
(2) in one extreme case, the number of members who disenrolled from a
plan equaled 71 percent of that plan's average monthly membership; (3)
in contrast, 32 HMOs had disenrollment rates below 5 percent; (4)
comparing disenrollment rates among HMOs operating in different markets
may be misleading; (5) local market characteristics, such as the
competition between plans or beneficiaries' familiarity with managed
care, may affect plans' disenrollment rates; (6) in some cases, a rate
that is relatively high in one market might be relatively low in
another; (7) for example, in 1996 the highest disenrollment rate in the
Portland-Vancouver area (7.4 percent) was below the lowest rate in Miami
(10.1 percent); (8) among plans operating in the same market,
disenrollment rates varied substantially; (9) in many markets, the
highest disenrollment rate exceeded the lowest disenrollment rate by
more than fourfold; (10) for example, in Houston, Texas, the highest
disenrollment rate was nearly 56 percent while the lowest rate was 8
percent; (11) the data clearly indicate that competing plans vary widely
in their ability to retain members but do not reveal why; (12)
disenrollment rates that are high relative to rates at competing plans
could, for example, be caused by plans' poor marketing practices,
less-generous benefits, higher beneficiary out-of-pocket costs, or
inferior service; (13) HMOs in operation for less than 2 years tended to
have higher annual disenrollment rates than older plans; (14) however,
rapid disenrollment rates--that is, the percentage of new members who
left within 3 months of their enrollment--tended to be slightly lower
for plans that were in operation for less than 2 years; (15) many HMO
members who disenroll switch to fee-for-service Medicare; and (16) in
markets served by at least two plans, more than one-third of
disenrollees switched to fee-for-service.
--------------------------- Indexing Terms -----------------------------
REPORTNUM: HEHS-98-142
TITLE: Medicare: Many HMOs Experience High Rates of Beneficiary
Disenrollment
DATE: 04/30/98
SUBJECT: Health maintenance organizations
Statistical data
Health care programs
Beneficiaries
Comparative analysis
Managed health care
Health services administration
IDENTIFIER: Medicare Health Maintenance Organizations Program
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Cover
================================================================ COVER
Report to the Special Committee on Aging, U.S. Senate
April 1998
MEDICARE - MANY HMOS EXPERIENCE
HIGH RATES OF BENEFICIARY
DISENROLLMENT
GAO/HEHS-98-142
Medicare HMO Disenrollment Rates
(101532)
Abbreviations
=============================================================== ABBREV
BBA - Balanced Budget Act of 1997
GHP - Group Health Plan
HCFA - Health Care Financing Administration
HMO - health maintenance organization
MSA - metropolitan statistical area
NECMA - New England county metropolitan area
PMSA - primary metropolitan statistical area
Letter
=============================================================== LETTER
B-279786
April 30, 1998
The Honorable Charles E. Grassley
Chairman
The Honorable John B. Breaux
Ranking Minority Member
Special Committee on Aging
United States Senate
Most Medicare beneficiaries live in areas where they can choose to
receive health care through the program's traditional fee-for-service
arrangement or from a managed care plan that contracts with Medicare.
Many beneficiaries who wish to enroll in a health maintenance
organization (HMO) can choose from among several available plans. In
1996, we recommended several steps that the Health Care Financing
Administration (HCFA), the agency that administers the Medicare
program, could take to help beneficiaries choose a managed care plan
wisely.\1 Among other things, we recommended that HCFA publicize
HMOs' disenrollment rates. Because Medicare beneficiaries enrolled
in HMOs can easily switch to another plan or to fee-for-service,
disenrollment rates may reflect beneficiaries' relative satisfaction
with available HMOs.
In August 1997, the Congress enacted the Balanced Budget Act of 1997
(BBA) which, among other things, mandated that HCFA make comparative
information available to beneficiaries, including data on health
plans' disenrollment rates.\2 However, HCFA is not required to
publish disenrollment rates until the fall of 1999, when the agency
will conduct the first annual Medicare-sponsored health information
fair. Moreover, the BBA is unclear as to whether HCFA must publish
disenrollment rates for plans that have been in operation for less
than 2 years.
This letter responds to your request that we evaluate the feasibility
of computing HMO voluntary disenrollment rates from readily available
data and analyze the extent to which these rates vary among plans.
Specifically, we (1) calculated disenrollment rates for all Medicare
HMOs operating in 1996, the most recent data available to us at the
time of our analysis; (2) compared the disenrollment rates of plans
operating in the same markets; (3) analyzed disenrollment rates of
relatively new plans; and (4) computed the percentage of disenrollees
who switched to fee-for-service.
To conduct our study, we analyzed the data HCFA provided us that
contained the records of every beneficiary who was enrolled in a
Medicare risk-contract HMO in 1996.\3 We did not count as
disenrollees individuals who died, lost their Medicare eligibility,
or moved out of their plans' service areas. We were also careful not
to count administrative changes, such as one plan merging with
another, as disenrollment. Because disenrollment rates may be
misleading for small or very new plans, we do not report rates for
plans that have fewer than 250 members or that have operated for less
than 7 months. Appendix I describes our methodology. We did our
work between January 1997 and April 1998 in accordance with generally
accepted government auditing standards.
--------------------
\1 Medicare: HCFA Should Release Data to Aid Consumers, Prompt
Better HMO Performance (GAO/HEHS-97-23, Oct. 22, 1996).
\2 P.L. 105-33.
\3 Approximately 87 percent of the beneficiaries enrolled in Medicare
managed care in December 1996 were in "risk contract" HMOs, so-called
because the plan assumes the financial risk of providing care for the
fixed per-beneficiary fee that Medicare pays.
RESULTS IN BRIEF
------------------------------------------------------------ Letter :1
Annual disenrollment rates exceeded 20 percent of plans' average
monthly membership at more than 40 Medicare HMOs in 1996. In one
extreme case, the number of members who disenrolled from a plan
equaled 71 percent of that plan's average monthly membership. In
contrast, 32 HMOs had disenrollment rates below 5 percent. Comparing
disenrollment rates among HMOs operating in different markets may be
misleading. Local market characteristics, such as the competition
between plans or beneficiaries' familiarity with managed care, may
affect plans' disenrollment rates. In some cases, a rate that is
relatively high in one market might be relatively low in another.
For example, in 1996 the highest disenrollment rate in the
Portland-Vancouver area (7.4 percent) was below the lowest rate in
Miami (10.1 percent).
Among plans operating in the same market, disenrollment rates varied
substantially. In many markets, the highest disenrollment rate
exceeded the lowest disenrollment rate by more than fourfold. For
example, in Houston, Texas, the highest disenrollment rate was nearly
56 percent while the lowest rate was 8 percent. The data clearly
indicate that competing plans vary widely in their ability to retain
members but do not reveal why. Disenrollment rates that are high
relative to rates at competing plans could, for example, be caused by
plans' poor marketing practices, less-generous benefits, higher
beneficiary out-of-pocket costs, or inferior service.
HMOs in operation for less than 2 years tended to have higher annual
disenrollment rates than older plans. However, rapid disenrollment
rates--that is, the percentage of new members who left within 3
months of their enrollment--tended to be slightly lower for plans
that were in operation for less than 2 years. Many HMO members who
disenroll switch to fee-for-service Medicare. In markets served by
at least two plans, more than one-third of disenrollees switched to
fee-for-service.
BACKGROUND
------------------------------------------------------------ Letter :2
The number of Medicare beneficiaries enrolled in risk-contract HMOs
more than doubled over the past 3 years, from 2.3 million in December
1994 to 5.2 million in December 1997. The number of Medicare risk
HMOs increased from 154 to 307 over the same time period. The growth
in Medicare managed care enrollees and plans is expected to continue,
fueled in part by the BBA, which provided for new types of Medicare
managed care plans and increased plan payments in many areas that
previously lacked a fee-for-service alternative.
Recognizing beneficiaries' need for comparative information on
available choices, the Congress included several consumer information
provisions in the BBA. To help beneficiaries judge quality and
performance, HCFA is required to publicize plans' disenrollment
rates, enrollee satisfaction measures, health outcome measures, and
record of compliance with certain requirements. HCFA is also
required to provide beneficiaries with comparative information on
plans' benefits, premiums, service areas, and supplemental benefits.
HCFA is working to meet these requirements and recently launched an
Internet Web page containing data on HMOs' benefits and premiums.
As we reported in 1996, Medicare beneficiaries voluntarily disenroll
from their HMOs for a variety of reasons.\4 High disenrollment rates
may result from the poor education of enrollees during an HMO's
marketing and enrollment process: enrollees may be ill informed
about HMO provider-choice restrictions in general or the operation of
their particular plan. High disenrollment rates may also result from
beneficiaries' dissatisfaction with access or quality of care.
Alternatively, high disenrollments may reflect a different aspect of
relative satisfaction--beneficiaries' awareness that competing HMOs
are offering better benefits or lower premiums. A 1992 study
reported that 48 percent of disenrollees from Medicare HMOs cited
dissatisfaction as their reason for leaving, 23 percent cited a
misunderstanding of HMO services or procedures, and 29 percent cited
some other reason.\5 While rates alone cannot distinguish among
possible causes for disenrollment, a relatively high disenrollment
rate should caution beneficiaries to investigate further before
enrolling.
Currently, Medicare beneficiaries enrolled in an HMO may decide each
month to switch to another available managed care plan or to
fee-for-service. However, BBA provisions will curtail this option
beginning in 2002.\6
--------------------
\4 GAO/HEHS-97-23, Oct. 22, 1996.
\5 Frank W. Porell and others, Factors Associated with Disenrollment
from Medicare HMOs: Findings from a Survey of Disenrollees (Boston:
Health Policy Research Consortium of Brandeis University, 1992).
\6 Every November beginning in 2001, beneficiaries will decide how
they will receive their Medicare benefits during the following year
by selecting traditional fee-for-service, a managed care plan, or
some other available option specified in the BBA. With some
exceptions, beneficiaries are expected to remain in the health plan
they select for the entire calendar year. However, beneficiaries
will be able to make one switch during the first 6 months of 2002.
In 2003 and beyond, beneficiaries will be able to make one switch
during the first 3 months of each year. These switches are in
addition to those made during the planned annual open season.
DISENROLLMENT RATES EXCEED 20
PERCENT AT MANY MEDICARE HMOS
------------------------------------------------------------ Letter :3
Many Medicare HMOs across the nation experience high rates of
beneficiary disenrollment. In 1996, annual disenrollment equaled 71
percent of average plan membership at PCA Health Plans of Florida
(PCA-Jacksonville, Florida)--the highest HMO contract service-area
disenrollment rate in the nation that year.\7 Nearly 1 of 6
beneficiaries who joined PCA left the plan within 3 months. Of the
194 HMOs that operated a Medicare risk contract for at least 7 months
in 1996 and had at least 250 members, about one-fifth (41) had annual
disenrollment rates in excess of 20 percent. Rapid
disenrollment--that is, the percentage of new members who left their
plans within the first 3 months--was 10 percent or higher at 21 HMOs.
Despite sometimes sizable membership losses, most Medicare risk HMOs
(90 percent) attracted enough new members to increase in size during
1996.
In contrast, a number of HMOs had low disenrollment rates. Annual
voluntary disenrollment was less than 5 percent of average membership
at 31 HMOs in 1996. Rapid disenrollment rates were below 3 percent
at 65 HMOs. (See tables 1 and 2.) Some of the national variation in
disenrollment rates may be the result of differences among markets.
For example, disenrollment rates may tend to be high in areas where
competition is strong or where many beneficiaries are unaccustomed to
managed care. In some cases, a rate considered relatively high in
one market may be considered low in another. For example, in 1996
the highest annual disenrollment rate in the Portland-Vancouver area
(7.4 percent) was less than the lowest rate in Miami (10.1 percent).
Table 1
Distribution of HMOs by Annual
Disenrollment Rate, 1996
Annual disenrollment rate Number of HMOs
---------------------------- ----------------------------
Greater than 30% 20
21% -30% 21
11% -20% 60
5% -10% 62
Less than 5% 31
==========================================================
Total HMOs\a 194
----------------------------------------------------------
\a Excludes HMOs that operated less than 7 months in 1996 or that had
an average monthly membership below 250.
Source: GAO analysis of HCFA data.
Table 2
Distribution of HMOs by Rapid
Disenrollment Rate, 1996
Number
of
Rapid disenrollment rate HMOs
-------------------------------------------------------------- ------
Greater than 15% 4
10% -15% 17
3% -9% 108
Less than 3% 65
======================================================================
Total HMOs\a 194
----------------------------------------------------------------------
\a Excludes HMOs that operated less than 7 months in 1996 or that had
an average monthly membership below 250.
Source: GAO analysis of HCFA data.
--------------------
\7 Some HMOs had higher disenrollment rates in portions of their
service areas.
AMONG COMPETING HMOS,
DISENROLLMENT RATES VARY WIDELY
------------------------------------------------------------ Letter :4
Among plans competing in the same market, disenrollment rates often
vary widely.\8 For example, in Tampa, Florida, PCA had an annual
disenrollment rate of 59 percent in 1996--much higher than the
10-percent disenrollment rate at Prudential Health Care Plan (see
fig. 1). Nearly 12 percent of all new PCA members left the plan
within the first 3 months of enrolling, while only 3 percent of
Prudential's new enrollees left that quickly. The differences in the
disenrollment rates at the two plans cannot be explained by
differences in plan size, experience, or market conditions. Both PCA
and Prudential had been operating Medicare risk contracts for about 2
years and had approximately the same number of enrollees (7,600 and
9,200, respectively) in the Tampa market. Moreover, the wide
variation in HMOs' disenrollment rates is not unique to the Tampa
market. In 55 percent of the markets served by four or more HMOs,
the highest disenrollment rate was greater than four times the lowest
rate in that market. For example, disenrollment rates ranged from 8
percent to 56 percent in Houston, from 3 percent to 34 percent in Los
Angeles, and from 8 percent to 38 percent in Washington, D.C.
Figure 1: Annual Rate of
Voluntary Disenrollment at HMOs
in the Tampa Market, 1996, as a
Percentage of Average Number of
Plan Members
(See figure in printed
edition.)
Source: Group Health Plan File, Feb. 1997.
--------------------
\8 An HMO's service area may extend over a wide geographic area and
encompass more than one market area. To facilitate fair comparisons
among competing plans, we defined market areas and computed the
annual disenrollment each plan experienced within those market areas.
Because of data limitations, we calculated rapid disenrollment rates
over plans' entire contract service areas. In appendix II, we group
plans by market and present their market area annual disenrollment
rates. In appendix II, we also list disenrollment rates for each
plan's service area. For a particular plan, market area and service
area disenrollment rates can differ because disenrollment is not
evenly distributed over the plan's service area.
NEW MEMBER DISENROLLMENT RATES
ARE SLIGHTLY LOWER IN NEW HMOS
------------------------------------------------------------ Letter :5
New plans tend to have higher annual disenrollment rates than more
established plans. This may be because older plans have learned
through experience how to better satisfy their Medicare members.
Alternatively, older plans may have a larger proportion of members
who are accustomed to managed care or who are reluctant to make any
health care changes. Thus, lower disenrollment rates at established
HMOs may partly reflect the characteristics of their members. This
latter explanation is supported by the data on rapid disenrollment
rates. The disenrollment rate of new enrollees varies substantially
among HMOs but tends to be slightly lower at HMOs with less than 2
years of experience.
