United States General Accounting Office

GAO 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

GAO United States

General Accounting Office

Washington, D.C. 20548

Health, Education, and

Human Services Division

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

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.

Page 1 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

(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.

Results in Brief 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.

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.

Page 2 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

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 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

4

GAO/HEHS-97-23, Oct. 22, 1996.

Page 3 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

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

Disenrollment Rates

Exceed 20 Percent at

Many Medicare HMOs

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

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.

7

Some HMOs had higher disenrollment rates in portions of their service areas.

Page 4 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

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 HMOsa 194

aExcludes 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

Rapid disenrollment rate

Number of

HMOs

Greater than 15% 4

10% - 15% 17

3% - 9% 108

Less than 3% 65

Total HMOsa 194

aExcludes HMOs that operated less than 7 months in 1996 or that had an average monthly

membership below 250.

Source: GAO analysis of HCFA data.

Among Competing

HMOs, Disenrollment

Rates Vary Widely

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

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.

Page 5 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

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

PCA

AV-MED

United

Humana

Health Options

Cigna

HIP

Prudential

0 10 20 30 40 50 60 70

Percentage

Source: Group Health Plan File, Feb. 1997.

Page 6 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

New Member

Disenrollment Rates

Are Slightly Lower in

New HMOs

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.)

Page 7 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

Figure 2: Distribution of Medicare Risk

HMOs by Years in Operation as of

December 31, 1996

 6 Months or Less

7 to 23 Months

Two Years or More

15%

27%

59%

Age of Medicare Contract

Note: Does not add to 100 percent because of rounding.

Source: HCFA Group Health Plan System.

Page 8 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

Figure 3: Distribution of Medicare Risk

HMOs by Size of Plan, 1996

10%

13 - 249

11%

29% 250 - 999

1,000 - 4,999

20%

5,000 - 12,999

30%

13,000 and Above

Average Plan Membership

Source: HCFA Group Health Plan System.

Many HMO

Disenrollees Switch to

Fee-for-Service

Instead of Another

Available HMO

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

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

Page 9 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
B-279786 

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.

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

Page 10 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Page 11 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Contents

Letter 1

Appendix I 

Methodology

14

Data Sources 14

Rate Calculations 14

Appendix II 

Medicare Risk HMO

Voluntary

Disenrollment Rates,

1996

16

Explanation of Column Headings 16

Sort Order 16

Tables Table 1: Distribution of HMOs by Annual Disenrollment Rate,

1996

5

Table 2: Distribution of HMOs by Rapid Disenrollment Rate, 1996 5

Table II.1: Voluntary Disenrollment Rates for Medicare Risk

HMOs, Northeast Region

17

Table II.2: Voluntary Disenrollment Rates for Medicare Risk

HMOs, Southern Region

23

Table II.3: Voluntary Disenrollment Rates for Medicare Risk

HMOs, Midwest Region

31

Table II.4: Voluntary Disenrollment Rates for Medicare Risk

HMOs, Western Region

34

Figures Figure 1: Annual Rate of Voluntary Disenrollment at HMOs in the

Tampa Market, 1996, as a Percentage of Average Number of Plan

Members

6

Figure 2: Distribution of Medicare Risk HMOs by Years in

Operation as of December 31, 1996

8

Figure 3: Distribution of Medicare Risk HMOs by Size of Plan,

1996

9

Page 12 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Contents

Abbreviations

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

Page 13 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix I 

Methodology

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 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 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

9

GAO/HEHS-97-23, Oct. 22, 1996.

Page 14 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix I 

Methodology

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.

Page 15 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

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

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 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.

Page 16 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Table II.1: Voluntary Disenrollment Rates for Medicare Risk HMOs, Northeast Region

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Albany-Schenectady-Troy, NY MSA

H3361 WellCare of New York, Inc. 1/3 441 7.9 68.6 2,878 11.7 57.9 2.5

H3368 Capital Area Community HP 0/3 1,460 a a 1,479 a a a

Allentown-Bethlehem-Easton, PA MSA

H3962 Keystone Health Plan Central, Inc. 0/7 447 19.9 82.7 1,863 19.5 82.1 4.3

H3931 U.S. Health Care Systems of PA 11/2 5,408 6.4 85.0 63,494 5.3 62.1 3.3

H3956 Aetna Health Plans of Central/East PA 2/6 519 5.8 56.7 9,065 16.6 39.0 4.2

H3954 Geisinger Health Plan 2/9 99 a a 15,028 3.0 73.6 1.8

Altoona, PA MSA

H3957 Keystone Health Plan West 1/8 1,047 a a 48,663 5.2 83.0 2.1

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. 0/11 395 9.9 71.8 2,056 9.1 66.8 2.7

H3157 Aetna Health Plans of New Jersey 0/11 924 7.3 58.1 11,688 9.1 51.2 1.9

H3154 Medigroup, Inc. 0/10 213 a a 3,994 22.4 75.9 6.9

H3155 First Option Health Plan of NJ, Inc. 0/11 139 a a 2,996 11.2 84.4 3.7

H3107 Oxford Health Plans (New Jersey),

Inc. 4/10 16 a a 9,417 8.1 65.5 3.6

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. MASS 2/6 1,055 10.6 92.0 10,143 12.6 57.6 4.4

H2258 Pilgrim Health Care, Inc. 1/11 163 a a 8,065 6.8 45.8 2.0

H2261 HMO BLUE, Inc. 0/10 101 a a 9,759 5.2 44.4 2.0

Bergen-Passaic, NJ PMSA

H3154 Medigroup, Inc. 0/10 609 22.1 72.3 3,994 22.4 75.9 6.9

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 of NJ, Inc. 0/11 760 12.6 92.0 2,996 11.2 84.4 3.7

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 Jersey),

Inc. 4/10 5,425 4.7 67.6 9,417 8.1 65.5 3.6

H3157 Aetna Health Plans of New Jersey 0/11 216 a a 11,688 9.1 51.2 1.9

Binghamton, NY MSA

H3371 Community Health Plan 0/2 158 a a 159 a a a

(continued)

Page 17 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH NECMA

H2255 U.S. Healthcare, Inc. MASS 2/6 8,274 12.4 53.6 10,143 12.6 57.6 4.4

H3049 U.S. HealthCare of New Hampshire,

Inc. 2/6 848 12.0 96.1 967 13.3 91.5 6.4

H4102 United Health Plans of New England 8/11 3,062 9.8 30.1 14,317 4.8 49.4 2.0

H2261 HMO BLUE, Inc. 0/10 4,805 7.0 37.3 9,759 5.2 44.4 2.0

H2258 Pilgrim Health Care, Inc. 1/11 7,707 6.5 44.6 8,065 6.8 45.8 2.0

H2256 Tufts Associated HMO, Inc. 2/3 31,276 4.7 59.8 32,787 4.9 61.0 2.1

H2206 Harvard Community Health Plan 11/6 20,207 2.6 54.6 23,881 2.9 53.2 1.2

H9001 Fallon Community Health Plan, Inc. 11/9 26,105 1.3 50.3 27,811 1.5 49.9 0.8

H2204 Harvard Community Health Plan of

N.E. 11/4 193 a a 217 a a a

H4153 United Health Plans of New England 0/3 40 a a 174 a a a

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, Inc. 1/3 419 23.1 34.0 2,878 11.7 57.9 2.5

H3366 Physicians Health SVC of NY, Inc. 0/10 1 a a 679 16.8 71.6 3.7

H3312 U.S. HealthCare, Inc. 10/1 110 a a 15,096 12.9 57.3 5.8

H3373 Capital Area Community HP 0/2 147 a a 214 a a a

Erie, PA MSA

H3957 Keystone Health Plan West 1/8 1,800 a a 48,663 5.2 83.0 2.1

Harrisburg-Lebanon-Carlisle, PA MSA

H3962 Keystone Health Plan Central, Inc. 0/7 429 25.2 79.4 1,863 19.5 82.1 4.3

H3931 U.S. Health Care Systems of PA 11/2 1,167 12.3 75.5 63,494 5.3 62.1 3.3

H3956 Aetna Health Plans of Central/East PA 2/6 3,120 8.4 79.8 9,065 16.6 39.0 4.2

