Mount Sinai bets on Medicare Advantage

Another health system is taking a step into insurance with Medicare Advantage, banking on seniors wanting access to a prestigious brand.

Mount Sinai Health is partnering with the provider-based managed care administrator Healthfirst to offer seniors in Manhattan a Medicare Advantage HMO, including a majority of physicians from Mount Sinai and its hospitals, plus a second tier of other providers.

"This plan gives members affordable and exclusive access to Mount Sinai's top-rated network of doctors and specialists," said Kenneth Davis, MD, CEO and president of Mount Sinai Health System.

The preferred, Tier 1 will give seniors access to Mount Sinai providers, with lower levels of cost sharing, while the Tier 2 network will offer access to other providers in Greater New York City in Healthfirst's network.

In the main Mount Sinai network, seniors will not have any copayments for primary care visits, annual eye exams or Medicare-covered preventive services. They will be able to get 12 free round trips of car service to and from doctors' appointments each year.

"Our partnership will blend the best elements of our well-established Medicare Advantage plan infrastructure with the outstanding innovation and clinical excellence of the Sinai system to create a cost-efficient, superb new offering for Medicare members," said Pat Wang, CEO of Healthfirst, a 20-year-old managed care company created by New York hospitals.

The introduction of Mount Sinai's HMO is the latest Medicare Advantage or commercial insurance plan launched by a provider in pursuit of "moving up the food chain" -- trying to integrate comprehensive healthcare and benefits as a route to higher quality, lower cost and greater access.

The University of North Carolina Health Care is also launching a new Medicare Advantage HMO plan for seniors in Wake County, home to greater Raleigh, while Catholic Health Initiatives, the 93-hospital system based in Denver, is growing a portfolio of commercial and Medicare plans nationally.

In Pennsylvania, the University of Pittsburgh Medical Center's Medicare Advantage plan, UPMC for Life, is making some moves to attract more seniors: lower premiums for four plans next year and continuing to offer a $0 premium plan.

UPMC is also increasing its dental benefits; most Medicare Advantage plans will offer preventative dental services, such as a $15 oral exam and cleaning and $15 bitewing x-ray.