Because of the rapid growth of Medicare managed care, many plans are
relatively new. In 1996, 41 percent of Medicare HMOs had operated
for less than 2 years and 15 percent had operated for less than 7
months (see fig. 2). According to HCFA officials, the BBA requires
the agency to disclose disenrollment rates only for plans in
operation for 2 or more years. However, the law does not prohibit
HCFA from publishing rates of plans with less operating experience.
We calculated disenrollment rates for HMOs with as little as 7 months
of experience and a minimum membership average of 250 members per
month. Appendix II lists HMOs' years of experience and average
monthly membership because this information may be important to
beneficiaries considering a particular managed care plan. (Fig. 3
shows the distribution of HMOs by average monthly membership.)
Figure 2: Distribution of
Medicare Risk HMOs by Years in
Operation as of December 31,
1996
(See figure in printed
edition.)
Note: Does not add to 100 percent because of rounding.
Source: HCFA Group Health Plan System.
Figure 3: Distribution of
Medicare Risk HMOs by Size of
Plan, 1996
(See figure in printed
edition.)
Source: HCFA Group Health Plan System.
MANY HMO DISENROLLEES SWITCH TO
FEE-FOR-SERVICE INSTEAD OF
ANOTHER AVAILABLE HMO
------------------------------------------------------------ Letter :6
Many beneficiaries who disenroll from a managed care plan switch to
traditional fee-for-service Medicare. In areas served by only one
plan, HMO disenrollees have no other option. However, many
disenrollees could join a different managed care plan but switch to
fee-for-service instead. In the 92 urban market areas served by two
or more plans, more than one-third (36 percent) of HMO disenrollees
switched to fee-for-service. Even in markets served by multiple
plans, the proportion of beneficiaries changing to fee-for-service
can be high. For example, in Miami--a market served by nine
HMOs--more than 46 percent of beneficiaries who disenrolled from
United HealthCare of Florida during 1996 switched to fee-for-service
rather than join another HMO. (The percentage of each plan's
disenrollees who switched to fee-for-service is shown in app. II.)
AGENCY COMMENTS AND OUR
EVALUATION
------------------------------------------------------------ Letter :7
In commenting on a draft of this report, HCFA officials agreed that
the variation of HMO disenrollment rates among plans operating in the
same markets is useful information. HCFA is interested in making
disenrollment information more meaningful by developing a
disenrollment survey to determine why beneficiaries leave HMOs. In
addition, HCFA officials said they are interested in factors that
might explain the variation in rates, such as quality of and access
to care, NCQA accreditation, incidents of fraud or abuse, and the
extent of the provider network. However, at the time the officials
made these comments, HCFA had not decided on its methodology for
calculating disenrollment rates or the minimum size and age of plans
it would report rates on. HCFA officials said they will address
these and many other methodological issues before HCFA publishes
disenrollment rates--currently scheduled for the fall of 1999.
---------------------------------------------------------- Letter :7.1
As agreed with your office, unless you publicly announce its contents
earlier, we plan no further distribution of this report until 30 days
after its issue date. We will then send copies to appropriate
congressional committees, the Secretary of Health and Human Services,
and others who are interested.
If you have any questions about this report, please contact me at
(202) 512-7114 or James C. Cosgrove, Assistant Director, at (202)
512-7029. Other contributors include George M. Duncan, Beverly
Ross, and Wayne Turowski.
Sincerely yours,
William J. Scanlon
Director, Health Financing
and Systems Issues
METHODOLOGY
=========================================================== Appendix I
We used Health Care Financing Administration (HCFA) data to compute
beneficiary disenrollment rates for each health maintenance
organization (HMO) that operated a Medicare risk contract during
1996. To measure voluntary disenrollment, we excluded disenrollments
caused by death, loss of Medicare eligibility, or moves outside
plans' service areas. We also did not count as voluntary
disenrollment administrative changes such as one plan merging with
another.
DATA SOURCES
--------------------------------------------------------- Appendix I:1
We used the February 1997 Group Health Plan (GHP) file to identify
beneficiaries who were enrolled in a risk plan during any part of
1996. We then merged enrollees' GHP data with additional data
contained in the enrollment database. From these data, we calculated
monthly new enrollments, new disenrollments, and membership at all
risk plans operating in 1996.
We used HCFA's October 1996 Service Area File to determine the
counties and parts of counties each plan served. We used this
information to group HMOs in market areas defined by metropolitan
statistical areas (MSA) or New England county metropolitan areas
(NECMA) in the six New England states. To calculate plans' market
area disenrollment rates, we analyzed disenrollment within the MSA or
NECMA in comparison with the plans' membership within the same area.
RATE CALCULATIONS
--------------------------------------------------------- Appendix I:2
To compute total voluntary disenrollment rates, we first divided the
sum of 1996 voluntary disenrollments by the number of member-months
(the sum of total monthly enrollments for each month in 1996), to
compute a rate of disenrollment per member-month. We then multiplied
this result by 12 to obtain the rate per member-year (this rate could
represent a single member who stayed in the plan for all 12 months or
12 members who each stayed in the plan for only 1 month). Finally,
we multiplied the result by 100 to express disenrollment per 100
member-years. Conceptually, this disenrollment rate compares a
plan's total voluntary disenrollment with its average monthly
membership. For example, a plan that had voluntary disenrollments of
1,000 members during 1996 and averaged 5,000 members per month would
have a total voluntary disenrollment rate of 20 percent. This
methodology is conceptually similar to, but computationally somewhat
different from, the methodology in our October 1996 report.\9
We analyzed whether HMO disenrollees switched to a different managed
care plan or to fee-for-service. For each HMO, we then calculated
the proportion of disenrollees who switched to fee-for-service.
We computed each plan's rapid disenrollment rate by summing its 1996
disenrollments that occurred within 3 months of enrollment and
divided that sum by total new enrollments from November 1995 to
December 1996.
--------------------
\9 GAO/HEHS-97-23, Oct. 22, 1996.
MEDICARE RISK HMO VOLUNTARY
DISENROLLMENT RATES, 1996
========================================================== Appendix II
The four tables in this appendix detail the voluntary disenrollment
rates, by Bureau of the Census major geographic region--Northeast,
South, Midwest, and West--for Medicare risk HMOs.
EXPLANATION OF COLUMN HEADINGS
-------------------------------------------------------- Appendix II:1
Metropolitan area: U.S. Bureau of the Census statistical area:
metropolitan statistical areas (MSA), primary metropolitan
statistical areas (PMSA), or New England county metropolitan areas
(NECMA).
HCFA contract #: Plan contract number assigned by HCFA.
Plan name: Name of risk plan as reported by HCFA.
Plan age: Number of years and months between the plan's first
enrollment of beneficiaries and December 31, 1996.
Average monthly membership: Average monthly membership in 1996.
Vol. rate: Voluntary annual disenrollment rate.
FFS as % of vol.: Percentage of disenrollees who switched to
Medicare fee-for-service.
Rapid rate: Percentage of new members who disenrolled within 3
months of enrolling.
SORT ORDER
-------------------------------------------------------- Appendix II:2
Plans are listed by census region and metropolitan area. In
metropolitan areas with two or more plans, plans are listed in
descending order of voluntary disenrollment rate.
Table II.1
Voluntary Disenrollment Rates for
Medicare Risk HMOs, Northeast Region
Within metropolitan Overall contract
areas statistics
-------------------- --------------------------
Plan
age Average FFS Average FFS
HCFA yrs. monthly as % monthly as % Rapi
contrac / enrollme Vol. of enrollme Vol. of d
t # Plan name mos. nt rate vol. nt rate vol. rate
------- ------------------------ ---- -------- ---- ---- -------- ---- ---- ----
Albany-Schenectady-Troy, NY MSA
-----------------------------------------------------------------------------------------
H3361 WellCare of New York, 1/3 441 7.9 68.6 2,878 11.7 57.9 2.5
Inc.
H3368 Capital Area Community 0/3 1,460 \a \a 1,479 \a \a \a
HP
Allentown-Bethlehem-Easton, PA MSA
-----------------------------------------------------------------------------------------
H3962 Keystone Health Plan 0/7 447 19.9 82.7 1,863 19.5 82.1 4.3
Central, Inc.
H3931 U.S. Health Care Systems 11/ 5,408 6.4 85.0 63,494 5.3 62.1 3.3
of PA 2
H3956 Aetna Health Plans of 2/6 519 5.8 56.7 9,065 16.6 39.0 4.2
Central/East PA
H3954 Geisinger Health Plan 2/9 99 \a \a 15,028 3.0 73.6 1.8
Altoona, PA MSA
-----------------------------------------------------------------------------------------
H3957 Keystone Health Plan 1/8 1,047 \a \a 48,663 5.2 83.0 2.1
West
H3954 Geisinger Health Plan 2/9 184 \a \a 15,028 3.0 73.6 1.8
Atlantic-Cape May, NJ PMSA
-----------------------------------------------------------------------------------------
H3152 HMO of New Jersey, Inc. 3/2 2,584 12.0 54.0 32,261 11.0 55.4 5.1
H3156 Amerihealth HMO, Inc. 0/ 395 9.9 71.8 2,056 9.1 66.8 2.7
11
H3157 Aetna Health Plans of 0/ 924 7.3 58.1 11,688 9.1 51.2 1.9
New Jersey 11
H3154 Medigroup, Inc. 0/ 213 \a \a 3,994 22.4 75.9 6.9
10
H3155 First Option Health Plan 0/ 139 \a \a 2,996 11.2 84.4 3.7
of NJ, Inc. 11
H3107 Oxford Health Plans (New 4/ 16 \a \a 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3158 HIP of New Jersey 1/0 27 \a \a 4,513 6.8 41.2 2.1
Barnstable-Yarmouth, MA NECMA
-----------------------------------------------------------------------------------------
H2255 U.S. Healthcare, Inc. 2/6 1,055 10.6 92.0 10,143 12.6 57.6 4.4
MASS
H2258 Pilgrim Health Care, 1/ 163 \a \a 8,065 6.8 45.8 2.0
Inc. 11
H2261 HMO BLUE, Inc. 0/ 101 \a \a 9,759 5.2 44.4 2.0
10
Bergen-Passaic, NJ PMSA
-----------------------------------------------------------------------------------------
H3154 Medigroup, Inc. 0/ 609 22.1 72.3 3,994 22.4 75.9 6.9
10
H3152 HMO of New Jersey, Inc. 3/2 1,057 15.3 71.6 32,261 11.0 55.4 5.1
H3155 First Option Health Plan 0/ 760 12.6 92.0 2,996 11.2 84.4 3.7
of NJ, Inc. 11
H3158 HIP of New Jersey 1/0 635 5.5 42.9 4,513 6.8 41.2 2.1
H3107 Oxford Health Plans (New 4/ 5,425 4.7 67.6 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3157 Aetna Health Plans of 0/ 216 \a \a 11,688 9.1 51.2 1.9
New Jersey 11
Binghamton, NY MSA
-----------------------------------------------------------------------------------------
H3371 Community Health Plan 0/2 158 \a \a 159 \a \a \a
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH NECMA
-----------------------------------------------------------------------------------------
H2255 U.S. Healthcare, Inc. 2/6 8,274 12.4 53.6 10,143 12.6 57.6 4.4
MASS
H3049 U.S. HealthCare of New 2/6 848 12.0 96.1 967 13.3 91.5 6.4
Hampshire, Inc.
H4102 United Health Plans of 8/ 3,062 9.8 30.1 14,317 4.8 49.4 2.0
New England 11
H2261 HMO BLUE, Inc. 0/ 4,805 7.0 37.3 9,759 5.2 44.4 2.0
10
H2258 Pilgrim Health Care, 1/ 7,707 6.5 44.6 8,065 6.8 45.8 2.0
Inc. 11
H2256 Tufts Associated HMO, 2/3 31,276 4.7 59.8 32,787 4.9 61.0 2.1
Inc.
H2206 Harvard Community Health 11/ 20,207 2.6 54.6 23,881 2.9 53.2 1.2
Plan 6
H9001 Fallon Community Health 11/ 26,105 1.3 50.3 27,811 1.5 49.9 0.8
Plan, Inc. 9
H2204 Harvard Community Health 11/ 193 \a \a 217 \a \a \a
Plan of N.E. 4
H4153 United Health Plans of 0/3 40 \a \a 174 \a \a \a
New England
Buffalo-Niagara Falls, NY MSA
-----------------------------------------------------------------------------------------
H3362 Independent Health Assn. 0/8 1,548 8.8 93.4 1,608 9.4 94.1 2.8
H3351 Health Care Plan, Inc. 7/0 9,343 4.4 63.9 9,565 4.4 63.3 3.4
Dutchess County, NY PMSA
-----------------------------------------------------------------------------------------
H3361 WellCare of New York, 1/3 419 23.1 34.0 2,878 11.7 57.9 2.5
Inc.
H3366 Physicians Health SVC of 0/ 1 \a \a 679 16.8 71.6 3.7
NY, Inc. 10
H3312 U.S. HealthCare, Inc. 10/ 110 \a \a 15,096 12.9 57.3 5.8
1
H3373 Capital Area Community 0/2 147 \a \a 214 \a \a \a
HP
Erie, PA MSA
-----------------------------------------------------------------------------------------
H3957 Keystone Health Plan 1/8 1,800 \a \a 48,663 5.2 83.0 2.1
West
Harrisburg-Lebanon-Carlisle, PA MSA
-----------------------------------------------------------------------------------------
H3962 Keystone Health Plan 0/7 429 25.2 79.4 1,863 19.5 82.1 4.3
Central, Inc.