H3960 HealthAmerica of Central PA 0/5 108 a a 153 a a a

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 0/10 126 a a 1,390 13.7 50.3 4.2

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

(continued)

Page 18 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H3107 Oxford Health Plans (New Jersey),

Inc. 4/10 670 12.1 80.2 9,417 8.1 65.5 3.6

H3154 Medigroup, Inc. 0/10 241 a a 3,994 22.4 75.9 6.9

H3155 First Option Health Plan of NJ, Inc. 0/11 46 a a 2,996 11.2 84.4 3.7

H3157 Aetna Health Plans of New Jersey 0/11 40 a a 11,688 9.1 51.2 1.9

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 West 1/8 1,498 10.9 98.5 48,663 5.2 83.0 2.1

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 Central/East PA 2/6 427 14.8 79.4 9,065 16.6 39.0 4.2

H3931 U.S. Health Care Systems of PA 11/2 1,743 5.9 89.2 63,494 5.3 62.1 3.3

H3960 HealthAmerica of Central PA 0/5 30 a a 153 a a a

Middlesex-Somerset-Hunterdon, NJ PMSA

H3154 Medigroup, Inc. 0/10 386 21.5 76.8 3,994 22.4 75.9 6.9

H3157 Aetna Health Plans of New Jersey 0/11 2,032 11.2 46.9 11,688 9.1 51.2 1.9

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 Jersey),

Inc. 4/10 342 8.2 71.4 9,417 8.1 65.5 3.6

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 of NJ, Inc. 0/11 214 a a 2,996 11.2 84.4 3.7

Monmouth-Ocean, NJ PMSA

H3154 Medigroup, Inc. 0/10 982 21.1 76.9 3,994 22.4 75.9 6.9

H3107 Oxford Health Plans (New Jersey),

Inc. 4/10 319 20.3 60.0 9,417 8.1 65.5 3.6

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 New Jersey 0/11 1,020 12.7 47.9 11,688 9.1 51.2 1.9

H3155 First Option Health Plan of NJ, Inc. 0/11 1,423 11.0 78.5 2,996 11.2 84.4 3.7

H3156 Amerihealth HMO, Inc. 0/11 65 a a 2,056 9.1 66.8 2.7

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. 10/1 4,852 9.3 47.5 15,096 12.9 57.3 5.8

H3360 ChoiceCare Long Island, Inc. 1/4 4,192 6.8 55.9 4,449 7.9 57.3 2.2

H3307 Oxford Health Plans (New York), Inc. 5/0 25,669 5.8 48.2 88,850 7.0 59.8 3.6

H3330 HIP of Greater New York 9/5 12,285 4.2 41.6 51,339 5.2 47.6 4.2

(continued)

Page 19 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H3366 Physicians Health SVC of NY, Inc. 0/10 136 a a 679 16.8 71.6 3.7

H3365 Cigna HealthCare of New York 0/3 46 a a 259 a a a

H3370 Empire Blue Cross Blue Shield 0/4 16 a a 904 a a a

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 0/10 1,197 8.3 73.5 1,390 13.7 50.3 4.2

New London-Norwich, CT NECMA

H0752 Oxford Healthplan 0/10 44 a a 1,390 13.7 50.3 4.2

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 NY, Inc. 0/10 553 16.9 73.1 679 16.8 71.6 3.7

H3354 NYL Care 4/9 3,456 16.5 34.9 12,794 18.0 24.8 6.8

H3312 U.S. HealthCare, Inc. 10/1 9,018 13.4 60.9 15,096 12.9 57.3 5.8

H3359 Managed Health, Inc. 2/6 751 9.0 25.0 1,344 10.3 24.5 3.3

H3307 Oxford Health Plans (New York), Inc. 5/0 62,281 6.3 72.9 88,850 7.0 59.8 3.6

H3363 Kaiser Foundation HP of New York 1/1 1,015 4.7 31.3 1,086 4.8 28.8 1.7

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, Inc. 1/3 169 a a 2,878 11.7 57.9 2.5

H3360 ChoiceCare Long Island, Inc. 1/4 244 a a 4,449 7.9 57.3 2.2

H3365 Cigna HealthCare of New York 0/3 212 a a 259 a a a

H3370 Empire Blue Cross Blue Shield 0/4 880 a a 904 a a a

Newark, NJ PMSA

H3154 Medigroup, Inc. 0/10 956 24.5 84.1 3,994 22.4 75.9 6.9

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 of NJ, Inc. 0/11 297 9.5 96.2 2,996 11.2 84.4 3.7

H3157 Aetna Health Plans of New Jersey 0/11 721 9.2 39.3 11,688 9.1 51.2 1.9

H3107 Oxford Health Plans (New Jersey),

Inc. 4/10 2,298 9.2 75.5 9,417 8.1 65.5 3.6

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, Inc. 1/3 301 13.0 53.8 2,878 11.7 57.9 2.5

H3312 U.S. HealthCare, Inc. 10/1 824 10.1 81.9 15,096 12.9 57.3 5.8

H3366 Physicians Health SVC of NY, Inc. 0/10 1 a a 679 16.8 71.6 3.7

H3307 Oxford Health Plans (New York), Inc. 5/0 159 a a 88,850 7.0 59.8 3.6

H3953 HMO of Northeastern PA, Inc. 2/6 12 a a 11,504 6.3 84.8 1.9

(continued)

Page 20 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Philadelphia, PA-NJ PMSA

H3107 Oxford Health Plans (New Jersey),

Inc. 4/10 251 23.9 47.3 9,417 8.1 65.5 3.6

H3154 Medigroup, Inc. 0/10 466 18.5 59.7 3,994 22.4 75.9 6.9

H3949 Greater Atlantic Health Service, Inc. 4/7 13,077 12.0 34.7 13,195 12.3 36.2 7.9

H3157 Aetna Health Plans of New Jersey 0/11 2,718 10.2 37.3 11,688 9.1 51.2 1.9

H3956 Aetna Health Plans of Central/East PA 2/6 1,962 10.0 59.7 9,065 16.6 39.0 4.2

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. 0/11 1,309 8.0 61.9 2,056 9.1 66.8 2.7

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 East, Inc. 3/10 67,789 4.7 77.4 68,163 4.9 76.9 2.6

H3931 U.S. Health Care Systems of PA 11/2 51,048 4.2 58.0 63,494 5.3 62.1 3.3

H3155 First Option Health Plan of NJ, Inc. 0/11 99 a a 2,996 11.2 84.4 3.7

Pittsburgh, PA MSA

H3951 U.S. Health Care Systems of PA 5/5 21,009 8.0 44.7 22,537 8.5 46.3 4.4

H3957 Keystone Health Plan West 1/8 42,661 4.7 80.1 48,663 5.2 83.0 2.1

H3959 HealthAmerica Pennsylvania, Inc. 0/10 3,519 2.3 52.5 3,613 2.5 53.7 0.7

Pittsfield, MA NECMA

H2261 HMO BLUE, Inc. 0/10 8 a a 9,759 5.2 44.4 2.0

Providence-Warwick-Pawtucket, RI NECMA

H4149 Harvard Community Health Plan of

N.E. 1/5 3,980 4.4 70.5 4,002 4.7 69.3 3.8

H4102 United Health Plans of New England 8/11 10,679 3.2 69.2 14,317 4.8 49.4 2.0

Reading, PA MSA

H3956 Aetna Health Plans of Central/East PA 2/6 2,040 21.7 23.7 9,065 16.6 39.0 4.2