H3931 U.S. Health Care Systems 11/ 1,167 12.3 75.5 63,494 5.3 62.1 3.3
of PA 2
H3956 Aetna Health Plans of 2/6 3,120 8.4 79.8 9,065 16.6 39.0 4.2
Central/East PA
H3960 HealthAmerica of Central 0/5 108 \a \a 153 \a \a \a
PA
Hartford, CT NECMA
-----------------------------------------------------------------------------------------
H0751 U.S. Healthcare, Inc. 2/6 3,123 10.8 93.8 6,712 12.0 86.1 4.4
H0752 Oxford Healthplan 0/ 126 \a \a 1,390 13.7 50.3 4.2
10
Jamestown, NY MSA
-----------------------------------------------------------------------------------------
H3362 Independent Health Assn. 0/8 45 \a \a 1,608 9.4 94.1 2.8
H3351 Health Care Plan, Inc. 7/0 33 \a \a 9,565 4.4 63.3 3.4
Jersey City, NJ PMSA
-----------------------------------------------------------------------------------------
H3152 HMO of New Jersey, Inc. 3/2 450 23.4 72.4 32,261 11.0 55.4 5.1
H3107 Oxford Health Plans (New 4/ 670 12.1 80.2 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3154 Medigroup, Inc. 0/ 241 \a \a 3,994 22.4 75.9 6.9
10
H3155 First Option Health Plan 0/ 46 \a \a 2,996 11.2 84.4 3.7
of NJ, Inc. 11
H3157 Aetna Health Plans of 0/ 40 \a \a 11,688 9.1 51.2 1.9
New Jersey 11
H3158 HIP of New Jersey 1/0 218 \a \a 4,513 6.8 41.2 2.1
Johnstown, PA MSA
-----------------------------------------------------------------------------------------
H3957 Keystone Health Plan 1/8 1,498 10.9 98.5 48,663 5.2 83.0 2.1
West
H3954 Geisinger Health Plan 2/9 28 \a \a 15,028 3.0 73.6 1.8
Lancaster, PA MSA
-----------------------------------------------------------------------------------------
H3956 Aetna Health Plans of 2/6 427 14.8 79.4 9,065 16.6 39.0 4.2
Central/East PA
H3931 U.S. Health Care Systems 11/ 1,743 5.9 89.2 63,494 5.3 62.1 3.3
of PA 2
H3960 HealthAmerica of Central 0/5 30 \a \a 153 \a \a \a
PA
Middlesex-Somerset-Hunterdon, NJ PMSA
-----------------------------------------------------------------------------------------
H3154 Medigroup, Inc. 0/ 386 21.5 76.8 3,994 22.4 75.9 6.9
10
H3157 Aetna Health Plans of 0/ 2,032 11.2 46.9 11,688 9.1 51.2 1.9
New Jersey 11
H3152 HMO of New Jersey, Inc. 3/2 2,507 10.4 72.1 32,261 11.0 55.4 5.1
H3107 Oxford Health Plans (New 4/ 342 8.2 71.4 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3158 HIP of New Jersey 1/0 1,634 4.4 63.9 4,513 6.8 41.2 2.1
H3155 First Option Health Plan 0/ 214 \a \a 2,996 11.2 84.4 3.7
of NJ, Inc. 11
Monmouth-Ocean, NJ PMSA
-----------------------------------------------------------------------------------------
H3154 Medigroup, Inc. 0/ 982 21.1 76.9 3,994 22.4 75.9 6.9
10
H3107 Oxford Health Plans (New 4/ 319 20.3 60.0 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3152 HMO of New Jersey, Inc. 3/2 4,779 13.5 60.0 32,261 11.0 55.4 5.1
H3158 HIP of New Jersey 1/0 399 13.0 25.0 4,513 6.8 41.2 2.1
H3157 Aetna Health Plans of 0/ 1,020 12.7 47.9 11,688 9.1 51.2 1.9
New Jersey 11
H3155 First Option Health Plan 0/ 1,423 11.0 78.5 2,996 11.2 84.4 3.7
of NJ, Inc. 11
H3156 Amerihealth HMO, Inc. 0/ 65 \a \a 2,056 9.1 66.8 2.7
11
Nassau-Suffolk, NY PMSA
-----------------------------------------------------------------------------------------
H3354 NYL Care 4/9 9,227 18.3 20.5 12,794 18.0 24.8 6.8
H3359 Managed Health, Inc. 2/6 560 10.9 24.6 1,344 10.3 24.5 3.3
H3312 U.S. HealthCare, Inc. 10/ 4,852 9.3 47.5 15,096 12.9 57.3 5.8
1
H3360 ChoiceCare Long Island, 1/4 4,192 6.8 55.9 4,449 7.9 57.3 2.2
Inc.
H3307 Oxford Health Plans (New 5/0 25,669 5.8 48.2 88,850 7.0 59.8 3.6
York), Inc.
H3330 HIP of Greater New York 9/5 12,285 4.2 41.6 51,339 5.2 47.6 4.2
H3366 Physicians Health SVC of 0/ 136 \a \a 679 16.8 71.6 3.7
NY, Inc. 10
H3365 Cigna HealthCare of New 0/3 46 \a \a 259 \a \a \a
York
H3370 Empire Blue Cross Blue 0/4 16 \a \a 904 \a \a \a
Shield
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT NECMA
-----------------------------------------------------------------------------------------
H0751 U.S. Healthcare, Inc. 2/6 3,185 12.0 83.6 6,712 12.0 86.1 4.4
H0752 Oxford Healthplan 0/ 1,197 8.3 73.5 1,390 13.7 50.3 4.2
10
New London-Norwich, CT NECMA
-----------------------------------------------------------------------------------------
H0752 Oxford Healthplan 0/ 44 \a \a 1,390 13.7 50.3 4.2
10
H0751 U.S. Healthcare, Inc. 2/6 130 \a \a 6,712 12.0 86.1 4.4
New York, NY PMSA
-----------------------------------------------------------------------------------------
H3366 Physicians Health SVC of 0/ 553 16.9 73.1 679 16.8 71.6 3.7
NY, Inc. 10
H3354 NYL Care 4/9 3,456 16.5 34.9 12,794 18.0 24.8 6.8
H3312 U.S. HealthCare, Inc. 10/ 9,018 13.4 60.9 15,096 12.9 57.3 5.8
1
H3359 Managed Health, Inc. 2/6 751 9.0 25.0 1,344 10.3 24.5 3.3
H3307 Oxford Health Plans (New 5/0 62,281 6.3 72.9 88,850 7.0 59.8 3.6
York), Inc.
H3363 Kaiser Foundation HP of 1/1 1,015 4.7 31.3 1,086 4.8 28.8 1.7
New York
H3330 HIP of Greater New York 9/5 38,126 4.1 57.2 51,339 5.2 47.6 4.2
H3361 WellCare of New York, 1/3 169 \a \a 2,878 11.7 57.9 2.5
Inc.
H3360 ChoiceCare Long Island, 1/4 244 \a \a 4,449 7.9 57.3 2.2
Inc.
H3365 Cigna HealthCare of New 0/3 212 \a \a 259 \a \a \a
York
H3370 Empire Blue Cross Blue 0/4 880 \a \a 904 \a \a \a
Shield
Newark, NJ PMSA
-----------------------------------------------------------------------------------------
H3154 Medigroup, Inc. 0/ 956 24.5 84.1 3,994 22.4 75.9 6.9
10
H3152 HMO of New Jersey, Inc. 3/2 2,293 12.8 75.5 32,261 11.0 55.4 5.1
H3155 First Option Health Plan 0/ 297 9.5 96.2 2,996 11.2 84.4 3.7
of NJ, Inc. 11
H3157 Aetna Health Plans of 0/ 721 9.2 39.3 11,688 9.1 51.2 1.9
New Jersey 11
H3107 Oxford Health Plans (New 4/ 2,298 9.2 75.5 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3158 HIP of New Jersey 1/0 193 \a \a 4,513 6.8 41.2 2.1
Newburgh, NY-PA PMSA
-----------------------------------------------------------------------------------------
H3361 WellCare of New York, 1/3 301 13.0 53.8 2,878 11.7 57.9 2.5
Inc.
H3312 U.S. HealthCare, Inc. 10/ 824 10.1 81.9 15,096 12.9 57.3 5.8
1
H3366 Physicians Health SVC of 0/ 1 \a \a 679 16.8 71.6 3.7
NY, Inc. 10
H3307 Oxford Health Plans (New 5/0 159 \a \a 88,850 7.0 59.8 3.6
York), Inc.
H3953 HMO of Northeastern PA, 2/6 12 \a \a 11,504 6.3 84.8 1.9
Inc.
Philadelphia, PA-NJ PMSA
-----------------------------------------------------------------------------------------
H3107 Oxford Health Plans (New 4/ 251 23.9 47.3 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3154 Medigroup, Inc. 0/ 466 18.5 59.7 3,994 22.4 75.9 6.9
10
H3949 Greater Atlantic Health 4/7 13,077 12.0 34.7 13,195 12.3 36.2 7.9
Service, Inc.
H3157 Aetna Health Plans of 0/ 2,718 10.2 37.3 11,688 9.1 51.2 1.9
New Jersey 11
H3956 Aetna Health Plans of 2/6 1,962 10.0 59.7 9,065 16.6 39.0 4.2
Central/East PA
H3152 HMO of New Jersey, Inc. 3/2 14,901 8.7 46.4 32,261 11.0 55.4 5.1
H3156 Amerihealth HMO, Inc. 0/ 1,309 8.0 61.9 2,056 9.1 66.8 2.7
11
H3158 HIP of New Jersey 1/0 1,261 6.5 23.2 4,513 6.8 41.2 2.1
H3952 Keystone Health Plan 3/ 67,789 4.7 77.4 68,163 4.9 76.9 2.6
East, Inc. 10
H3931 U.S. Health Care Systems 11/ 51,048 4.2 58.0 63,494 5.3 62.1 3.3
of PA 2
H3155 First Option Health Plan 0/ 99 \a \a 2,996 11.2 84.4 3.7
of NJ, Inc. 11
Pittsburgh, PA MSA
-----------------------------------------------------------------------------------------
H3951 U.S. Health Care Systems 5/5 21,009 8.0 44.7 22,537 8.5 46.3 4.4
of PA
H3957 Keystone Health Plan 1/8 42,661 4.7 80.1 48,663 5.2 83.0 2.1
West
H3959 HealthAmerica 0/ 3,519 2.3 52.5 3,613 2.5 53.7 0.7
Pennsylvania, Inc. 10
Pittsfield, MA NECMA
-----------------------------------------------------------------------------------------
H2261 HMO BLUE, Inc. 0/ 8 \a \a 9,759 5.2 44.4 2.0
10
Providence-Warwick-Pawtucket, RI NECMA
-----------------------------------------------------------------------------------------
H4149 Harvard Community Health 1/5 3,980 4.4 70.5 4,002 4.7 69.3 3.8
Plan of N.E.
H4102 United Health Plans of 8/ 10,679 3.2 69.2 14,317 4.8 49.4 2.0
New England 11
Reading, PA MSA
-----------------------------------------------------------------------------------------
H3956 Aetna Health Plans of 2/6 2,040 21.7 23.7 9,065 16.6 39.0 4.2
Central/East PA
H3962 Keystone Health Plan 0/7 448 9.9 84.6 1,863 19.5 82.1 4.3
Central, Inc.
H3931 U.S. Health Care Systems 11/ 2,311 9.0 63.9 63,494 5.3 62.1 3.3
of PA 2
H3960 HealthAmerica of Central 0/5 6 \a \a 153 \a \a \a
PA
Rochester, NY MSA
-----------------------------------------------------------------------------------------
H3305 Rochester Area HMO, Inc. 11/ 14,908 3.2 45.8 15,118 3.2 46.5 0.7
1
H3362 Independent Health 0/8 8 \a \a 1,608 9.4 94.1 2.8
Assoc.
H3351 Health Care Plan, Inc. 7/0 27 \a \a 9,565 4.4 63.3 3.4
Scranton--Wilkes-Barre--Hazleton, PA MSA
-----------------------------------------------------------------------------------------
H3953 HMO of Northeastern PA, 2/6 7,256 5.2 74.1 11,504 6.3 84.8 1.9
Inc.
H3954 Geisinger Health Plan 2/9 4,658 2.7 66.1 15,028 3.0 73.6 1.8
H3960 HealthAmerica of Central 0/5 36 \a \a 153 \a \a \a
PA
Sharon, PA MSA
-----------------------------------------------------------------------------------------
H3957 Keystone Health Plan 1/8 762 11.6 100. 48,663 5.2 83.0 2.1
West 0
Springfield, MA NECMA
-----------------------------------------------------------------------------------------
H2255 U.S. Healthcare, Inc. 2/6 588 15.0 60.2 10,143 12.6 57.6 4.4
MASS
H2256 Tufts Associated HMO, 2/3 1,350 6.4 76.7 32,787 4.9 61.0 2.1
Inc.
H2261 HMO BLUE, Inc. 0/ 4,732 2.8 47.7 9,759 5.2 44.4 2.0
10
H9001 Fallon Community Health 11/ 70 \a \a 27,811 1.5 49.9 0.8
Plan, Inc. 9
State College, PA MSA
-----------------------------------------------------------------------------------------
H3954 Geisinger Health Plan 2/9 1,912 2.2 69.8 15,028 3.0 73.6 1.8
H3961 HealthAmerica of Central 0/3 13 \a \a 13 \a \a \a
PA
Trenton, NJ PMSA
-----------------------------------------------------------------------------------------
H3152 HMO of New Jersey, Inc. 3/2 2,125 7.1 60.9 32,261 11.0 55.4 5.1
H3157 Aetna Health Plans of 0/ 1,214 4.0 56.8 11,688 9.1 51.2 1.9
New Jersey 11
H3154 Medigroup, Inc. 0/ 126 \a \a 3,994 22.4 75.9 6.9
10
H3155 First Option Health Plan 0/ 9 \a \a 2,996 11.2 84.4 3.7
of NJ, Inc. 11
H3156 Amerihealth HMO, Inc. 0/ 90 \a \a 2,056 9.1 66.8 2.7
11
H3107 Oxford Health Plans (New 4/ 23 \a \a 9,417 8.1 65.5 3.6
Jersey), Inc. 10
H3158 HIP of New Jersey 1/0 92 \a \a 4,513 6.8 41.2 2.1
Vineland-Millville-Bridgeton, NJ PMSA
-----------------------------------------------------------------------------------------
H3152 HMO of New Jersey, Inc. 3/2 1,283 11.0 39.0 32,261 11.0 55.4 5.1
H3157 Aetna Health Plans of 0/ 1,097 5.0 82.0 11,688 9.1 51.2 1.9
New Jersey 11
H3154 Medigroup, Inc. 0/ 3 \a \a 3,994 22.4 75.9 6.9
10
H3155 First Option Health Plan 0/ 27 \a \a 2,996 11.2 84.4 3.7
of NJ, Inc. 11
H3156 Amerihealth HMO, Inc. 0/ 162 \a \a 2,056 9.1 66.8 2.7
11
H3107 Oxford Health Plans (New 4/ 11 \a \a 9,417 8.1 65.5 3.6
Jersey), Inc. 10
Williamsport, PA MSA
-----------------------------------------------------------------------------------------
H3953 HMO of Northeastern PA, 2/6 4,050 8.1 98.5 11,504 6.3 84.8 1.9
Inc.
H3954 Geisinger Health Plan 2/9 254 5.5 71.4 15,028 3.0 73.6 1.8
York, PA MSA
-----------------------------------------------------------------------------------------
H3956 Aetna Health Plans of 2/6 943 52.4 16.6 9,065 16.6 39.0 4.2
Central/East PA
H3962 Keystone Health Plan 0/7 413 17.4 92.9 1,863 19.5 82.1 4.3
Central, Inc.
H3931 U.S. Health Care Systems 11/ 550 16.9 67.7 63,494 5.3 62.1 3.3
of PA 2
Others, Not in an MSA
-----------------------------------------------------------------------------------------
H3931 U.S. Health Care Systems 11/ 627 14.5 81.3 63,494 5.3 62.1 3.3
of PA 2
H3951 U.S. Health Care Systems 5/5 1,299 12.1 65.6 22,537 8.5 46.3 4.4
of PA
H3957 Keystone Health Plan 1/8 2,601 7.8 86.6 48,663 5.2 83.0 2.1
West
H3361 WellCare of New York, 1/3 1,501 6.5 81.6 2,878 11.7 57.9 2.5
Inc.
H3954 Geisinger Health Plan 2/9 7,425 3.1 83.0 15,028 3.0 73.6 1.8
H3962 Keystone Health Plan 0/7 115 \a \a 1,863 19.5 82.1 4.3
Central, Inc.
H0752 Oxford Healthplan 0/ 4 \a \a 1,390 13.7 50.3 4.2
10
H3049 U.S. HealthCare of New 2/6 54 \a \a 967 13.3 91.5 6.4
Hampshire, Inc.
H0751 U.S. Healthcare, Inc. 2/6 183 \a \a 6,712 12.0 86.1 4.4
H3953 HMO of Northeastern PA, 2/6 95 \a \a 11,504 6.3 84.8 1.9
Inc.