H3962 Keystone Health Plan Central, Inc. 0/7 448 9.9 84.6 1,863 19.5 82.1 4.3

H3931 U.S. Health Care Systems of PA 11/2 2,311 9.0 63.9 63,494 5.3 62.1 3.3

H3960 HealthAmerica of Central PA 0/5 6 a a 153 a a a

Rochester, NY MSA

H3305 Rochester Area HMO, Inc. 11/1 14,908 3.2 45.8 15,118 3.2 46.5 0.7

H3362 Independent Health Assoc. 0/8 8 a a 1,608 9.4 94.1 2.8

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, Inc. 2/6 7,256 5.2 74.1 11,504 6.3 84.8 1.9

H3954 Geisinger Health Plan 2/9 4,658 2.7 66.1 15,028 3.0 73.6 1.8

H3960 HealthAmerica of Central PA 0/5 36 a a 153 a a a

(continued)

Page 21 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Sharon, PA MSA

H3957 Keystone Health Plan West 1/8 762 11.6 100.0 48,663 5.2 83.0 2.1

Springfield, MA NECMA

H2255 U.S. Healthcare, Inc. MASS 2/6 588 15.0 60.2 10,143 12.6 57.6 4.4

H2256 Tufts Associated HMO, Inc. 2/3 1,350 6.4 76.7 32,787 4.9 61.0 2.1

H2261 HMO BLUE, Inc. 0/10 4,732 2.8 47.7 9,759 5.2 44.4 2.0

H9001 Fallon Community Health Plan, Inc. 11/9 70 a a 27,811 1.5 49.9 0.8

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 PA 0/3 13 a a 13 a a a

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 New Jersey 0/11 1,214 4.0 56.8 11,688 9.1 51.2 1.9

H3154 Medigroup, Inc. 0/10 126 a a 3,994 22.4 75.9 6.9

H3155 First Option Health Plan of NJ, Inc. 0/11 9 a a 2,996 11.2 84.4 3.7

H3156 Amerihealth HMO, Inc. 0/11 90 a a 2,056 9.1 66.8 2.7

H3107 Oxford Health Plans (New Jersey),

Inc. 4/10 23 a a 9,417 8.1 65.5 3.6

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 New Jersey 0/11 1,097 5.0 82.0 11,688 9.1 51.2 1.9

H3154 Medigroup, Inc. 0/10 3 a a 3,994 22.4 75.9 6.9

H3155 First Option Health Plan of NJ, Inc. 0/11 27 a a 2,996 11.2 84.4 3.7

H3156 Amerihealth HMO, Inc. 0/11 162 a a 2,056 9.1 66.8 2.7

H3107 Oxford Health Plans (New Jersey),

Inc. 4/10 11 a a 9,417 8.1 65.5 3.6

Williamsport, PA MSA

H3953 HMO of Northeastern PA, Inc. 2/6 4,050 8.1 98.5 11,504 6.3 84.8 1.9

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 Central/East PA 2/6 943 52.4 16.6 9,065 16.6 39.0 4.2

H3962 Keystone Health Plan Central, Inc. 0/7 413 17.4 92.9 1,863 19.5 82.1 4.3

H3931 U.S. Health Care Systems of PA 11/2 550 16.9 67.7 63,494 5.3 62.1 3.3

Others, Not in an MSA

H3931 U.S. Health Care Systems of PA 11/2 627 14.5 81.3 63,494 5.3 62.1 3.3

H3951 U.S. Health Care Systems of PA 5/5 1,299 12.1 65.6 22,537 8.5 46.3 4.4

(continued)

Page 22 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H3957 Keystone Health Plan West 1/8 2,601 7.8 86.6 48,663 5.2 83.0 2.1

H3361 WellCare of New York, Inc. 1/3 1,501 6.5 81.6 2,878 11.7 57.9 2.5

H3954 Geisinger Health Plan 2/9 7,425 3.1 83.0 15,028 3.0 73.6 1.8

H3962 Keystone Health Plan Central, Inc. 0/7 115 a a 1,863 19.5 82.1 4.3

H0752 Oxford Healthplan 0/10 4 a a 1,390 13.7 50.3 4.2

H3049 U.S. HealthCare of New Hampshire,

Inc. 2/6 54 a a 967 13.3 91.5 6.4

H0751 U.S. Healthcare, Inc. 2/6 183 a a 6,712 12.0 86.1 4.4

H3953 HMO of Northeastern PA, Inc. 2/6 95 a a 11,504 6.3 84.8 1.9

H2261 HMO BLUE, Inc. 0/10 36 a a 9,759 5.2 44.4 2.0

H3351 Health Care Plan, Inc. 7/0 118 a a 9,565 4.4 63.3 3.4

H3305 Rochester Area HMO, Inc. 11/1 122 a a 15,118 3.2 46.5 0.7

H3959 HealthAmerica Pennsylvania, Inc. 0/10 85 a a 3,613 2.5 53.7 0.7

H9001 Fallon Community Health Plan, Inc. 11/9 13 a a 27,811 1.5 49.9 0.8

H0851 Amerihealth HMO, Inc. 0/2 18 a a 38 a a a

H3373 Capital Area Community HP 0/2 66 a a 214 a a a

H3960 HealthAmerica of Central PA 0/5 2 a a 153 a a a

aThis 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 areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Atlanta, GA MSA

H1155 United Healthcare of Georgia, Inc. 0/8 2,274 18.9 97.6 2,335 18.9 96.6 4.4

H1156 USHC of Georgia, Inc. 0/1 18 a a 19 a a a

Austin-San Marcos, TX MSA

H4557 PCA Health Plans of Texas, Inc. 3/10 4,438 6.6 96.6 18,517 35.1 53.6 13.8

H4558 NYLCARE Health Plans, Inc. 3/6 15 a a 28,994 8.6 55.3 3.4

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 Mid-Atlantic 10/7 3,327 14.4 75.6 4,966 14.7 79.5 4.8

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, Inc. 2/5 672 10.3 60.9 4,804 8.1 60.9 2.5

(continued)

Page 23 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H2151 Chesapeake Health Plan, Inc. 2/7 5,386 7.6 73.1 5,829 8.5 70.0 3.0

H0951 Humana Group Health Plan, Inc. 1/11 36 a a 7,497 23.0 77.0 8.1

Baton Rouge, LA MSA

H1956 Advantage Health Plan, Inc. 0/10 461 32.3 66.1 3,028 26.7 76.5 8.8

H1954 Community Health Network of

Louisiana 2/2 5,037 13.7 64.7 14,825 24.8 63.0 10.8

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, Inc. 1/9 2,597 5.7 46.9 3,686 8.3 51.1 3.0

Beaumont-Port Arthur, TX MSA

H4558 NYLCARE Health Plans, Inc. 3/6 1,980 11.5 92.5 28,994 8.6 55.3 3.4

H4565 HMO Texas, L.C. 0/3 534 a a 634 a a a

Birmingham, AL MSA

H0151 United Healthcare of Alabama 1/9 5,303 10.7 91.4 5,384 11.0 90.5 4.5

H0150 Health Partners of Alabama 2/8 5,807 8.0 70.1 5,924 8.2 71.2 3.8

Brazoria, TX PMSA

H4557 PCA Health Plans of Texas, Inc. 3/10 276 57.3 48.7 18,517 35.1 53.6 13.8

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, Inc. 3/6 1,061 8.3 45.5 28,994 8.6 55.3 3.4

H4563 Prudential Health Care Plan, Inc. 1/11 74 a a 5,392 29.8 47.0 9.5

H4565 HMO Texas, L.C. 0/3 3 a a 634 a a a

Bryan-College Station, TX MSA

H4557 PCA Health Plans of Texas, Inc. 3/10 10 a a 18,517 35.1 53.6 13.8

H4590 Pacificare of Texas, Inc. 9/0 16 a a 58,034 12.7 45.0 4.9

H4558 NYLCARE Health Plans, Inc. 3/6 3 a a 28,994 8.6 55.3 3.4

Charleston-North Charleston, SC MSA

H4249 Companion HealthCare Corporation 0/10 432 5.9 100.0 1,343 8.5 98.8 2.6

Clarksville-Hopkinsville, TN-KY MSA

H4452 Health 1*2*3 0/9 38 a a 915 13.0 100.0 3.4

Columbia, SC MSA

H4249 Companion HealthCare Corporation 0/10 718 8.7 97.9 1,343 8.5 98.8 2.6

Corpus Christi, TX MSA

H4504 Humana HP of Texas 11/0 8,551 12.0 98.6 8,747 12.3 98.0 7.5

H4557 PCA Health Plans of Texas, Inc. 3/10 3 a a 18,517 35.1 53.6 13.8

H4558 NYLCARE Health Plans, Inc. 3/6 2 a a 28,994 8.6 55.3 3.4

(continued)