H2261 HMO BLUE, Inc. 0/ 36 \a \a 9,759 5.2 44.4 2.0
10
H3351 Health Care Plan, Inc. 7/0 118 \a \a 9,565 4.4 63.3 3.4
H3305 Rochester Area HMO, Inc. 11/ 122 \a \a 15,118 3.2 46.5 0.7
1
H3959 HealthAmerica 0/ 85 \a \a 3,613 2.5 53.7 0.7
Pennsylvania, Inc. 10
H9001 Fallon Community Health 11/ 13 \a \a 27,811 1.5 49.9 0.8
Plan, Inc. 9
H0851 Amerihealth HMO, Inc. 0/2 18 \a \a 38 \a \a \a
H3373 Capital Area Community 0/2 66 \a \a 214 \a \a \a
HP
H3960 HealthAmerica of Central 0/5 2 \a \a 153 \a \a \a
PA
-----------------------------------------------------------------------------------------
\a This plan either had an average enrollment of less than 250 or was
in operation 6 months or less.
Table II.2
Voluntary Disenrollment Rates for
Medicare Risk HMOs, Southern Region
Within metropolitan Overall contract
areas statistics
-------------------- --------------------------
Plan
age Average FFS Average FFS
HCFA yrs. monthly as % monthly as % Rapi
contrac / enrollme Vol. of enrollme Vol. of d
t # Plan name mos. nt rate vol. nt rate vol. rate
------- ------------------------ ---- -------- ---- ---- -------- ---- ---- ----
Atlanta, GA MSA
-----------------------------------------------------------------------------------------
H1155 United Healthcare of 0/8 2,274 18.9 97.6 2,335 18.9 96.6 4.4
Georgia, Inc.
H1156 USHC of Georgia, Inc. 0/1 18 \a \a 19 \a \a \a
Austin-San Marcos, TX MSA
-----------------------------------------------------------------------------------------
H4557 PCA Health Plans of 3/ 4,438 6.6 96.6 18,517 35.1 53.6 13.8
Texas, Inc. 10
H4558 NYLCARE Health Plans, 3/6 15 \a \a 28,994 8.6 55.3 3.4
Inc.
Baltimore, MD PMSA
-----------------------------------------------------------------------------------------
H2153 Optimum Choice, Inc. 2/5 2,332 29.2 22.9 11,611 59.9 40.2 6.0
H2101 HealthCare Corp. of the 10/ 3,327 14.4 75.6 4,966 14.7 79.5 4.8
Mid-Atlantic 7
H2154 U.S. HealthCare Delaware 2/2 2,863 11.4 67.7 4,026 12.0 65.5 4.2
H2152 NYLCARE Health Plans, 2/5 672 10.3 60.9 4,804 8.1 60.9 2.5
Inc.
H2151 Chesapeake Health Plan, 2/7 5,386 7.6 73.1 5,829 8.5 70.0 3.0
Inc.
H0951 Humana Group Health 1/ 36 \a \a 7,497 23.0 77.0 8.1
Plan, Inc. 11
Baton Rouge, LA MSA
-----------------------------------------------------------------------------------------
H1956 Advantage Health Plan, 0/ 461 32.3 66.1 3,028 26.7 76.5 8.8
Inc. 10
H1954 Community Health Network 2/2 5,037 13.7 64.7 14,825 24.8 63.0 10.8
of Louisiana
H1951 Ochsner Health Plan 2/1 4,301 10.3 33.5 21,558 9.5 42.9 4.2
H1955 Gulf South Health Plans, 1/9 2,597 5.7 46.9 3,686 8.3 51.1 3.0
Inc.
Beaumont-Port Arthur, TX MSA
-----------------------------------------------------------------------------------------
H4558 NYLCARE Health Plans, 3/6 1,980 11.5 92.5 28,994 8.6 55.3 3.4
Inc.
H4565 HMO Texas, L.C. 0/3 534 \a \a 634 \a \a \a
Birmingham, AL MSA
-----------------------------------------------------------------------------------------
H0151 United Healthcare of 1/9 5,303 10.7 91.4 5,384 11.0 90.5 4.5
Alabama
H0150 Health Partners of 2/8 5,807 8.0 70.1 5,924 8.2 71.2 3.8
Alabama
Brazoria, TX PMSA
-----------------------------------------------------------------------------------------
H4557 PCA Health Plans of 3/ 276 57.3 48.7 18,517 35.1 53.6 13.8
Texas, Inc. 10
H4562 FHP of Texas, Inc. 1/7 292 35.9 68.6 3,381 36.6 47.3 10.7
H4510 Humana HP of Texas 8/7 358 25.2 74.4 19,813 22.2 49.2 10.0
H4558 NYLCARE Health Plans, 3/6 1,061 8.3 45.5 28,994 8.6 55.3 3.4
Inc.
H4563 Prudential Health Care 1/ 74 \a \a 5,392 29.8 47.0 9.5
Plan, Inc. 11
H4565 HMO Texas, L.C. 0/3 3 \a \a 634 \a \a \a
Bryan-College Station, TX MSA
-----------------------------------------------------------------------------------------
H4557 PCA Health Plans of 3/ 10 \a \a 18,517 35.1 53.6 13.8
Texas, Inc. 10
H4590 Pacificare of Texas, 9/0 16 \a \a 58,034 12.7 45.0 4.9
Inc.
H4558 NYLCARE Health Plans, 3/6 3 \a \a 28,994 8.6 55.3 3.4
Inc.
Charleston-North Charleston, SC MSA
-----------------------------------------------------------------------------------------
H4249 Companion HealthCare 0/ 432 5.9 100. 1,343 8.5 98.8 2.6
Corporation 10 0
Clarksville-Hopkinsville, TN-KY MSA
-----------------------------------------------------------------------------------------
H4452 Health 1*2*3 0/9 38 \a \a 915 13.0 100. 3.4
0
Columbia, SC MSA
-----------------------------------------------------------------------------------------
H4249 Companion HealthCare 0/ 718 8.7 97.9 1,343 8.5 98.8 2.6
Corporation 10
Corpus Christi, TX MSA
-----------------------------------------------------------------------------------------
H4504 Humana HP of Texas 11/ 8,551 12.0 98.6 8,747 12.3 98.0 7.5
0
H4557 PCA Health Plans of 3/ 3 \a \a 18,517 35.1 53.6 13.8
Texas, Inc. 10
H4558 NYLCARE Health Plans, 3/6 2 \a \a 28,994 8.6 55.3 3.4
Inc.
Cumberland, MD-WV MSA
-----------------------------------------------------------------------------------------
H2153 Optimum Choice, Inc. 2/5 194 \a \a 11,611 59.9 40.2 6.0
H2101 HealthCare Corp. of the 10/ 156 \a \a 4,966 14.7 79.5 4.8
Mid-Atlantic 7
H2151 Chesapeake Health Plan, 2/7 3 \a \a 5,829 8.5 70.0 3.0
Inc.
Dallas, TX PMSA
-----------------------------------------------------------------------------------------
H4507 NYLCARE Health Plans, 10/ 11,521 9.3 70.0 19,289 9.2 64.5 3.7
Inc. 0
H4590 Pacificare of Texas, 9/0 7,606 8.9 83.1 58,034 12.7 45.0 4.9
Inc.
Daytona Beach, FL MSA
-----------------------------------------------------------------------------------------
H1061 AV-MED Health Plan, Inc. 3/3 739 150. 30.1 5,641 54.1 21.0 9.5
3
H1036 Humana Medical Plan, 11/ 21,158 10.0 53.7 216,043 17.5 32.5 8.4
Inc. 9
H1035 Florida Health Care 11/ 13,096 4.9 49.8 13,399 5.0 49.2 2.6
Plan, Inc. 2
Dover, DE MSA
-----------------------------------------------------------------------------------------
H0850 U.S. HealthCare Delaware 2/6 323 11.5 73.0 2,053 13.3 62.4 5.4
H2153 Optimum Choice, Inc. 2/5 50 \a \a 11,611 59.9 40.2 6.0
H0851 Amerihealth HMO, Inc. 0/2 2 \a \a 38 \a \a \a
Florence, SC MSA
-----------------------------------------------------------------------------------------
H4249 Companion HealthCare 0/ 50 \a \a 1,343 8.5 98.8 2.6
Corporation 10
Fort Lauderdale, FL PMSA
-----------------------------------------------------------------------------------------
H1056 PCA Health Plans of 5/2 7,995 33.3 18.0 17,278 40.5 20.0 19.9
Florida, Inc.
H1076 HIP Health Plan of 1/9 4,956 29.2 21.6 11,869 29.7 24.2 13.5
Florida, Inc.
H1013 Foundation Health, A 9/7 11,115 27.4 17.2 26,070 34.6 21.6 22.5
Florida Health Plan
H9011 United HealthCare of 11/ 9,110 22.3 21.4 49,307 16.6 41.2 11.3
Florida, Inc. 9
H1073 Prudential Health Care 2/3 3,916 14.9 32.0 11,706 16.1 31.3 5.0
Plan, Inc.
H1036 Humana Medical Plan, 11/ 40,057 14.0 25.5 216,043 17.5 32.5 8.4
Inc. 9
H1026 Health Options, Inc. 11/ 15,352 11.7 29.6 45,247 12.3 34.4 6.1
9
H1016 AV-MED Health Plan, Inc. 11/ 9,161 9.1 31.3 21,614 10.9 31.9 6.6
9
H1078 Neighborhood Health 1/6 206 \a \a 3,378 19.6 35.1 6.7
Partnership, Inc.
Fort Myers-Cape Coral, FL MSA
-----------------------------------------------------------------------------------------
H1036 Humana Medical Plan, 11/ 1,850 15.2 97.5 216,043 17.5 32.5 8.4
Inc. 9
H1068 PCA Health Plans of 2/3 9 \a \a 10,304 51.7 18.7 11.6
Florida, Inc.
Fort Pierce-Port St. Lucie, FL MSA
-----------------------------------------------------------------------------------------
H1036 Humana Medical Plan, 11/ 2,808 13.2 96.2 216,043 17.5 32.5 8.4
Inc. 9
Fort Worth-Arlington, TX PMSA
-----------------------------------------------------------------------------------------
H4590 Pacificare of Texas, 9/0 1,476 14.8 52.1 58,034 12.7 45.0 4.9
Inc.
H4507 NYLCARE Health Plans, 10/ 6,441 8.6 54.1 19,289 9.2 64.5 3.7
Inc. 0
H4559 Harris Health Plan, Inc. 2/0 18,171 7.8 80.9 18,585 7.9 80.6 4.3
Gainesville, FL MSA
-----------------------------------------------------------------------------------------
H1057 AV-MED Health Plan, Inc. 3/2 3,011 7.6 96.9 11,106 20.5 97.6 4.5
Galveston-Texas City, TX PMSA
-----------------------------------------------------------------------------------------
H4557 PCA Health Plans of 3/ 660 52.3 42.0 18,517 35.1 53.6 13.8
Texas, Inc. 10
H4510 Humana HP of Texas 8/7 768 23.8 75.4 19,813 22.2 49.2 10.0
H4590 Pacificare of Texas, 9/0 2,159 11.6 65.6 58,034 12.7 45.0 4.9
Inc.
H4558 NYLCARE Health Plans, 3/6 1,570 9.7 32.9 28,994 8.6 55.3 3.4
Inc.
H4562 FHP of Texas, Inc. 1/7 79 \a \a 3,381 36.6 47.3 10.7
H4563 Prudential Health Care 1/ 105 \a \a 5,392 29.8 47.0 9.5
Plan, Inc. 11
H4565 HMO Texas, L.C. 0/3 3 \a \a 634 \a \a \a
Greensboro--Winston-Salem--High Point, NC MSA
-----------------------------------------------------------------------------------------
H3449 Partners National Health 1/0 847 5.4 91.3 863 5.4 91.5 1.4
Plans of NC
H3455 QualChoice of North 0/1 20 \a \a 20 \a \a \a
Carolina, Inc.
H4250 Companion HealthCare 0/9 91 \a \a 92 \a \a \a
Corporation
Hagerstown, MD PMSA
-----------------------------------------------------------------------------------------
H2153 Optimum Choice, Inc. 2/5 313 5.8 38.9 11,611 59.9 40.2 6.0
H2101 HealthCare Corp. of the 10/ 188 \a \a 4,966 14.7 79.5 4.8
Mid-Atlantic 7
H2151 Chesapeake Health Plan, 2/7 7 \a \a 5,829 8.5 70.0 3.0
Inc.
Houma, LA MSA
-----------------------------------------------------------------------------------------
H1954 Community Health Network 2/2 261 112. 95.9 14,825 24.8 63.0 10.8
of Louisiana 4
H1951 Ochsner Health Plan 2/1 828 15.3 56.7 21,558 9.5 42.9 4.2
H1956 Advantage Health Plan, 0/ 5 \a \a 3,028 26.7 76.5 8.8
Inc. 10
H1958 SMA HMO, Inc. 0/2 51 \a \a 105 \a \a \a
Houston, TX PMSA
-----------------------------------------------------------------------------------------
H4557 PCA Health Plans of 3/ 7,183 55.7 57.6 18,517 35.1 53.6 13.8
Texas, Inc. 10
H4510 Humana HP of Texas 8/7 3,126 43.6 50.3 19,813 22.2 49.2 10.0
H4562 FHP of Texas, Inc. 1/7 2,930 36.4 45.2 3,381 36.6 47.3 10.7
H4563 Prudential Health Care 1/ 5,119 29.5 46.4 5,392 29.8 47.0 9.5
Plan, Inc. 11
H4590 Pacificare of Texas, 9/0 16,584 18.6 38.3 58,034 12.7 45.0 4.9
Inc.
H4558 NYLCARE Health Plans, 3/6 23,441 8.1 51.0 28,994 8.6 55.3 3.4
Inc.
H4565 HMO Texas, L.C. 0/3 90 \a \a 634 \a \a \a
Jacksonville, FL MSA
-----------------------------------------------------------------------------------------
H1069 PCA Health Plans of 2/3 6,929 71.6 16.4 7,331 71.1 17.1 15.6
Florida, Inc.
H1059 AV-MED Health Plan, Inc. 3/2 7,420 42.6 21.1 7,728 42.9 22.0 9.4
H1036 Humana Medical Plan, 11/ 2,988 42.1 41.8 216,043 17.5 32.5 8.4
Inc. 9
H1071 Health Options, Inc. 2/7 4,923 32.7 20.1 5,023 33.0 21.0 8.2
H1070 Prudential Health Care 2/4 5,146 12.3 28.5 5,330 12.4 30.0 4.2
Plan, Inc.
H1088 Principal Health Care of 0/5 406 \a \a 415 \a \a \a
Florida, Inc.
Lakeland-Winter Haven, FL MSA
-----------------------------------------------------------------------------------------
H1068 PCA Health Plans of 2/3 60 \a \a 10,304 51.7 18.7 11.6
Florida, Inc.
Little Rock-North Little Rock, AR MSA
-----------------------------------------------------------------------------------------
H0451 HMO Partners 0/9 1,998 9.7 87.7 2,964 10.8 92.1 3.1
H0453 HealthSource, Arkansas, 0/3 69 \a \a 70 \a \a \a
Inc.