Page 24 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

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 Mid-Atlantic 10/7 156 a a 4,966 14.7 79.5 4.8

H2151 Chesapeake Health Plan, Inc. 2/7 3 a a 5,829 8.5 70.0 3.0

Dallas, TX PMSA

H4507 NYLCARE Health Plans, Inc. 10/0 11,521 9.3 70.0 19,289 9.2 64.5 3.7

H4590 Pacificare of Texas, Inc. 9/0 7,606 8.9 83.1 58,034 12.7 45.0 4.9

Daytona Beach, FL MSA

H1061 AV-MED Health Plan, Inc. 3/3 739 150.3 30.1 5,641 54.1 21.0 9.5

H1036 Humana Medical Plan, Inc. 11/9 21,158 10.0 53.7 216,043 17.5 32.5 8.4

H1035 Florida Health Care Plan, Inc. 11/2 13,096 4.9 49.8 13,399 5.0 49.2 2.6

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 Corporation 0/10 50 a a 1,343 8.5 98.8 2.6

Fort Lauderdale, FL PMSA

H1056 PCA Health Plans of Florida, Inc. 5/2 7,995 33.3 18.0 17,278 40.5 20.0 19.9

H1076 HIP Health Plan of Florida, Inc. 1/9 4,956 29.2 21.6 11,869 29.7 24.2 13.5

H1013 Foundation Health, A Florida Health

Plan 9/7 11,115 27.4 17.2 26,070 34.6 21.6 22.5

H9011 United HealthCare of Florida, Inc. 11/9 9,110 22.3 21.4 49,307 16.6 41.2 11.3

H1073 Prudential Health Care Plan, Inc. 2/3 3,916 14.9 32.0 11,706 16.1 31.3 5.0

H1036 Humana Medical Plan, Inc. 11/9 40,057 14.0 25.5 216,043 17.5 32.5 8.4

H1026 Health Options, Inc. 11/9 15,352 11.7 29.6 45,247 12.3 34.4 6.1

H1016 AV-MED Health Plan, Inc. 11/9 9,161 9.1 31.3 21,614 10.9 31.9 6.6

H1078 Neighborhood Health Partnership,

Inc. 1/6 206 a a 3,378 19.6 35.1 6.7

Fort Myers-Cape Coral, FL MSA

H1036 Humana Medical Plan, Inc. 11/9 1,850 15.2 97.5 216,043 17.5 32.5 8.4

H1068 PCA Health Plans of Florida, Inc. 2/3 9 a a 10,304 51.7 18.7 11.6

Fort Pierce-Port St. Lucie, FL MSA

H1036 Humana Medical Plan, Inc. 11/9 2,808 13.2 96.2 216,043 17.5 32.5 8.4

Fort Worth-Arlington, TX PMSA

H4590 Pacificare of Texas, Inc. 9/0 1,476 14.8 52.1 58,034 12.7 45.0 4.9

H4507 NYLCARE Health Plans, Inc. 10/0 6,441 8.6 54.1 19,289 9.2 64.5 3.7

(continued)

Page 25 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

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 Texas, Inc. 3/10 660 52.3 42.0 18,517 35.1 53.6 13.8

H4510 Humana HP of Texas 8/7 768 23.8 75.4 19,813 22.2 49.2 10.0

H4590 Pacificare of Texas, Inc. 9/0 2,159 11.6 65.6 58,034 12.7 45.0 4.9

H4558 NYLCARE Health Plans, Inc. 3/6 1,570 9.7 32.9 28,994 8.6 55.3 3.4

H4562 FHP of Texas, Inc. 1/7 79 a a 3,381 36.6 47.3 10.7

H4563 Prudential Health Care Plan, Inc. 1/11 105 a a 5,392 29.8 47.0 9.5

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 Plans of NC 1/0 847 5.4 91.3 863 5.4 91.5 1.4

H3455 QualChoice of North Carolina, Inc. 0/1 20 a a 20 a a a

H4250 Companion HealthCare Corporation 0/9 91 a a 92 a a a

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 Mid-Atlantic 10/7 188 a a 4,966 14.7 79.5 4.8

H2151 Chesapeake Health Plan, Inc. 2/7 7 a a 5,829 8.5 70.0 3.0

Houma, LA MSA

H1954 Community Health Network of

Louisiana 2/2 261 112.4 95.9 14,825 24.8 63.0 10.8

H1951 Ochsner Health Plan 2/1 828 15.3 56.7 21,558 9.5 42.9 4.2

H1956 Advantage Health Plan, Inc. 0/10 5 a a 3,028 26.7 76.5 8.8

H1958 SMA HMO, Inc. 0/2 51 a a 105 a a a

Houston, TX PMSA

H4557 PCA Health Plans of Texas, Inc. 3/10 7,183 55.7 57.6 18,517 35.1 53.6 13.8

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 Plan, Inc. 1/11 5,119 29.5 46.4 5,392 29.8 47.0 9.5

H4590 Pacificare of Texas, Inc. 9/0 16,584 18.6 38.3 58,034 12.7 45.0 4.9

H4558 NYLCARE Health Plans, Inc. 3/6 23,441 8.1 51.0 28,994 8.6 55.3 3.4

H4565 HMO Texas, L.C. 0/3 90 a a 634 a a a

Jacksonville, FL MSA

H1069 PCA Health Plans of Florida, Inc. 2/3 6,929 71.6 16.4 7,331 71.1 17.1 15.6

H1059 AV-MED Health Plan, Inc. 3/2 7,420 42.6 21.1 7,728 42.9 22.0 9.4

(continued)

Page 26 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H1036 Humana Medical Plan, Inc. 11/9 2,988 42.1 41.8 216,043 17.5 32.5 8.4

H1071 Health Options, Inc. 2/7 4,923 32.7 20.1 5,023 33.0 21.0 8.2

H1070 Prudential Health Care Plan, Inc. 2/4 5,146 12.3 28.5 5,330 12.4 30.0 4.2

H1088 Principal Health Care of Florida, Inc. 0/5 406 a a 415 a a a

Lakeland-Winter Haven, FL MSA

H1068 PCA Health Plans of Florida, Inc. 2/3 60 a a 10,304 51.7 18.7 11.6

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, Inc. 0/3 69 a a 70 a a a

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. 0/10 2 a a 32 a a a

Melbourne-Titusville-Palm Bay, FL MSA

H1036 Humana Medical Plan, Inc. 11/9 292 25.7 98.7 216,043 17.5 32.5 8.4

Miami, FL PMSA

H1076 HIP Health Plan of Florida, Inc. 1/9 1,316 55.9 21.2 11,869 29.7 24.2 13.5

H1056 PCA Health Plans of Florida, Inc. 5/2 5,596 49.9 22.0 17,278 40.5 20.0 19.9

H1013 Foundation Health, A Florida Health

Plan 9/7 9,557 37.3 25.4 26,070 34.6 21.6 22.5

H1078 Neighborhood Health Partnership,

Inc. 1/6 3,104 18.1 35.2 3,378 19.6 35.1 6.7

H1073 Prudential Health Care Plan, Inc. 2/3 3,299 15.4 31.8 11,706 16.1 31.3 5.0

H1036 Humana Medical Plan, Inc. 11/9 27,529 14.9 30.3 216,043 17.5 32.5 8.4

H1026 Health Options, Inc. 11/9 10,919 14.4 33.6 45,247 12.3 34.4 6.1

H9011 United HealthCare of Florida, Inc. 11/9 34,681 11.8 46.4 49,307 16.6 41.2 11.3