Louisville, KY-IN MSA
-----------------------------------------------------------------------------------------
H1890 Humana Health Plan, Inc. 9/1 6,606 17.2 99.6 6,872 17.3 99.3 7.9
Lynchburg, VA MSA
-----------------------------------------------------------------------------------------
H2157 Optimum Choice, Inc. 0/ 2 \a \a 32 \a \a \a
10
Melbourne-Titusville-Palm Bay, FL MSA
-----------------------------------------------------------------------------------------
H1036 Humana Medical Plan, 11/ 292 25.7 98.7 216,043 17.5 32.5 8.4
Inc. 9
Miami, FL PMSA
-----------------------------------------------------------------------------------------
H1076 HIP Health Plan of 1/9 1,316 55.9 21.2 11,869 29.7 24.2 13.5
Florida, Inc.
H1056 PCA Health Plans of 5/2 5,596 49.9 22.0 17,278 40.5 20.0 19.9
Florida, Inc.
H1013 Foundation Health, A 9/7 9,557 37.3 25.4 26,070 34.6 21.6 22.5
Florida Health Plan
H1078 Neighborhood Health 1/6 3,104 18.1 35.2 3,378 19.6 35.1 6.7
Partnership, Inc.
H1073 Prudential Health Care 2/3 3,299 15.4 31.8 11,706 16.1 31.3 5.0
Plan, Inc.
H1036 Humana Medical Plan, 11/ 27,529 14.9 30.3 216,043 17.5 32.5 8.4
Inc. 9
H1026 Health Options, Inc. 11/ 10,919 14.4 33.6 45,247 12.3 34.4 6.1
9
H9011 United HealthCare of 11/ 34,681 11.8 46.4 49,307 16.6 41.2 11.3
Florida, Inc. 9
H1016 AV-MED Health Plan, Inc. 11/ 7,730 10.1 30.8 21,614 10.9 31.9 6.6
9
Mobile, AL MSA
-----------------------------------------------------------------------------------------
H0152 United Healthcare of 1/9 5,765 15.0 99.9 5,847 15.4 98.1 6.5
Alabama
Naples, FL MSA
-----------------------------------------------------------------------------------------
H1036 Humana Medical Plan, 11/ 9 \a \a 216,043 17.5 32.5 8.4
Inc. 9
Nashville, TN MSA
-----------------------------------------------------------------------------------------
H4452 Health 1*2*3 0/9 758 10.4 100. 915 13.0 100. 3.4
0 0
New Orleans, LA MSA
-----------------------------------------------------------------------------------------
H1954 Community Health Network 2/2 9,150 27.2 55.9 14,825 24.8 63.0 10.8
of Louisiana
H1956 Advantage Health Plan, 0/ 2,151 22.8 84.1 3,028 26.7 76.5 8.8
Inc. 10
H1955 Gulf South Health Plans, 1/9 515 14.8 57.9 3,686 8.3 51.1 3.0
Inc.
H1951 Ochsner Health Plan 2/1 14,993 8.5 40.7 21,558 9.5 42.9 4.2
H1958 SMA HMO, Inc. 0/2 52 \a \a 105 \a \a \a
Norfolk-Virginia Beach-Newport News, VA-NC MSA
-----------------------------------------------------------------------------------------
H2153 Optimum Choice, Inc. 2/5 1,013 137. 50.5 11,611 59.9 40.2 6.0
8
H4949 Sentara Health Plans 5/9 5,058 14.0 59.2 5,131 14.1 59.7 5.4
Ocala, FL MSA
-----------------------------------------------------------------------------------------
H1057 AV-MED Health Plan, Inc. 3/2 4,084 36.5 98.3 11,106 20.5 97.6 4.5
Oklahoma City, OK MSA
-----------------------------------------------------------------------------------------
H3754 Pacificare of Oklahoma, 0/7 6,882 8.6 59.1 7,011 8.7 59.8 2.0
Inc.
H3749 Pacificare of Oklahoma, 5/ 2,841 5.0 96.5 16,652 6.6 61.1 3.0
Inc. 11
H3755 Community Care HMO, Inc. 0/6 204 \a \a 1,094 \a \a \a
H3756 HealthCare Oklahoma, 0/3 84 \a \a 88 \a \a \a
Inc.
H3757 Bluelincs HMO, Inc. 0/2 54 \a \a 75 \a \a \a
Orlando, FL MSA
-----------------------------------------------------------------------------------------
H1067 PCA Health Plans of 2/3 4,322 66.0 15.8 4,651 64.1 17.1 13.5
Florida, Inc.
H1061 AV-MED Health Plan, Inc. 3/3 4,730 38.7 13.7 5,641 54.1 21.0 9.5
H1036 Humana Medical Plan, 11/ 23,889 19.0 22.5 216,043 17.5 32.5 8.4
Inc. 9
H1081 Prudential Health Care 1/4 4,666 6.0 47.5 4,816 7.2 53.6 1.4
Plan, Inc.
H1095 Health Options, Inc. 0/6 2,133 \a \a 2,198 \a \a \a
Punta Gorda, FL MSA
-----------------------------------------------------------------------------------------
H1036 Humana Medical Plan, 11/ 336 29.2 88.8 216,043 17.5 32.5 8.4
Inc. 9
H1068 PCA Health Plans of 2/3 9 \a \a 10,304 51.7 18.7 11.6
Florida, Inc.
Richmond-Petersburg, VA MSA
-----------------------------------------------------------------------------------------
H2153 Optimum Choice, Inc. 2/5 1,191 125. 41.2 11,611 59.9 40.2 6.0
2
H2152 NYLCARE Health Plans, 2/5 195 \a \a 4,804 8.1 60.9 2.5
Inc.
H4951 Cigna HealthCare of 0/2 72 \a \a 74 \a \a \a
Virginia
Roanoke, VA MSA
-----------------------------------------------------------------------------------------
H2157 Optimum Choice, Inc. 0/ 17 \a \a 32 \a \a \a
10
San Antonio, TX MSA
-----------------------------------------------------------------------------------------
H4560 Prudential Health Care 2/1 1,441 40.3 26.2 1,452 41.0 26.2 14.6
Plan, Inc.
H4557 PCA Health Plans of 3/ 5,029 28.9 35.7 18,517 35.1 53.6 13.8
Texas, Inc. 10
H4510 Humana HP of Texas 8/7 14,806 17.3 43.5 19,813 22.2 49.2 10.0
H4590 Pacificare of Texas, 9/0 28,966 9.8 37.5 58,034 12.7 45.0 4.9
Inc.
H4558 NYLCARE Health Plans, 3/6 4 \a \a 28,994 8.6 55.3 3.4
Inc.
Sarasota-Bradenton, FL MSA
-----------------------------------------------------------------------------------------
H1068 PCA Health Plans of 2/3 2,290 27.2 35.9 10,304 51.7 18.7 11.6
Florida, Inc.
H1036 Humana Medical Plan, 11/ 2,930 25.1 91.2 216,043 17.5 32.5 8.4
Inc. 9
Tampa-St. Petersburg-Clearwater, FL MSA
-----------------------------------------------------------------------------------------
H1068 PCA Health Plans of 2/3 7,583 59.3 14.8 10,304 51.7 18.7 11.6
Florida, Inc.
H1062 AV-MED Health Plan, Inc. 3/2 15,834 40.3 13.6 18,168 40.6 23.1 8.9
H1080 United Health Care of 0/ 4,021 30.9 26.6 4,187 30.4 27.5 6.7
FL, Inc. 11
H1036 Humana Medical Plan, 11/ 58,174 21.0 22.4 216,043 17.5 32.5 8.4
Inc. 9
H1082 Health Options, Inc. 0/9 10,003 20.5 50.8 10,319 20.9 50.8 5.9
H1087 Cigna HealthCare of 1/2 1,247 20.0 26.5 1,269 19.9 27.4 5.0
Florida, Inc.
H1084 HIP Health Plan of 1/2 1,012 13.1 42.1 1,068 13.9 41.9 3.9
Florida
H1074 Prudential Health Care 2/0 9,157 10.0 39.1 9,459 10.3 39.7 3.3
Plan, Inc.
Tulsa, OK MSA
-----------------------------------------------------------------------------------------
H3749 Pacificare of Oklahoma, 5/ 12,250 6.9 53.1 16,652 6.6 61.1 3.0
Inc. 11
H3755 Community Care HMO, Inc. 0/6 872 \a \a 1,094 \a \a \a
H3757 Bluelincs HMO, Inc. 0/2 45 \a \a 75 \a \a \a
Washington, DC-MD-VA-WV PMSA
-----------------------------------------------------------------------------------------
H2153 Optimum Choice, Inc. 2/5 4,203 37.5 35.0 11,611 59.9 40.2 6.0
H0951 Humana Group Health 1/ 7,182 23.0 77.0 7,497 23.0 77.0 8.1
Plan, Inc. 11
H2154 U.S. HealthCare Delaware 2/2 446 15.0 64.2 4,026 12.0 65.5 4.2
H2152 NYLCARE Health Plans, 2/5 3,796 7.5 57.7 4,804 8.1 60.9 2.5
Inc.
H2101 HealthCare Corp. of the 10/ 230 \a \a 4,966 14.7 79.5 4.8
Mid-Atlantic 7
H2151 Chesapeake Health Plan, 2/7 165 \a \a 5,829 8.5 70.0 3.0
Inc.
H0953 U.S. HealthCare Delaware 2/5 80 \a \a 83 \a \a \a
West Palm Beach-Boca Raton, FL MSA
-----------------------------------------------------------------------------------------
H1013 Foundation Health, A 9/7 4,701 44.5 15.4 26,070 34.6 21.6 22.5
Florida Health Plan
H1056 PCA Health Plans of 5/2 2,720 43.1 15.2 17,278 40.5 20.0 19.9
Florida, Inc.
H9011 United HealthCare of 11/ 4,458 26.6 25.0 49,307 16.6 41.2 11.3
Florida, Inc. 9
H1076 HIP Health Plan of 1/9 4,921 24.0 25.9 11,869 29.7 24.2 13.5
Florida, Inc.
H1073 Prudential Health Care 2/3 4,376 17.1 28.9 11,706 16.1 31.3 5.0
Plan, Inc.
H1036 Humana Medical Plan, 11/ 27,168 14.2 27.8 216,043 17.5 32.5 8.4
Inc. 9
H1016 AV-MED Health Plan, Inc. 11/ 4,313 14.0 28.9 21,614 10.9 31.9 6.6
9
H1026 Health Options, Inc. 11/ 17,994 10.6 36.0 45,247 12.3 34.4 6.1
9
H1078 Neighborhood Health 1/6 17 \a \a 3,378 19.6 35.1 6.7
Partnership, Inc.
Wilmington-Newark, DE-MD PMSA
-----------------------------------------------------------------------------------------
H0850 U.S. HealthCare Delaware 2/6 1,435 12.5 63.9 2,053 13.3 62.4 5.4
H3157 Aetna Health Plans of 0/ 1,364 7.5 74.5 11,688 9.1 51.2 1.9
New Jersey 11
H2154 U.S. HealthCare Delaware 2/2 367 5.4 60.0 4,026 12.0 65.5 4.2
H2153 Optimum Choice, Inc. 2/5 33 \a \a 11,611 59.9 40.2 6.0
H2101 HealthCare Corp. of the 10/ 45 \a \a 4,966 14.7 79.5 4.8
Mid-Atlantic 7
H2151 Chesapeake Health Plan, 2/7 198 \a \a 5,829 8.5 70.0 3.0
Inc.
H0851 Amerihealth HMO, Inc. 0/2 19 \a \a 38 \a \a \a
Others, Not in an MSA
-----------------------------------------------------------------------------------------
H2153 Optimum Choice, Inc. 2/5 2,121 71.0 39.8 11,611 59.9 40.2 6.0
H1954 Community Health Network 2/2 371 66.6 96.4 14,825 24.8 63.0 10.8
of Louisiana
H1062 AV-MED Health Plan, Inc. 3/2 1,551 43.6 97.8 18,168 40.6 23.1 8.9
H1956 Advantage Health Plan, 0/ 396 41.8 63.0 3,028 26.7 76.5 8.8
Inc. 10
H4557 PCA Health Plans of 3/ 579 27.6 52.5 18,517 35.1 53.6 13.8
Texas, Inc. 10
H1036 Humana Medical Plan, 11/ 1,362 17.0 94.4 216,043 17.5 32.5 8.4
Inc. 9
H0850 U.S. HealthCare Delaware 2/6 268 15.3 58.5 2,053 13.3 62.4 5.4
H1955 Gulf South Health Plans, 1/9 548 13.3 52.1 3,686 8.3 51.1 3.0
Inc.
H0451 HMO Partners 0/9 942 13.0 98.9 2,964 10.8 92.1 3.1
H4590 Pacificare of Texas, 9/0 831 12.4 76.7 58,034 12.7 45.0 4.9
Inc.
H1057 AV-MED Health Plan, Inc. 3/2 3,563 12.3 96.8 11,106 20.5 97.6 4.5
H1951 Ochsner Health Plan 2/1 1,075 10.1 56.9 21,558 9.5 42.9 4.2
H2101 HealthCare Corp. of the 10/ 1,079 9.7 92.4 4,966 14.7 79.5 4.8
Mid-Atlantic 7
H4558 NYLCARE Health Plans, 3/6 814 9.6 96.2 28,994 8.6 55.3 3.4
Inc.
H1069 PCA Health Plans of 2/3 177 \a \a 7,331 71.1 17.1 15.6
Florida, Inc.
H1068 PCA Health Plans of 2/3 26 \a \a 10,304 51.7 18.7 11.6
Florida, Inc.
H1059 AV-MED Health Plan, Inc. 3/2 164 \a \a 7,728 42.9 22.0 9.4
H4510 Humana HP of Texas 8/7 249 \a \a 19,813 22.2 49.2 10.0
H4452 Health 1*2*3 0/9 127 \a \a 915 13.0 100. 3.4
0
H1070 Prudential Health Care 2/4 82 \a \a 5,330 12.4 30.0 4.2
Plan, Inc.
H4249 Companion HealthCare 0/ 129 \a \a 1,343 8.5 98.8 2.6
Corporation 10
H2151 Chesapeake Health Plan, 2/7 24 \a \a 5,829 8.5 70.0 3.0
Inc.
H2152 NYLCARE Health Plans, 2/5 80 \a \a 4,804 8.1 60.9 2.5
Inc.
H1958 SMA HMO, Inc. 0/2 4 \a \a 105 \a \a \a
H2157 Optimum Choice, Inc. 0/ 10 \a \a 32 \a \a \a
10
H3755 Community Care HMO, Inc. 0/6 10 \a \a 1,094 \a \a \a
H3756 HealthCare Oklahoma, 0/3 2 \a \a 88 \a \a \a
Inc.
H3757 Bluelincs HMO, Inc. 0/2 6 \a \a 75 \a \a \a
-----------------------------------------------------------------------------------------
\a This plan either had an average enrollment of less than 250 or was
in operation 6 months or less.
Table II.3
Voluntary Disenrollment Rates for
Medicare Risk HMOs, Midwest Region
Within metropolitan Overall contract
areas statistics
-------------------- --------------------------
Plan
age Average FFS Average FFS
HCFA yrs. monthly as % monthly as % Rapi
contrac / enrollme Vol. of enrollme Vol. of d
t # Plan name mos. nt rate vol. nt rate vol. rate
------- ------------------------ ---- -------- ---- ---- -------- ---- ---- ----
Akron, OH PMSA
-----------------------------------------------------------------------------------------
H3607 Kaiser Foundation HP of 10/ 2,785 7.6 54.0 21,161 4.8 62.8 2.7
Ohio 0
H3655 Community Insurance 2/1 173 \a \a 6,687 12.6 62.5 4.1
Company
H3659 United HealthCare of 0/6 110 \a \a 5,314 \a \a \a
Ohio, Inc.