H1016 AV-MED Health Plan, Inc. 11/9 7,730 10.1 30.8 21,614 10.9 31.9 6.6

Mobile, AL MSA

H0152 United Healthcare of Alabama 1/9 5,765 15.0 99.9 5,847 15.4 98.1 6.5

Naples, FL MSA

H1036 Humana Medical Plan, Inc. 11/9 9 a a 216,043 17.5 32.5 8.4

Nashville, TN MSA

H4452 Health 1*2*3 0/9 758 10.4 100.0 915 13.0 100.0 3.4

New Orleans, LA MSA

H1954 Community Health Network of

Louisiana 2/2 9,150 27.2 55.9 14,825 24.8 63.0 10.8

H1956 Advantage Health Plan, Inc. 0/10 2,151 22.8 84.1 3,028 26.7 76.5 8.8

(continued)

Page 27 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H1955 Gulf South Health Plans, Inc. 1/9 515 14.8 57.9 3,686 8.3 51.1 3.0

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 1,013 137.8 50.5 11,611 59.9 40.2 6.0

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, Inc. 0/7 6,882 8.6 59.1 7,011 8.7 59.8 2.0

H3749 Pacificare of Oklahoma, Inc. 5/11 2,841 5.0 96.5 16,652 6.6 61.1 3.0

H3755 Community Care HMO, Inc. 0/6 204 a a 1,094 a a a

H3756 HealthCare Oklahoma, Inc. 0/3 84 a a 88 a a a

H3757 Bluelincs HMO, Inc. 0/2 54 a a 75 a a a

Orlando, FL MSA

H1067 PCA Health Plans of Florida, Inc. 2/3 4,322 66.0 15.8 4,651 64.1 17.1 13.5

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, Inc. 11/9 23,889 19.0 22.5 216,043 17.5 32.5 8.4

H1081 Prudential Health Care Plan, Inc. 1/4 4,666 6.0 47.5 4,816 7.2 53.6 1.4

H1095 Health Options, Inc. 0/6 2,133 a a 2,198 a a a

Punta Gorda, FL MSA

H1036 Humana Medical Plan, Inc. 11/9 336 29.2 88.8 216,043 17.5 32.5 8.4

H1068 PCA Health Plans of Florida, Inc. 2/3 9 a a 10,304 51.7 18.7 11.6

Richmond-Petersburg, VA MSA

H2153 Optimum Choice, Inc. 2/5 1,191 125.2 41.2 11,611 59.9 40.2 6.0

H2152 NYLCARE Health Plans, Inc. 2/5 195 a a 4,804 8.1 60.9 2.5

H4951 Cigna HealthCare of Virginia 0/2 72 a a 74 a a a

Roanoke, VA MSA

H2157 Optimum Choice, Inc. 0/10 17 a a 32 a a a

San Antonio, TX MSA

H4560 Prudential Health Care Plan, Inc. 2/1 1,441 40.3 26.2 1,452 41.0 26.2 14.6

H4557 PCA Health Plans of Texas, Inc. 3/10 5,029 28.9 35.7 18,517 35.1 53.6 13.8

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, Inc. 9/0 28,966 9.8 37.5 58,034 12.7 45.0 4.9

H4558 NYLCARE Health Plans, Inc. 3/6 4 a a 28,994 8.6 55.3 3.4

(continued)

Page 28 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Sarasota-Bradenton, FL MSA

H1068 PCA Health Plans of Florida, Inc. 2/3 2,290 27.2 35.9 10,304 51.7 18.7 11.6

H1036 Humana Medical Plan, Inc. 11/9 2,930 25.1 91.2 216,043 17.5 32.5 8.4

Tampa-St. Petersburg-Clearwater, FL MSA

H1068 PCA Health Plans of Florida, Inc. 2/3 7,583 59.3 14.8 10,304 51.7 18.7 11.6

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 FL, Inc. 0/11 4,021 30.9 26.6 4,187 30.4 27.5 6.7

H1036 Humana Medical Plan, Inc. 11/9 58,174 21.0 22.4 216,043 17.5 32.5 8.4

H1082 Health Options, Inc. 0/9 10,003 20.5 50.8 10,319 20.9 50.8 5.9

H1087 Cigna HealthCare of Florida, Inc. 1/2 1,247 20.0 26.5 1,269 19.9 27.4 5.0

H1084 HIP Health Plan of Florida 1/2 1,012 13.1 42.1 1,068 13.9 41.9 3.9

H1074 Prudential Health Care Plan, Inc. 2/0 9,157 10.0 39.1 9,459 10.3 39.7 3.3

Tulsa, OK MSA

H3749 Pacificare of Oklahoma, Inc. 5/11 12,250 6.9 53.1 16,652 6.6 61.1 3.0

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 Plan, Inc. 1/11 7,182 23.0 77.0 7,497 23.0 77.0 8.1

H2154 U.S. HealthCare Delaware 2/2 446 15.0 64.2 4,026 12.0 65.5 4.2

H2152 NYLCARE Health Plans, Inc. 2/5 3,796 7.5 57.7 4,804 8.1 60.9 2.5

H2101 HealthCare Corp. of the Mid-Atlantic 10/7 230 a a 4,966 14.7 79.5 4.8

H2151 Chesapeake Health Plan, Inc. 2/7 165 a a 5,829 8.5 70.0 3.0

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 Florida Health

Plan 9/7 4,701 44.5 15.4 26,070 34.6 21.6 22.5

H1056 PCA Health Plans of Florida, Inc. 5/2 2,720 43.1 15.2 17,278 40.5 20.0 19.9

H9011 United HealthCare of Florida, Inc. 11/9 4,458 26.6 25.0 49,307 16.6 41.2 11.3

H1076 HIP Health Plan of Florida, Inc. 1/9 4,921 24.0 25.9 11,869 29.7 24.2 13.5

H1073 Prudential Health Care Plan, Inc. 2/3 4,376 17.1 28.9 11,706 16.1 31.3 5.0

H1036 Humana Medical Plan, Inc. 11/9 27,168 14.2 27.8 216,043 17.5 32.5 8.4

H1016 AV-MED Health Plan, Inc. 11/9 4,313 14.0 28.9 21,614 10.9 31.9 6.6

H1026 Health Options, Inc. 11/9 17,994 10.6 36.0 45,247 12.3 34.4 6.1

H1078 Neighborhood Health Partnership,

Inc. 1/6 17 a a 3,378 19.6 35.1 6.7

(continued)

Page 29 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

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 New Jersey 0/11 1,364 7.5 74.5 11,688 9.1 51.2 1.9

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 Mid-Atlantic 10/7 45 a a 4,966 14.7 79.5 4.8

H2151 Chesapeake Health Plan, Inc. 2/7 198 a a 5,829 8.5 70.0 3.0

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 of

Louisiana 2/2 371 66.6 96.4 14,825 24.8 63.0 10.8

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, Inc. 0/10 396 41.8 63.0 3,028 26.7 76.5 8.8

H4557 PCA Health Plans of Texas, Inc. 3/10 579 27.6 52.5 18,517 35.1 53.6 13.8

H1036 Humana Medical Plan, Inc. 11/9 1,362 17.0 94.4 216,043 17.5 32.5 8.4

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, Inc. 1/9 548 13.3 52.1 3,686 8.3 51.1 3.0

H0451 HMO Partners 0/9 942 13.0 98.9 2,964 10.8 92.1 3.1

H4590 Pacificare of Texas, Inc. 9/0 831 12.4 76.7 58,034 12.7 45.0 4.9

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 Mid-Atlantic 10/7 1,079 9.7 92.4 4,966 14.7 79.5 4.8

H4558 NYLCARE Health Plans, Inc. 3/6 814 9.6 96.2 28,994 8.6 55.3 3.4

H1069 PCA Health Plans of Florida, Inc. 2/3 177 a a 7,331 71.1 17.1 15.6

H1068 PCA Health Plans of Florida, Inc. 2/3 26 a a 10,304 51.7 18.7 11.6

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 13.0 100.0 3.4

H1070 Prudential Health Care Plan, Inc. 2/4 82 a a 5,330 12.4 30.0 4.2

H4249 Companion HealthCare Corporation 0/10 129 a a 1,343 8.5 98.8 2.6

H2151 Chesapeake Health Plan, Inc. 2/7 24 a a 5,829 8.5 70.0 3.0

H2152 NYLCARE Health Plans, Inc. 2/5 80 a a 4,804 8.1 60.9 2.5

H1958 SMA HMO, Inc. 0/2 4 a a 105 a a a

H2157 Optimum Choice, Inc. 0/10 10 a a 32 a a a

(continued)

Page 30 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H3755 Community Care HMO, Inc. 0/6 10 a a 1,094 a a a

H3756 HealthCare Oklahoma, Inc. 0/3 2 a a 88 a a a

H3757 Bluelincs HMO, Inc. 0/2 6 a a 75 a a a

aThis 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 areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Akron, OH PMSA

H3607 Kaiser Foundation HP of Ohio 10/0 2,785 7.6 54.0 21,161 4.8 62.8 2.7

H3655 Community Insurance Company 2/1 173 a a 6,687 12.6 62.5 4.1

H3659 United HealthCare of Ohio, Inc. 0/6 110 a a 5,314 a a a

H3660 SummaCare, Inc. 0/5 738 a a 863 a a a

Bloomington, IN MSA

H1551 HealthSource Indiana Managed

Care Plan 5/5 27 a a 382 15.1 100.0 4.8

Canton-Massillon, OH MSA

H3655 Community Insurance Company 2/1 150 a a 6,687 12.6 62.5 4.1

H3607 Kaiser Foundation HP of Ohio 10/0 116 a a 21,161 4.8 62.8 2.7

H3659 United HealthCare of Ohio, Inc. 0/6 227 a a 5,314 a a a

H3660 SummaCare, Inc. 0/5 69 a a 863 a a a

Chicago, IL PMSA

H1460 FHP of Illinois, Inc. 0/11 1,291 50.5 47.0 1,307 50.8 47.1 12.8

H1461 NYLCARE, Inc. 1/2 857 29.0 58.6 868 28.9 58.6 7.7

H1458 Health Direct Insurance, Inc. 2/0 2,740 23.4 57.9 2,766 23.6 57.9 6.8

H1406 Humana Health Plan, Inc. 11/6 39,272 13.0 57.0 41,686 13.6 60.4 7.7

H9045 United HealthCare of Illinois 11/6 45,524 9.2 49.2 45,919 9.3 49.4 4.9

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 Company 2/1 4,921 9.4 57.1 6,687 12.6 62.5 4.1

H3659 United HealthCare of Ohio, Inc. 0/6 579 a a 5,314 a a a

Cleveland-Lorain-Elyria, OH PMSA

H3657 QualChoice Health Plan 0/9 575 15.8 70.6 583 16.2 71.8 3.8

(continued)

Page 31 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H3654 Prudential Health Care Plan of N.

Ohio 2/4 8,002 13.6 59.4 8,062 13.7 59.6 4.8

H3656 Aetna Health Plans of Ohio, Inc. 2/1 5,919 11.0 60.1 5,959 11.1 59.7 4.7

H3607 Kaiser Foundation HP of Ohio 10/0 17,901 4.2 64.8 21,161 4.8 62.8 2.7

H3655 Community Insurance Company 2/1 248 a a 6,687 12.6 62.5 4.1

H3659 United HealthCare of Ohio, Inc. 0/6 408 a a 5,314 a a a

H3660 SummaCare, Inc. 0/5 72 a a 863 a a a

Columbus, OH MSA

H3655 Community Insurance Company 2/1 265 32.5 75.6 6,687 12.6 62.5 4.1

H3659 United HealthCare of Ohio, Inc. 0/6 978 a a 5,314 a a a

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 Company 2/1 292 21.2 79.0 6,687 12.6 62.5 4.1

H3659 United HealthCare of Ohio, Inc. 0/6 1,189 a a 5,314 a a a

Detroit, MI PMSA

H2312 Health Alliance Plan of Michigan 10/0 7,376 7.2 97.5 7,481 7.3 97.1 2.9

Gary, IN PMSA

H1406 Humana Health Plan, Inc. 11/6 1,804 22.1 99.2 41,686 13.6 60.4 7.7

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 Company 2/1 588 12.4 38.4 6,687 12.6 62.5 4.1

H3659 United HealthCare of Ohio, Inc. 0/6 125 a a 5,314 a a a

Indianapolis, IN MSA

H9028 Maxicare Indiana, Inc. 11/9 3,027 7.1 73.5 3,076 7.3 72.9 3.2

H1557 Anthem Health of Indiana, Inc. 0/5 255 a a 276 a a a

Jackson, MI MSA

H9009 Blue Care Network-Health Central 11/9 130 a a 4,308 1.4 95.1 0.5

Kankakee, IL PMSA

H9045 United HealthCare of Illinois 11/6 21 a a 45,919 9.3 49.4 4.9

Kansas City, MO-KS MSA

H2652 Total Health Care 6/10 3,891 29.4 20.6 3,949 29.2 20.7 3.0

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 KS City, Inc. 0/5 857 a a 888 a a a

H2666 HealthNet 0/5 1,299 a a 1,308 a a a

(continued)

Page 32 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Kokomo, IN MSA

H1557 Anthem Health of Indiana, Inc. 0/5 8 a a 276 a a a

Lansing-East Lansing, MI MSA

H9009 Blue Care Network-Health Central 11/9 3,858 1.3 94.1 4,308 1.4 95.1 0.5

Milwaukee-Waukesha, WI PMSA

H5253 PrimeCare Health Plan, Inc. 1/3 2,501 6.4 98.1 2,539 6.5 97.0 1.9

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 11/9 39,690 3.0 87.0 40,513 3.3 86.4 1.2

H9005 Group Health Plan, Inc. 11/9 17,126 3.0 74.0 17,473 3.1 74.9 1.8

Omaha, NE-IA MSA

H2802 United HealthCare of the Midlands,

Inc. 11/3 3,865 8.5 61.9 3,922 8.5 62.1 3.1

H2849 Exclusive HealthCare, Inc. 0/2 718 a a 724 a a a

St. Louis, MO-IL MSA

H2658 Gencare Health Systems, Inc. 1/11 1,764 22.4 21.3 1,781 22.6 21.7 8.4

H2659 HMO Missouri, Inc. 1/9 4,926 12.4 51.9 4,991 12.5 51.9 5.0

H2654 Gencare Health Systems, Inc. 4/1 15,773 8.2 65.9 15,936 8.3 66.0 2.9

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 2.8 100.0 1,937 2.8 100.0 1.0

Wichita, KS MSA

H1750 Preferred Plus of Kansas, Inc. 0/6 122 a a 123 a a a

Youngstown-Warren, OH MSA

H3655 Community Insurance Company 2/1 226 a a 6,687 12.6 62.5 4.1

H3659 United HealthCare of Ohio, Inc. 0/6 912 a a 5,314 a a a

Others, Not in an MSA

H1551 HealthSource Indiana Managed

Care Plan 5/5 351 14.6 100.0 382 15.1 100.0 4.8

H3655 Community Insurance Company 2/1 103 a a 6,687 12.6 62.5 4.1

H3649 Family Health Plan, Inc. 3/9 106 a a 2,422 6.6 25.6 1.9

H9006 Medica 11/9 88 a a 40,513 3.3 86.4 1.2

H9005 Group Health Plan, Inc. 11/9 89 a a 17,473 3.1 74.9 1.8

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 2.8 100.0 1.0

H9009 Blue Care Network-Health Central 11/9 95 a a 4,308 1.4 95.1 0.5

(continued)

Page 33 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H1557 Anthem Health of Indiana, Inc. 0/5 7 a a 276 a a a

H3659 United HealthCare of Ohio, Inc. 0/6 709 a a 5,314 a a a

aThis 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 areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