H3660 SummaCare, Inc. 0/5 738 \a \a 863 \a \a \a
Bloomington, IN MSA
-----------------------------------------------------------------------------------------
H1551 HealthSource Indiana 5/5 27 \a \a 382 15.1 100. 4.8
Managed Care Plan 0
Canton-Massillon, OH MSA
-----------------------------------------------------------------------------------------
H3655 Community Insurance 2/1 150 \a \a 6,687 12.6 62.5 4.1
Company
H3607 Kaiser Foundation HP of 10/ 116 \a \a 21,161 4.8 62.8 2.7
Ohio 0
H3659 United HealthCare of 0/6 227 \a \a 5,314 \a \a \a
Ohio, Inc.
H3660 SummaCare, Inc. 0/5 69 \a \a 863 \a \a \a
Chicago, IL PMSA
-----------------------------------------------------------------------------------------
H1460 FHP of Illinois, Inc. 0/ 1,291 50.5 47.0 1,307 50.8 47.1 12.8
11
H1461 NYLCARE, Inc. 1/2 857 29.0 58.6 868 28.9 58.6 7.7
H1458 Health Direct Insurance, 2/0 2,740 23.4 57.9 2,766 23.6 57.9 6.8
Inc.
H1406 Humana Health Plan, Inc. 11/ 39,272 13.0 57.0 41,686 13.6 60.4 7.7
6
H9045 United HealthCare of 11/ 45,524 9.2 49.2 45,919 9.3 49.4 4.9
Illinois 6
Cincinnati, OH-KY-IN PMSA
-----------------------------------------------------------------------------------------
H3658 FHP of Ohio, Inc. 0/7 2,014 14.8 90.8 3,187 23.9 72.1 5.8
H3655 Community Insurance 2/1 4,921 9.4 57.1 6,687 12.6 62.5 4.1
Company
H3659 United HealthCare of 0/6 579 \a \a 5,314 \a \a \a
Ohio, Inc.
Cleveland-Lorain-Elyria, OH PMSA
-----------------------------------------------------------------------------------------
H3657 QualChoice Health Plan 0/9 575 15.8 70.6 583 16.2 71.8 3.8
H3654 Prudential Health Care 2/4 8,002 13.6 59.4 8,062 13.7 59.6 4.8
Plan of N. Ohio
H3656 Aetna Health Plans of 2/1 5,919 11.0 60.1 5,959 11.1 59.7 4.7
Ohio, Inc.
H3607 Kaiser Foundation HP of 10/ 17,901 4.2 64.8 21,161 4.8 62.8 2.7
Ohio 0
H3655 Community Insurance 2/1 248 \a \a 6,687 12.6 62.5 4.1
Company
H3659 United HealthCare of 0/6 408 \a \a 5,314 \a \a \a
Ohio, Inc.
H3660 SummaCare, Inc. 0/5 72 \a \a 863 \a \a \a
Columbus, OH MSA
-----------------------------------------------------------------------------------------
H3655 Community Insurance 2/1 265 32.5 75.6 6,687 12.6 62.5 4.1
Company
H3659 United HealthCare of 0/6 978 \a \a 5,314 \a \a \a
Ohio, Inc.
Dayton-Springfield, OH MSA
-----------------------------------------------------------------------------------------
H3658 FHP of Ohio, Inc. 0/7 834 44.0 56.5 3,187 23.9 72.1 5.8
H3655 Community Insurance 2/1 292 21.2 79.0 6,687 12.6 62.5 4.1
Company
H3659 United HealthCare of 0/6 1,189 \a \a 5,314 \a \a \a
Ohio, Inc.
Detroit, MI PMSA
-----------------------------------------------------------------------------------------
H2312 Health Alliance Plan of 10/ 7,376 7.2 97.5 7,481 7.3 97.1 2.9
Michigan 0
Gary, IN PMSA
-----------------------------------------------------------------------------------------
H1406 Humana Health Plan, Inc. 11/ 1,804 22.1 99.2 41,686 13.6 60.4 7.7
6
Hamilton-Middletown, OH PMSA
-----------------------------------------------------------------------------------------
H3658 FHP of Ohio, Inc. 0/7 309 25.5 71.7 3,187 23.9 72.1 5.8
H3655 Community Insurance 2/1 588 12.4 38.4 6,687 12.6 62.5 4.1
Company
H3659 United HealthCare of 0/6 125 \a \a 5,314 \a \a \a
Ohio, Inc.
Indianapolis, IN MSA
-----------------------------------------------------------------------------------------
H9028 Maxicare Indiana, Inc. 11/ 3,027 7.1 73.5 3,076 7.3 72.9 3.2
9
H1557 Anthem Health of 0/5 255 \a \a 276 \a \a \a
Indiana, Inc.
Jackson, MI MSA
-----------------------------------------------------------------------------------------
H9009 Blue Care Network- 11/ 130 \a \a 4,308 1.4 95.1 0.5
Health Central 9
Kankakee, IL PMSA
-----------------------------------------------------------------------------------------
H9045 United HealthCare of 11/ 21 \a \a 45,919 9.3 49.4 4.9
Illinois 6
Kansas City, MO-KS MSA
-----------------------------------------------------------------------------------------
H2652 Total Health Care 6/ 3,891 29.4 20.6 3,949 29.2 20.7 3.0
10
H2656 Good Health HMO, Inc. 2/8 4,589 19.2 53.7 4,653 19.2 53.9 6.5
H2649 Humana Kansas City, Inc. 7/0 14,206 10.3 46.4 14,482 10.3 47.1 4.7
H1751 Kaiser Foundation HP of 0/5 857 \a \a 888 \a \a \a
KS City, Inc.
H2666 HealthNet 0/5 1,299 \a \a 1,308 \a \a \a
Kokomo, IN MSA
-----------------------------------------------------------------------------------------
H1557 Anthem Health of 0/5 8 \a \a 276 \a \a \a
Indiana, Inc.
Lansing-East Lansing, MI MSA
-----------------------------------------------------------------------------------------
H9009 Blue Care Network- 11/ 3,858 1.3 94.1 4,308 1.4 95.1 0.5
Health Central 9
Milwaukee-Waukesha, WI PMSA
-----------------------------------------------------------------------------------------
H5253 PrimeCare Health Plan, 1/3 2,501 6.4 98.1 2,539 6.5 97.0 1.9
Inc.
Minneapolis-St. Paul, MN-WI MSA
-----------------------------------------------------------------------------------------
H2455 Blue Plus, Inc. 2/0 684 5.0 70.6 696 4.9 70.6 1.2
H9006 Medica 11/ 39,690 3.0 87.0 40,513 3.3 86.4 1.2
9
H9005 Group Health Plan, Inc. 11/ 17,126 3.0 74.0 17,473 3.1 74.9 1.8
9
Omaha, NE-IA MSA
-----------------------------------------------------------------------------------------
H2802 United HealthCare of the 11/ 3,865 8.5 61.9 3,922 8.5 62.1 3.1
Midlands, Inc. 3
H2849 Exclusive HealthCare, 0/2 718 \a \a 724 \a \a \a
Inc.
St. Louis, MO-IL MSA
-----------------------------------------------------------------------------------------
H2658 Gencare Health Systems, 1/ 1,764 22.4 21.3 1,781 22.6 21.7 8.4
Inc. 11
H2659 HMO Missouri, Inc. 1/9 4,926 12.4 51.9 4,991 12.5 51.9 5.0
H2654 Gencare Health Systems, 4/1 15,773 8.2 65.9 15,936 8.3 66.0 2.9
Inc.
H2663 Group Health Plan, Inc. 1/0 9,993 2.9 70.8 10,212 3.0 71.0 1.1
Toledo, OH MSA
-----------------------------------------------------------------------------------------
H3649 Family Health Plan, Inc. 3/9 2,268 6.7 25.5 2,422 6.6 25.6 1.9
H3653 Paramount Care, Inc. 1/9 1,857 2.8 100. 1,937 2.8 100. 1.0
0 0
Wichita, KS MSA
-----------------------------------------------------------------------------------------
H1750 Preferred Plus of 0/6 122 \a \a 123 \a \a \a
Kansas, Inc.
Youngstown-Warren, OH MSA
-----------------------------------------------------------------------------------------
H3655 Community Insurance 2/1 226 \a \a 6,687 12.6 62.5 4.1
Company
H3659 United HealthCare of 0/6 912 \a \a 5,314 \a \a \a
Ohio, Inc.
Others, Not in an MSA
-----------------------------------------------------------------------------------------
H1551 HealthSource Indiana 5/5 351 14.6 100. 382 15.1 100. 4.8
Managed Care Plan 0 0
H3655 Community Insurance 2/1 103 \a \a 6,687 12.6 62.5 4.1
Company
H3649 Family Health Plan, Inc. 3/9 106 \a \a 2,422 6.6 25.6 1.9
H9006 Medica 11/ 88 \a \a 40,513 3.3 86.4 1.2
9
H9005 Group Health Plan, Inc. 11/ 89 \a \a 17,473 3.1 74.9 1.8
9
H2663 Group Health Plan, Inc. 1/0 103 \a \a 10,212 3.0 71.0 1.1
H3653 Paramount Care, Inc. 1/9 58 \a \a 1,937 2.8 100. 1.0
0
H9009 Blue Care Network- 11/ 95 \a \a 4,308 1.4 95.1 0.5
Health Central 9
H1557 Anthem Health of 0/5 7 \a \a 276 \a \a \a
Indiana, Inc.
H3659 United HealthCare of 0/6 709 \a \a 5,314 \a \a \a
Ohio, Inc.
-----------------------------------------------------------------------------------------
\a This plan either had an average enrollment of less than 250 or was
in operation 6 months or less.
Table II.4
Voluntary Disenrollment Rates for
Medicare Risk HMOs, Western Region
Within metropolitan Overall contract
areas statistics
-------------------- --------------------------
Plan
age Average FFS Average FFS
HCFA yrs. monthly as % monthly as % Rapi
contrac / enrollme Vol. of enrollme Vol. of d
t # Plan name mos. nt rate vol. nt rate vol. rate
------- ------------------------ ---- -------- ---- ---- -------- ---- ---- ----
Albuquerque, NM MSA
-----------------------------------------------------------------------------------------
H3249 QualMed, New Mexico 4/9 1,830 9.7 35.0 1,953 11.7 34.5 4.2
H3204 FHP of New Mexico, Inc. 10/ 16,039 4.9 43.3 17,491 5.4 48.6 3.8
9
H3250 Presbyterian Health 3/0 1,548 4.6 45.1 1,571 4.7 47.3 1.3
Plan, Inc.
H3251 Lovelace Health Plan, 3/0 9,785 2.8 59.3 13,106 4.0 56.8 2.0
Inc.
Bakersfield, CA MSA
-----------------------------------------------------------------------------------------
H0523 Aetna HP of California, 10/ 563 17.6 34.3 55,036 11.5 26.5 5.0
Inc. 5
H9030 FHP, Inc. 11/ 4,873 17.2 35.4 200,230 12.6 26.7 6.7
9
H0563 Health Net 4/1 1,901 9.0 31.4 50,913 13.6 22.0 5.1
H0543 Pacificare of CA, Inc. 11/ 14,345 8.2 23.3 284,714 7.3 33.1 4.0
4
H0526 Kaiser Foundation HP, 9/0 2,918 4.6 50.0 3,142 4.8 48.3 3.4
Inc.
H0564 CaliforniaCare Health 3/4 92 \a \a 1,303 32.5 37.1 10.1
Plans
H0576 Prudential Health Care 2/6 189 \a \a 2,698 22.7 35.5 8.6
Plan of CA
H0554 CareAmerica Health Plans 6/2 2 \a \a 38,358 17.1 27.5 9.0
Bellingham, WA MSA
-----------------------------------------------------------------------------------------
H5050 Group Health Coop. of 8/0 1,162 4.6 55.6 50,900 4.0 36.1 1.9
Puget Sound
H5063 Options Health Care, 0/4 18 \a \a 974 \a \a \a
Inc.
Boulder-Longmont, CO PMSA
-----------------------------------------------------------------------------------------
H0609 FHP of Colorado, Inc. 10/ 1,098 5.7 52.4 40,369 7.0 44.1 3.0
6
H0630 Kaiser Foundation HP of 11/ 3,881 4.2 41.5 32,721 4.4 31.3 2.3
Colo. 1
H0603 HMO Colorado, Inc. 11/ 59 \a \a 2,347 16.4 16.8 3.3
0
H0615 Qual-Med, Inc., Denver 8/5 146 \a \a 7,383 14.0 21.6 3.6
Bremerton, WA PMSA
-----------------------------------------------------------------------------------------
H5050 Group Health Coop. of 8/0 2,349 5.4 37.3 50,900 4.0 36.1 1.9
Puget Sound
H5055 Qual-Med Washington 2/ 18 \a \a 275 10.9 46.7 2.8
Health Plan, Inc. 11
H5063 Options Health Care, 0/4 108 \a \a 974 \a \a \a
Inc.
Chico-Paradise, CA MSA
-----------------------------------------------------------------------------------------
H0562 Health Net 4/1 3,209 29.9 19.4 58,588 11.2 23.3 3.7
H0598 PacifiCare of CA, Inc. 1/4 3,026 8.1 80.8 3,074 8.4 78.4 2.8
Colorado Springs, CO MSA
-----------------------------------------------------------------------------------------
H0609 FHP of Colorado, Inc. 10/ 6,845 4.2 92.3 40,369 7.0 44.1 3.0
6
Denver, CO PMSA
-----------------------------------------------------------------------------------------
H0659 Cigna HealthCare of 2/2 3,175 24.8 17.6 3,246 24.9 18.0 6.2
Colorado, Inc.
H0603 HMO Colorado, Inc. 11/ 2,021 15.2 17.2 2,347 16.4 16.8 3.3
0
H0615 Qual-Med, Inc., Denver 8/5 7,145 13.0 20.6 7,383 14.0 21.6 3.6
H0609 FHP of Colorado, Inc. 10/ 26,780 8.5 33.6 40,369 7.0 44.1 3.0
6
H0630 Kaiser Foundation HP of 11/ 25,555 4.2 27.6 32,721 4.4 31.3 2.3
Colo. 1
H0660 Mutual of Omaha of 0/2 229 \a \a 232 \a \a \a
Colorado
Eugene-Springfield, OR MSA
-----------------------------------------------------------------------------------------
H3805 Pacificare of Oregon 10/ 700 6.9 45.8 35,938 8.2 43.3 2.7
11
H3858 SelectCare Health Plans 1/3 4,609 6.5 58.2 8,353 4.9 64.1 2.6
Flagstaff, AZ-UT MSA
-----------------------------------------------------------------------------------------
H0303 FHP, Inc. 10/ 52 \a \a 86,650 7.0 34.6 2.9
9
H0356 Premier HealthCare, Inc. 0/5 72 \a \a 1,255 \a \a \a
Fort Collins-Loveland, CO MSA
-----------------------------------------------------------------------------------------
H0630 Kaiser Foundation HP of 11/ 293 3.4 80.0 32,721 4.4 31.3 2.3
Colo. 1
Fresno, CA MSA
-----------------------------------------------------------------------------------------
H0570 Health Net 3/2 3,995 49.2 19.1 4,248 47.7 19.5 4.9
H0590 CaliforniaCare Health 1/3 326 44.4 64.1 332 44.3 63.9 10.5
Plans
H0559 Pacificare of 4/9 7,371 9.4 41.8 89,360 8.9 40.0 3.5
California, Inc.