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. 10/9 16,039 4.9 43.3 17,491 5.4 48.6 3.8

H3250 Presbyterian Health Plan, Inc. 3/0 1,548 4.6 45.1 1,571 4.7 47.3 1.3

H3251 Lovelace Health Plan, Inc. 3/0 9,785 2.8 59.3 13,106 4.0 56.8 2.0

Bakersfield, CA MSA

H0523 Aetna HP of California, Inc. 10/5 563 17.6 34.3 55,036 11.5 26.5 5.0

H9030 FHP, Inc. 11/9 4,873 17.2 35.4 200,230 12.6 26.7 6.7

H0563 Health Net 4/1 1,901 9.0 31.4 50,913 13.6 22.0 5.1

H0543 Pacificare of CA, Inc. 11/4 14,345 8.2 23.3 284,714 7.3 33.1 4.0

H0526 Kaiser Foundation HP, Inc. 9/0 2,918 4.6 50.0 3,142 4.8 48.3 3.4

H0564 CaliforniaCare Health Plans 3/4 92 a a 1,303 32.5 37.1 10.1

H0576 Prudential Health Care Plan of CA 2/6 189 a a 2,698 22.7 35.5 8.6

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 Puget Sound 8/0 1,162 4.6 55.6 50,900 4.0 36.1 1.9

H5063 Options Health Care, Inc. 0/4 18 a a 974 a a a

Boulder-Longmont, CO PMSA

H0609 FHP of Colorado, Inc. 10/6 1,098 5.7 52.4 40,369 7.0 44.1 3.0

H0630 Kaiser Foundation HP of Colo. 11/1 3,881 4.2 41.5 32,721 4.4 31.3 2.3

H0603 HMO Colorado, Inc. 11/0 59 a a 2,347 16.4 16.8 3.3

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 Puget Sound 8/0 2,349 5.4 37.3 50,900 4.0 36.1 1.9

H5055 Qual-Med Washington Health Plan,

Inc. 2/11 18 a a 275 10.9 46.7 2.8

(continued)

Page 34 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H5063 Options Health Care, Inc. 0/4 108 a a 974 a a a

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 6,845 4.2 92.3 40,369 7.0 44.1 3.0

Denver, CO PMSA

H0659 Cigna HealthCare of Colorado, Inc. 2/2 3,175 24.8 17.6 3,246 24.9 18.0 6.2

H0603 HMO Colorado, Inc. 11/0 2,021 15.2 17.2 2,347 16.4 16.8 3.3

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. 10/6 26,780 8.5 33.6 40,369 7.0 44.1 3.0

H0630 Kaiser Foundation HP of Colo. 11/1 25,555 4.2 27.6 32,721 4.4 31.3 2.3

H0660 Mutual of Omaha of Colorado 0/2 229 a a 232 a a a

Eugene-Springfield, OR MSA

H3805 Pacificare of Oregon 10/11 700 6.9 45.8 35,938 8.2 43.3 2.7

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. 10/9 52 a a 86,650 7.0 34.6 2.9

H0356 Premier HealthCare, Inc. 0/5 72 a a 1,255 a a a

Fort Collins-Loveland, CO MSA

H0630 Kaiser Foundation HP of Colo. 11/1 293 3.4 80.0 32,721 4.4 31.3 2.3

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 Plans 1/3 326 44.4 64.1 332 44.3 63.9 10.5

H0559 Pacificare of California, Inc. 4/9 7,371 9.4 41.8 89,360 8.9 40.0 3.5

H0584 Kaiser Foundation HP, Inc. 1/11 5,355 3.6 67.2 5,790 4.0 64.7 2.0

Greeley, CO PMSA

H0630 Kaiser Foundation HP of Colo. 11/1 327 3.1 70.0 32,721 4.4 31.3 2.3

Honolulu, HI MSA

H1230 Kaiser Foundation HP, Inc. 10/8 10,191 1.9 85.1 13,795 2.0 81.1 1.2

Las Vegas, NV-AZ MSA

H2931 Health Plan of Nevada, Inc. 11/6 22,964 57.8 6.6 24,892 55.5 8.5 8.3

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. 10/9 19 a a 86,650 7.0 34.6 2.9

H0356 Premier HealthCare, Inc. 0/5 429 a a 1,255 a a a

(continued)

Page 35 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Los Angeles-Long Beach, CA PMSA

H0557 Foundation Health, A California Plan 4/7 3,491 33.7 38.1 8,344 28.8 33.9 9.7

H0576 Prudential Health Care Plan of CA 2/6 820 26.6 44.5 2,698 22.7 35.5 8.6

H0564 CaliforniaCare Health Plans 3/4 384 25.8 33.3 1,303 32.5 37.1 10.1

H9016 Watts Foundation Health, Inc./

United Health Plan 11/9 9,680 20.5 48.3 12,334 22.0 49.7 18.6

H0558 MaxiCare, A California Corporation 5/1 1,780 19.0 55.0 2,864 23.7 46.8 10.0

H0523 Aetna HP of California, Inc. 10/5 7,450 17.8 32.3 55,036 11.5 26.5 5.0

H0554 CareAmerica Health Plans 6/2 25,111 15.0 31.1 38,358 17.1 27.5 9.0

H0581 Cigna Healthcare of California 2/6 9,705 14.5 36.2 13,496 15.9 32.6 8.6

H0563 Health Net 4/1 11,876 13.4 26.7 50,913 13.6 22.0 5.1

H9030 FHP, Inc. 11/9 86,171 11.1 28.5 200,230 12.6 26.7 6.7

H0543 Pacificare of CA, Inc. 11/4 71,399 8.0 31.3 284,714 7.3 33.1 4.0

H0545 Inter Valley Health Plan, Inc. 10/7 7,695 5.7 23.4 13,112 10.4 15.2 3.7

H0524 Kaiser Foundation HP, Inc. 9/4 82,382 2.7 62.3 169,003 2.9 55.5 2.8

H0504 California Physicians’ Services Corp. 0/5 112 a a 204 a a a

Medford-Ashland, OR MSA

H3805 Pacificare of Oregon 10/11 1,299 5.9 63.6 35,938 8.2 43.3 2.7

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 California, Inc. 4/9 104 a a 89,360 8.9 40.0 3.5

Modesto, CA MSA

H0559 Pacificare of California, Inc. 4/9 6,674 13.8 20.2 89,360 8.9 40.0 3.5

H0580 FHP, Inc. 1/10 2,751 6.6 36.5 13,124 14.4 43.8 5.8

H0568 National Med, Inc. 3/1 7,858 5.0 24.9 11,152 5.1 33.9 1.7

H0586 Foundation Health, A California Plan 2/9 20 a a 12,319 11.6 30.6 4.5

Oakland, CA PMSA

H0580 FHP, Inc. 1/10 2,296 18.9 50.7 13,124 14.4 43.8 5.8

H0594 Lifeguard, Inc. 1/3 460 13.7 22.2 2,930 12.5 40.1 3.8

H0577 Prudential Health Care Plan of CA 2/6 973 12.4 36.4 2,711 15.6 29.8 7.1

H0547 Aetna Health Plan of California, Inc. 10/11 3,478 9.1 30.2 26,859 5.4 37.2 3.1

H0562 Health Net 4/1 15,718 9.1 25.9 58,588 11.2 23.3 3.7

H0559 Pacificare of California, Inc. 4/9 17,371 7.2 39.3 89,360 8.9 40.0 3.5

H0583 Kaiser Foundation HP, Inc. 2/6 41,836 1.2 40.2 142,719 1.8 47.3 0.9

H0591 CaliforniaCare Health Plans 1/3 202 a a 650 43.9 35.8 10.2

(continued)

Page 36 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H0588 Cigna Healthcare of California 1/4 136 a a 859 21.9 40.4 7.9