H0584 Kaiser Foundation HP, 1/ 5,355 3.6 67.2 5,790 4.0 64.7 2.0
Inc. 11
Greeley, CO PMSA
-----------------------------------------------------------------------------------------
H0630 Kaiser Foundation HP of 11/ 327 3.1 70.0 32,721 4.4 31.3 2.3
Colo. 1
Honolulu, HI MSA
-----------------------------------------------------------------------------------------
H1230 Kaiser Foundation HP, 10/ 10,191 1.9 85.1 13,795 2.0 81.1 1.2
Inc. 8
Las Vegas, NV-AZ MSA
-----------------------------------------------------------------------------------------
H2931 Health Plan of Nevada, 11/ 22,964 57.8 6.6 24,892 55.5 8.5 8.3
Inc. 6
H2959 Humana Health Plan, Inc. 1/2 2,928 21.1 38.9 3,035 21.3 38.6 5.3
H2949 FHP, Inc. 4/2 20,120 13.0 22.3 21,374 13.1 23.4 3.5
H0303 FHP, Inc. 10/ 19 \a \a 86,650 7.0 34.6 2.9
9
H0356 Premier HealthCare, Inc. 0/5 429 \a \a 1,255 \a \a \a
Los Angeles-Long Beach, CA PMSA
-----------------------------------------------------------------------------------------
H0557 Foundation Health, A 4/7 3,491 33.7 38.1 8,344 28.8 33.9 9.7
California Plan
H0576 Prudential Health Care 2/6 820 26.6 44.5 2,698 22.7 35.5 8.6
Plan of CA
H0564 CaliforniaCare Health 3/4 384 25.8 33.3 1,303 32.5 37.1 10.1
Plans
H9016 Watts Foundation Health, 11/ 9,680 20.5 48.3 12,334 22.0 49.7 18.6
Inc./United Health Plan 9
H0558 MaxiCare, A California 5/1 1,780 19.0 55.0 2,864 23.7 46.8 10.0
Corporation
H0523 Aetna HP of California, 10/ 7,450 17.8 32.3 55,036 11.5 26.5 5.0
Inc. 5
H0554 CareAmerica Health Plans 6/2 25,111 15.0 31.1 38,358 17.1 27.5 9.0
H0581 Cigna Healthcare of 2/6 9,705 14.5 36.2 13,496 15.9 32.6 8.6
California
H0563 Health Net 4/1 11,876 13.4 26.7 50,913 13.6 22.0 5.1
H9030 FHP, Inc. 11/ 86,171 11.1 28.5 200,230 12.6 26.7 6.7
9
H0543 Pacificare of CA, Inc. 11/ 71,399 8.0 31.3 284,714 7.3 33.1 4.0
4
H0545 Inter Valley Health 10/ 7,695 5.7 23.4 13,112 10.4 15.2 3.7
Plan, Inc. 7
H0524 Kaiser Foundation HP, 9/4 82,382 2.7 62.3 169,003 2.9 55.5 2.8
Inc.
H0504 California Physicians' 0/5 112 \a \a 204 \a \a \a
Services Corp.
Medford-Ashland, OR MSA
-----------------------------------------------------------------------------------------
H3805 Pacificare of Oregon 10/ 1,299 5.9 63.6 35,938 8.2 43.3 2.7
11
H3855 Providence Health Plans 2/8 3,168 4.4 61.9 3,240 4.6 63.1 2.1
Merced, CA MSA
-----------------------------------------------------------------------------------------
H0568 National Med, Inc. 3/1 1,002 5.4 63.0 11,152 5.1 33.9 1.7
H0559 Pacificare of 4/9 104 \a \a 89,360 8.9 40.0 3.5
California, Inc.
Modesto, CA MSA
-----------------------------------------------------------------------------------------
H0559 Pacificare of 4/9 6,674 13.8 20.2 89,360 8.9 40.0 3.5
California, Inc.
H0580 FHP, Inc. 1/ 2,751 6.6 36.5 13,124 14.4 43.8 5.8
10
H0568 National Med, Inc. 3/1 7,858 5.0 24.9 11,152 5.1 33.9 1.7
H0586 Foundation Health, A 2/9 20 \a \a 12,319 11.6 30.6 4.5
California Plan
Oakland, CA PMSA
-----------------------------------------------------------------------------------------
H0580 FHP, Inc. 1/ 2,296 18.9 50.7 13,124 14.4 43.8 5.8
10
H0594 Lifeguard, Inc. 1/3 460 13.7 22.2 2,930 12.5 40.1 3.8
H0577 Prudential Health Care 2/6 973 12.4 36.4 2,711 15.6 29.8 7.1
Plan of CA
H0547 Aetna Health Plan of 10/ 3,478 9.1 30.2 26,859 5.4 37.2 3.1
California, Inc. 11
H0562 Health Net 4/1 15,718 9.1 25.9 58,588 11.2 23.3 3.7
H0559 Pacificare of 4/9 17,371 7.2 39.3 89,360 8.9 40.0 3.5
California, Inc.
H0583 Kaiser Foundation HP, 2/6 41,836 1.2 40.2 142,719 1.8 47.3 0.9
Inc.
H0591 CaliforniaCare Health 1/3 202 \a \a 650 43.9 35.8 10.2
Plans
H0588 Cigna Healthcare of 1/4 136 \a \a 859 21.9 40.4 7.9
California
H0568 National Med, Inc. 3/1 2 \a \a 11,152 5.1 33.9 1.7
H0599 California Physicians' 0/6 27 \a \a 133 \a \a \a
Services Corp.
Olympia, WA PMSA
-----------------------------------------------------------------------------------------
H5005 Pacificare of 9/2 1,811 6.5 65.0 43,797 6.6 47.5 2.7
Washington, Inc.
H5050 Group Health Coop. of 8/0 4,031 3.4 40.9 50,900 4.0 36.1 1.9
Puget Sound
H5055 Qual-Med Washington 2/ 39 \a \a 275 10.9 46.7 2.8
Health Plan, Inc. 11
H5063 Options Health Care, 0/4 73 \a \a 974 \a \a \a
Inc.
Orange County, CA PMSA
-----------------------------------------------------------------------------------------
H0558 MaxiCare, A California 5/1 895 33.0 39.3 2,864 23.7 46.8 10.0
Corporation
H9016 Watts Foundation Health, 11/ 509 31.3 45.3 12,334 22.0 49.7 18.6
Inc./United Health Plan 9
H0576 Prudential Health Care 2/6 327 22.6 40.5 2,698 22.7 35.5 8.6
Plan of CA
H0523 Aetna HP of California, 10/ 2,439 20.3 23.6 55,036 11.5 26.5 5.0
Inc. 5
H0554 CareAmerica Health Plans 6/2 4,257 16.0 24.5 38,358 17.1 27.5 9.0
H0563 Health Net 4/1 6,678 13.8 18.1 50,913 13.6 22.0 5.1
H0581 Cigna Healthcare of 2/6 1,796 11.3 20.7 13,496 15.9 32.6 8.6
California
H9030 FHP, Inc. 11/ 33,450 10.2 18.7 200,230 12.6 26.7 6.7
9
H0543 Pacificare of CA, Inc. 11/ 39,566 6.4 37.0 284,714 7.3 33.1 4.0
4
H0524 Kaiser Foundation HP, 9/4 13,610 3.3 52.2 169,003 2.9 55.5 2.8
Inc.
H0564 CaliforniaCare Health 3/4 117 \a \a 1,303 32.5 37.1 10.1
Plans
H0557 Foundation Health, A 4/7 12 \a \a 8,344 28.8 33.9 9.7
California Plan
H0545 Inter Valley Health 10/ 127 \a \a 13,112 10.4 15.2 3.7
Plan, Inc. 7
H0504 California Physicians' 0/5 42 \a \a 204 \a \a \a
Services Corp.
Phoenix-Mesa, AZ MSA
-----------------------------------------------------------------------------------------
H0307 Humana Health Plan, Inc. 8/7 17,575 16.4 26.1 18,273 17.1 28.2 7.1
H0350 Maricopa County Health 3/0 2,017 11.2 63.1 2,105 11.4 65.3 2.7
Plan
H0351 Intergroup Prepaid 4/8 21,629 9.4 36.5 39,571 8.5 44.0 3.2
Health Serv of AZ, Inc.
H0352 Partners Health Plan of 4/5 386 9.3 47.2 18,974 5.1 50.1 2.1
Arizona, Inc.
H0303 FHP, Inc. 10/ 61,837 6.9 29.9 86,650 7.0 34.6 2.9
9
H0354 Cigna HealthCare of 4/0 27,002 6.0 41.2 29,459 6.8 40.3 3.4
Arizona, Inc.
H0355 Blue Cross/Blue Shield 0/5 455 \a \a 600 \a \a \a
of Ariz.
H0356 Premier HealthCare, Inc. 0/5 13 \a \a 1,255 \a \a \a
Portland-Vancouver, OR-WA PMSA
-----------------------------------------------------------------------------------------
H3805 Pacificare of Oregon 10/ 25,316 7.4 28.1 35,938 8.2 43.3 2.7
11
H3856 HMO Oregon 3/0 16,460 6.0 57.6 16,876 6.3 57.5 4.3
H9003 Kaiser Foundation HP of 11/ 22,063 5.2 50.5 32,390 5.1 52.6 2.9
the NW 9
H9047 Providence Health Plans 9/ 22,683 3.5 47.6 24,208 3.8 49.9 2.7
10
H5005 Pacificare of 9/2 4,743 3.0 81.1 43,797 6.6 47.5 2.7
Washington, Inc.
H3857 SelectCare Health Plans 2/2 176 \a \a 1,800 8.2 61.9 2.3
H9049 HMO Oregon, Inc. 8/ 16 \a \a 22 \a \a \a
10
Provo-Orem, UT MSA
-----------------------------------------------------------------------------------------
H4653 FHP of Utah, Inc. 0/4 1,014 \a \a 5,647 \a \a \a
Pueblo, CO MSA
-----------------------------------------------------------------------------------------
H0609 FHP of Colorado, Inc. 10/ 4,876 2.1 94.2 40,369 7.0 44.1 3.0
6
Redding, CA MSA
-----------------------------------------------------------------------------------------
H0593 National Med, Inc. 0/9 415 7.7 100. 523 6.6 100. 2.6
0 0
Reno, NV MSA
-----------------------------------------------------------------------------------------
H2931 Health Plan of Nevada, 11/ 739 18.3 54.1 24,892 55.5 8.5 8.3
Inc. 6
H2960 Hometown Health Plan 1/1 3,445 5.8 64.2 3,550 6.0 65.7 1.6
Riverside-San Bernardino, CA PMSA
-----------------------------------------------------------------------------------------
H0554 CareAmerica Health Plans 6/2 6,333 25.2 18.2 38,358 17.1 27.5 9.0
H0576 Prudential Health Care 2/6 661 22.1 28.1 2,698 22.7 35.5 8.6
Plan of CA
H0557 Foundation Health, A 4/7 2,254 22.0 29.4 8,344 28.8 33.9 9.7
California Plan
H0581 Cigna Healthcare of 2/6 418 18.4 16.9 13,496 15.9 32.6 8.6
California
H0545 Inter Valley Health 10/ 4,761 17.3 9.2 13,112 10.4 15.2 3.7
Plan, Inc. 7
H9030 FHP, Inc. 11/ 31,051 14.0 21.0 200,230 12.6 26.7 6.7
9
H0563 Health Net 4/1 7,239 13.3 21.3 50,913 13.6 22.0 5.1
H0523 Aetna HP of California, 10/ 36,394 9.2 21.0 55,036 11.5 26.5 5.0
Inc. 5
H0543 Pacificare of CA, Inc. 11/ 42,470 8.0 28.0 284,714 7.3 33.1 4.0
4
H0524 Kaiser Foundation HP, 9/4 26,840 3.0 44.3 169,003 2.9 55.5 2.8
Inc.
H0564 CaliforniaCare Health 3/4 163 \a \a 1,303 32.5 37.1 10.1
Plans
H0558 MaxiCare, A California 5/1 113 \a \a 2,864 23.7 46.8 10.0
Corporation
H0504 California Physicians' 0/5 40 \a \a 204 \a \a \a
Services Corp.
Sacramento, CA PMSA
-----------------------------------------------------------------------------------------
H0577 Prudential Health Care 2/6 716 21.4 18.3 2,711 15.6 29.8 7.1
Plan of CA
H0562 Health Net 4/1 9,352 19.9 11.5 58,588 11.2 23.3 3.7
H0580 FHP, Inc. 1/ 1,842 18.5 38.8 13,124 14.4 43.8 5.8
10
H0586 Foundation Health, A 2/9 11,555 11.2 28.4 12,319 11.6 30.6 4.5
California Plan
H0559 Pacificare of 4/9 10,990 7.5 32.6 89,360 8.9 40.0 3.5
California, Inc.
H0583 Kaiser Foundation HP, 2/6 22,169 1.8 31.6 142,719 1.8 47.3 0.9
Inc.
H0591 CaliforniaCare Health 1/3 205 \a \a 650 43.9 35.8 10.2
Plans
H0599 California Physicians' 0/6 57 \a \a 133 \a \a \a
Services Corp.
Salem, OR PMSA
-----------------------------------------------------------------------------------------
H3805 Pacificare of Oregon 10/ 2,244 14.3 57.6 35,938 8.2 43.3 2.7
11
H9003 Kaiser Foundation HP of 11/ 5,251 4.0 54.2 32,390 5.1 52.6 2.9
the NW 9
H3858 SelectCare Health Plans 1/3 1,680 2.6 81.8 8,353 4.9 64.1 2.6
H9047 Providence Health Plans 9/ 140 \a \a 24,208 3.8 49.9 2.7
10
Salinas, CA MSA
-----------------------------------------------------------------------------------------
H0559 Pacificare of 4/9 3,287 7.2 95.7 89,360 8.9 40.0 3.5
California, Inc.
Salt Lake City-Ogden, UT MSA
-----------------------------------------------------------------------------------------
H4651 IHC Care, Inc. 0/8 1,822 7.2 54.5 1,855 7.4 53.8 1.7
H4653 FHP of Utah, Inc. 0/4 4,383 \a \a 5,647 \a \a \a
San Diego, CA MSA
-----------------------------------------------------------------------------------------
H0581 Cigna Healthcare of 2/6 1,109 30.5 26.9 13,496 15.9 32.6 8.6
California
H9030 FHP, Inc. 11/ 26,731 14.8 25.9 200,230 12.6 26.7 6.7
9
H0563 Health Net 4/1 8,370 12.4 22.8 50,913 13.6 22.0 5.1
H0543 Pacificare of CA, Inc. 11/ 68,771 5.8 32.6 284,714 7.3 33.1 4.0
4
H0524 Kaiser Foundation HP, 9/4 26,080 2.0 58.6 169,003 2.9 55.5 2.8
Inc.
H0564 CaliforniaCare Health 3/4 130 \a \a 1,303 32.5 37.1 10.1
Plans
H0557 Foundation Health, A 4/7 15 \a \a 8,344 28.8 33.9 9.7
California Plan
H0576 Prudential Health Care 2/6 178 \a \a 2,698 22.7 35.5 8.6
Plan of CA
San Francisco, CA PMSA
-----------------------------------------------------------------------------------------
H0580 FHP, Inc. 1/ 1,750 23.7 50.8 13,124 14.4 43.8 5.8
10
H0588 Cigna Healthcare of 1/4 521 23.0 40.0 859 21.9 40.4 7.9
California
H0577 Prudential Health Care 2/6 430 14.2 29.5 2,711 15.6 29.8 7.1
Plan of CA
H0559 Pacificare of 4/9 6,585 11.4 30.4 89,360 8.9 40.0 3.5
California, Inc.
H0562 Health Net 4/1 18,216 5.9 31.3 58,588 11.2 23.3 3.7
H0547 Aetna Health Plan of 10/ 20,424 3.6 39.6 26,859 5.4 37.2 3.1
California, Inc. 11
H0583 Kaiser Foundation HP, 2/6 28,830 1.3 47.9 142,719 1.8 47.3 0.9
Inc.
H0591 CaliforniaCare Health 1/3 44 \a \a 650 43.9 35.8 10.2
Plans
H0594 Lifeguard, Inc. 1/3 173 \a \a 2,930 12.5 40.1 3.8
H0571 Chinese Community Health 0/8 169 \a \a 174 \a \a \a
Plan
H0599 California Physicians' 0/6 36 \a \a 133 \a \a \a
Services Corp.
San Jose, CA PMSA
-----------------------------------------------------------------------------------------
H0577 Prudential Health Care 2/6 553 13.4 39.2 2,711 15.6 29.8 7.1
Plan of CA
H0594 Lifeguard, Inc. 1/3 2,216 12.2 45.4 2,930 12.5 40.1 3.8
H0547 Aetna Health Plan of 10/ 2,575 12.2 31.9 26,859 5.4 37.2 3.1
California, Inc. 11
H0580 FHP, Inc. 1/ 3,847 11.1 34.2 13,124 14.4 43.8 5.8
10
H0559 Pacificare of 4/9 20,098 7.6 37.5 89,360 8.9 40.0 3.5
California, Inc.
H0562 Health Net 4/1 3,920 7.2 31.7 58,588 11.2 23.3 3.7
H0583 Kaiser Foundation HP, 2/6 18,221 1.1 42.6 142,719 1.8 47.3 0.9
Inc.
H0591 CaliforniaCare Health 1/3 164 \a \a 650 43.9 35.8 10.2
Plans
H0588 Cigna Healthcare of 1/4 191 \a \a 859 21.9 40.4 7.9
California
H0599 California Physicians' 0/6 19 \a \a 133 \a \a \a
Services Corp.
San Luis Obispo-Atascadero-Paso Robles, CA MSA
-----------------------------------------------------------------------------------------
H0563 Health Net 4/1 3,674 20.4 10.9 50,913 13.6 22.0 5.1
H0595 Lifeguard, Inc. 2/0 834 20.0 25.7 1,036 19.7 29.9 6.4
H0576 Prudential Health Care 2/6 338 8.9 40.0 2,698 22.7 35.5 8.6
Plan of CA
H0543 Pacificare of CA, Inc. 11/ 6,036 7.6 44.8 284,714 7.3 33.1 4.0
4
H0564 CaliforniaCare Health 3/4 127 \a \a 1,303 32.5 37.1 10.1
Plans
Santa Barbara-Santa Maria-Lompoc, CA MSA
-----------------------------------------------------------------------------------------
H9030 FHP, Inc. 11/ 551 19.4 53.3 200,230 12.6 26.7 6.7
9
H0563 Health Net 4/1 6,679 12.3 13.5 50,913 13.6 22.0 5.1
H0543 Pacificare of CA, Inc. 11/ 9,712 7.3 35.0 284,714 7.3 33.1 4.0
4
H0564 CaliforniaCare Health 3/4 220 \a \a 1,303 32.5 37.1 10.1
Plans
Santa Cruz-Watsonville, CA PMSA
-----------------------------------------------------------------------------------------
H0559 Pacificare of 4/9 3,363 3.9 94.7 89,360 8.9 40.0 3.5
California, Inc.
Santa Fe, NM MSA
-----------------------------------------------------------------------------------------
H3204 FHP of New Mexico, Inc. 10/ 1,038 8.3 68.6 17,491 5.4 48.6 3.8
9
H3251 Lovelace Health Plan, 3/0 1,688 8.1 30.1 13,106 4.0 56.8 2.0
Inc.
H3249 QualMed, New Mexico 4/9 96 \a \a 1,953 11.7 34.5 4.2
Santa Rosa, CA PMSA
-----------------------------------------------------------------------------------------
H0562 Health Net 4/1 840 23.2 13.8 58,588 11.2 23.3 3.7
H0559 Pacificare of 4/9 1,362 18.4 32.3 89,360 8.9 40.0 3.5
California, Inc.
H0566 Health Plan of the 3/4 9,602 6.5 33.7 9,773 6.5 34.5 2.5
Redwoods
H0583 Kaiser Foundation HP, 2/6 7,870 1.3 52.0 142,719 1.8 47.3 0.9
Inc.
H0580 FHP, Inc. 1/ 3 \a \a 13,124 14.4 43.8 5.8
10
Seattle-Bellevue-Everett, WA PMSA
-----------------------------------------------------------------------------------------
H5052 Providence Good Health 3/7 9,381 9.4 33.9 16,004 7.9 39.8 2.4
Plan of Washington
H5005 Pacificare of 9/2 25,735 4.4 50.5 43,797 6.6 47.5 2.7
Washington, Inc.
H5050 Group Health Coop. of 8/0 34,040 3.6 29.5 50,900 4.0 36.1 1.9
Puget Sound
H5055 Qual-Med Washington 2/ 117 \a \a 275 10.9 46.7 2.8
Health Plan, Inc. 11
H5063 Options Health Care, 0/4 603 \a \a 974 \a \a \a
Inc.
Spokane, WA MSA
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H5053 Qual-Med, Inland 3/7 1,852 8.9 31.1 2,250 8.2 33.7 1.6
Northwest Division
H5066 Medical Service 0/7 667 6.9 85.2 669 6.9 85.2 2.0
Corporation of E. WA
H5005 Pacificare of 9/2 1,258 6.9 49.4 43,797 6.6 47.5 2.7
Washington, Inc.
H5052 Providence Good Health 3/7 2,828 4.5 37.0 16,004 7.9 39.8 2.4
Plan of Washington
H5069 Group Health Northwest 0/ 698 2.8 43.8 709 2.9 41.2 0.7
10
Stockton-Lodi, CA MSA
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H0559 Pacificare of 4/9 6,810 7.9 48.8 89,360 8.9 40.0 3.5
California, Inc.
H0583 Kaiser Foundation HP, 2/6 3,454 4.3 33.1 142,719 1.8 47.3 0.9
Inc.
H0568 National Med, Inc. 3/1 1,618 3.5 29.8 11,152 5.1 33.9 1.7
H0586 Foundation Health, A 2/9 152 \a \a 12,319 11.6 30.6 4.5
California Plan
Tacoma, WA PMSA
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H5005 Pacificare of 9/2 6,432 16.9 30.3 43,797 6.6 47.5 2.7
Washington, Inc.
H5052 Providence Good Health 3/7 586 16.2 45.3 16,004 7.9 39.8 2.4
Plan of Washigton
H5050 Group Health Coop. of 8/0 4,162 4.0 38.8 50,900 4.0 36.1 1.9
Puget Sound
H5055 Qual-Med Washington 2/ 93 \a \a 275 10.9 46.7 2.8
Health Plan, Inc. 11
H5063 Options Health Care, 0/4 86 \a \a 974 \a \a \a
Inc.
Tucson, AZ MSA
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H0354 Cigna HealthCare of 4/0 1,827 15.5 25.4 29,459 6.8 40.3 3.4
Arizona, Inc.
H0351 Intergroup Prepaid 4/8 10,010 7.3 38.3 39,571 8.5 44.0 3.2
Health Serv of AZ, Inc.
H0303 FHP, Inc. 10/ 22,144 5.6 37.0 86,650 7.0 34.6 2.9
9
H0352 Partners Health Plan of 4/5 16,005 4.4 45.8 18,974 5.1 50.1 2.1
Arizona, Inc.
H0307 Humana Health Plan, Inc. 8/7 97 \a \a 18,273 17.1 28.2 7.1
H0355 Blue Cross/Blue Shield 0/5 128 \a \a 600 \a \a \a
of Ariz.
H0356 Premier HealthCare, Inc. 0/5 4 \a \a 1,255 \a \a \a
Vallejo-Fairfield-Napa, CA PMSA
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H0562 Health Net 4/1 1,086 15.7 13.5 58,588 11.2 23.3 3.7
H0559 Pacificare of 4/9 3,677 11.7 41.9 89,360 8.9 40.0 3.5
California, Inc.
H0583 Kaiser Foundation HP, 2/6 8,836 1.3 58.8 142,719 1.8 47.3 0.9
Inc.
H0580 FHP, Inc. 1/ 12 \a \a 13,124 14.4 43.8 5.8
10
Ventura, CA PMSA
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H0557 Foundation Health, A 4/7 2,468 27.3 27.5 8,344 28.8 33.9 9.7
California Plan
H9030 FHP, Inc. 11/ 3,666 20.1 19.4 200,230 12.6 26.7 6.7
9
H0523 Aetna HP of California, 10/ 960 16.4 33.8 55,036 11.5 26.5 5.0
Inc. 5
H0563 Health Net 4/1 2,999 12.1 28.7 50,913 13.6 22.0 5.1
H0543 Pacificare of CA, Inc. 11/ 13,726 6.1 37.4 284,714 7.3 33.1 4.0
4
H0524 Kaiser Foundation HP, 9/4 2,104 2.3 52.1 169,003 2.9 55.5 2.8
Inc.
H0564 CaliforniaCare Health 3/4 31 \a \a 1,303 32.5 37.1 10.1
Plans
H0576 Prudential Health Care 2/6 131 \a \a 2,698 22.7 35.5 8.6
Plan of CA
H0554 CareAmerica Health Plans 6/2 49 \a \a 38,358 17.1 27.5 9.0
H0581 Cigna Healthcare of 2/6 187 \a \a 13,496 15.9 32.6 8.6
California
H0545 Inter Valley Health 10/ 3 \a \a 13,112 10.4 15.2 3.7
Plan, Inc. 7
Visalia-Tulare-Porterville, CA MSA
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H0559 Pacificare of 4/9 385 19.0 98.6 89,360 8.9 40.0 3.5
California, Inc.
H0570 Health Net 3/2 141 \a \a 4,248 47.7 19.5 4.9
H9030 FHP, Inc. 11/ 76 \a \a 200,230 12.6 26.7 6.7
9
H0584 Kaiser Foundation HP, 1/ 35 \a \a 5,790 4.0 64.7 2.0
Inc. 11
Yolo, CA PMSA
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H0586 Foundation Health, A 2/9 343 9.3 34.4 12,319 11.6 30.6 4.5
California Plan
H0562 Health Net 4/1 3,111 3.4 65.7 58,588 11.2 23.3 3.7
H0583 Kaiser Foundation HP, 2/6 1,348 1.5 5.0 142,719 1.8 47.3 0.9
Inc.
Yuba City, CA MSA
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H0562 Health Net 4/1 1,126 7.0 79.7 58,588 11.2 23.3 3.7
H0583 Kaiser Foundation HP, 2/6 96 \a \a 142,719 1.8 47.3 0.9
Inc.
Yuma, AZ MSA
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H0303 FHP, Inc. 10/ 27 \a \a 86,650 7.0 34.6 2.9
9
H0352 Partners Health Plan of 4/5 9 \a \a 18,974 5.1 50.1 2.1
Arizona, Inc.
H0356 Premier HealthCare, Inc. 0/5 532 \a \a 1,255 \a \a \a
Others, Not in an MSA
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H0303 FHP, Inc. 10/ 539 24.3 55.7 86,650 7.0 34.6 2.9
9
H2931 Health Plan of Nevada, 11/ 575 12.5 94.4 24,892 55.5 8.5 8.3
Inc. 6
H0609 FHP of Colorado, Inc. 10/ 461 10.8 98.0 40,369 7.0 44.1 3.0
6
H0562 Health Net 4/1 651 9.5 93.5 58,588 11.2 23.3 3.7
H3805 Pacificare of Oregon 10/ 5,833 8.6 87.6 35,938 8.2 43.3 2.7
11
H3857 SelectCare Health Plans 2/2 1,566 7.9 63.7 1,800 8.2 61.9 2.3
H9047 Providence Health Plans 9/ 912 7.7 67.1 24,208 3.8 49.9 2.7
10
H5005 Pacificare of 9/2 3,225 6.6 80.3 43,797 6.6 47.5 2.7
Washington, Inc.
H0352 Partners Health Plan of 4/5 2,314 6.3 51.7 18,974 5.1 50.1 2.1
Arizona, Inc.
H5050 Group Health Coop. of 8/0 2,950 6.0 47.8 50,900 4.0 36.1 1.9
Puget Sound
H0568 National Med, Inc. 3/1 448 5.1 87.0 11,152 5.1 33.9 1.7
H0351 Intergroup Prepaid 4/8 6,924 4.7 73.5 39,571 8.5 44.0 3.2
Health Serv of AZ, Inc.
H5052 Providence Good Health 3/7 3,084 4.2 71.5 16,004 7.9 39.8 2.4
Plan of Washington
H9003 Kaiser Foundation HP of 11/ 3,780 3.6 51.8 32,390 5.1 52.6 2.9
the NW 9
H3251 Lovelace Health Plan, 3/0 741 3.1 52.2 13,106 4.0 56.8 2.0
Inc.
H3858 SelectCare Health Plans 1/3 1,952 2.8 80.0 8,353 4.9 64.1 2.6
H1230 Kaiser Foundation HP, 10/ 3,370 1.1 81.6 13,795 2.0 81.1 1.2
Inc. 8
H0570 Health Net 3/2 1 \a \a 4,248 47.7 19.5 4.9
H0581 Cigna Healthcare of 2/6 36 \a \a 13,496 15.9 32.6 8.6
California
H0615 Qual-Med, Inc, Denver 8/5 9 \a \a 7,383 14.0 21.6 3.6
H9030 FHP, Inc. 11/ 137 \a \a 200,230 12.6 26.7 6.7
9
H0559 Pacificare of 4/9 139 \a \a 89,360 8.9 40.0 3.5
California, Inc.
H4651 IHC Care, Inc. 0/8 6 \a \a 1,855 7.4 53.8 1.7
H0593 National Med, Inc. 0/9 101 \a \a 523 6.6 100. 2.6
0
H3204 FHP of New Mexico, Inc. 10/ 53 \a \a 17,491 5.4 48.6 3.8
9
H0630 Kaiser Foundation HP of 11/ 192 \a \a 32,721 4.4 31.3 2.3
Colo. 1
H0584 Kaiser Foundation HP, 1/ 103 \a \a 5,790 4.0 64.7 2.0
Inc. 11
H0583 Kaiser Foundation HP, 2/6 141 \a \a 142,719 1.8 47.3 0.9
Inc.
H0356 Premier HealthCare, Inc. 0/5 348 \a \a 1,255 \a \a \a
H4653 FHP of Utah, Inc. 0/4 202 \a \a 5,647 \a \a \a
H5063 Options Health Care, 0/4 47 \a \a 974 \a \a \a
Inc.
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\a This plan either had an average enrollment of less than 250 or was
in operation 6 months or less.
*** End of document. ***