H0568 National Med, Inc. 3/1 2 a a 11,152 5.1 33.9 1.7

H0599 California Physicians’ Services Corp. 0/6 27 a a 133 a a a

Olympia, WA PMSA

H5005 Pacificare of Washington, Inc. 9/2 1,811 6.5 65.0 43,797 6.6 47.5 2.7

H5050 Group Health Coop. of Puget Sound 8/0 4,031 3.4 40.9 50,900 4.0 36.1 1.9

H5055 Qual-Med Washington Health Plan,

Inc. 2/11 39 a a 275 10.9 46.7 2.8

H5063 Options Health Care, Inc. 0/4 73 a a 974 a a a

Orange County, CA PMSA

H0558 MaxiCare, A California Corporation 5/1 895 33.0 39.3 2,864 23.7 46.8 10.0

H9016 Watts Foundation Health, Inc./

United Health Plan 11/9 509 31.3 45.3 12,334 22.0 49.7 18.6

H0576 Prudential Health Care Plan of CA 2/6 327 22.6 40.5 2,698 22.7 35.5 8.6

H0523 Aetna HP of California, Inc. 10/5 2,439 20.3 23.6 55,036 11.5 26.5 5.0

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 California 2/6 1,796 11.3 20.7 13,496 15.9 32.6 8.6

H9030 FHP, Inc. 11/9 33,450 10.2 18.7 200,230 12.6 26.7 6.7

H0543 Pacificare of CA, Inc. 11/4 39,566 6.4 37.0 284,714 7.3 33.1 4.0

H0524 Kaiser Foundation HP, Inc. 9/4 13,610 3.3 52.2 169,003 2.9 55.5 2.8

H0564 CaliforniaCare Health Plans 3/4 117 a a 1,303 32.5 37.1 10.1

H0557 Foundation Health, A California Plan 4/7 12 a a 8,344 28.8 33.9 9.7

H0545 Inter Valley Health Plan, Inc. 10/7 127 a a 13,112 10.4 15.2 3.7

H0504 California Physicians’ Services Corp. 0/5 42 a a 204 a a a

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 Plan 3/0 2,017 11.2 63.1 2,105 11.4 65.3 2.7

H0351 Intergroup Prepaid Health Serv of

AZ, Inc. 4/8 21,629 9.4 36.5 39,571 8.5 44.0 3.2

H0352 Partners Health Plan of Arizona, Inc. 4/5 386 9.3 47.2 18,974 5.1 50.1 2.1

H0303 FHP, Inc. 10/9 61,837 6.9 29.9 86,650 7.0 34.6 2.9

H0354 Cigna HealthCare of Arizona, Inc. 4/0 27,002 6.0 41.2 29,459 6.8 40.3 3.4

H0355 Blue Cross/Blue Shield of Ariz. 0/5 455 a a 600 a a a

H0356 Premier HealthCare, Inc. 0/5 13 a a 1,255 a a a

Portland-Vancouver, OR-WA PMSA

H3805 Pacificare of Oregon 10/11 25,316 7.4 28.1 35,938 8.2 43.3 2.7

(continued)

Page 37 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H3856 HMO Oregon 3/0 16,460 6.0 57.6 16,876 6.3 57.5 4.3

H9003 Kaiser Foundation HP of the NW 11/9 22,063 5.2 50.5 32,390 5.1 52.6 2.9

H9047 Providence Health Plans 9/10 22,683 3.5 47.6 24,208 3.8 49.9 2.7

H5005 Pacificare of Washington, Inc. 9/2 4,743 3.0 81.1 43,797 6.6 47.5 2.7

H3857 SelectCare Health Plans 2/2 176 a a 1,800 8.2 61.9 2.3

H9049 HMO Oregon, Inc. 8/10 16 a a 22 a a a

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. 10/6 4,876 2.1 94.2 40,369 7.0 44.1 3.0

Redding, CA MSA

H0593 National Med, Inc. 0/9 415 7.7 100.0 523 6.6 100.0 2.6

Reno, NV MSA

H2931 Health Plan of Nevada, Inc. 11/6 739 18.3 54.1 24,892 55.5 8.5 8.3

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 Plan of CA 2/6 661 22.1 28.1 2,698 22.7 35.5 8.6

H0557 Foundation Health, A California Plan 4/7 2,254 22.0 29.4 8,344 28.8 33.9 9.7

H0581 Cigna Healthcare of California 2/6 418 18.4 16.9 13,496 15.9 32.6 8.6

H0545 Inter Valley Health Plan, Inc. 10/7 4,761 17.3 9.2 13,112 10.4 15.2 3.7

H9030 FHP, Inc. 11/9 31,051 14.0 21.0 200,230 12.6 26.7 6.7

H0563 Health Net 4/1 7,239 13.3 21.3 50,913 13.6 22.0 5.1

H0523 Aetna HP of California, Inc. 10/5 36,394 9.2 21.0 55,036 11.5 26.5 5.0

H0543 Pacificare of CA, Inc. 11/4 42,470 8.0 28.0 284,714 7.3 33.1 4.0

H0524 Kaiser Foundation HP, Inc. 9/4 26,840 3.0 44.3 169,003 2.9 55.5 2.8

H0564 CaliforniaCare Health Plans 3/4 163 a a 1,303 32.5 37.1 10.1

H0558 MaxiCare, A California Corporation 5/1 113 a a 2,864 23.7 46.8 10.0

H0504 California Physicians’ Services Corp. 0/5 40 a a 204 a a a

Sacramento, CA PMSA

H0577 Prudential Health Care Plan of CA 2/6 716 21.4 18.3 2,711 15.6 29.8 7.1

H0562 Health Net 4/1 9,352 19.9 11.5 58,588 11.2 23.3 3.7

H0580 FHP, Inc. 1/10 1,842 18.5 38.8 13,124 14.4 43.8 5.8

H0586 Foundation Health, A California Plan 2/9 11,555 11.2 28.4 12,319 11.6 30.6 4.5

H0559 Pacificare of California, Inc. 4/9 10,990 7.5 32.6 89,360 8.9 40.0 3.5

H0583 Kaiser Foundation HP, Inc. 2/6 22,169 1.8 31.6 142,719 1.8 47.3 0.9

(continued)

Page 38 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H0591 CaliforniaCare Health Plans 1/3 205 a a 650 43.9 35.8 10.2

H0599 California Physicians’ Services Corp. 0/6 57 a a 133 a a a

Salem, OR PMSA

H3805 Pacificare of Oregon 10/11 2,244 14.3 57.6 35,938 8.2 43.3 2.7

H9003 Kaiser Foundation HP of the NW 11/9 5,251 4.0 54.2 32,390 5.1 52.6 2.9

H3858 SelectCare Health Plans 1/3 1,680 2.6 81.8 8,353 4.9 64.1 2.6

H9047 Providence Health Plans 9/10 140 a a 24,208 3.8 49.9 2.7

Salinas, CA MSA

H0559 Pacificare of California, Inc. 4/9 3,287 7.2 95.7 89,360 8.9 40.0 3.5

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 California 2/6 1,109 30.5 26.9 13,496 15.9 32.6 8.6

H9030 FHP, Inc. 11/9 26,731 14.8 25.9 200,230 12.6 26.7 6.7

H0563 Health Net 4/1 8,370 12.4 22.8 50,913 13.6 22.0 5.1

H0543 Pacificare of CA, Inc. 11/4 68,771 5.8 32.6 284,714 7.3 33.1 4.0

H0524 Kaiser Foundation HP, Inc. 9/4 26,080 2.0 58.6 169,003 2.9 55.5 2.8

H0564 CaliforniaCare Health Plans 3/4 130 a a 1,303 32.5 37.1 10.1

H0557 Foundation Health, A California Plan 4/7 15 a a 8,344 28.8 33.9 9.7

H0576 Prudential Health Care Plan of CA 2/6 178 a a 2,698 22.7 35.5 8.6

San Francisco, CA PMSA

H0580 FHP, Inc. 1/10 1,750 23.7 50.8 13,124 14.4 43.8 5.8

H0588 Cigna Healthcare of California 1/4 521 23.0 40.0 859 21.9 40.4 7.9

H0577 Prudential Health Care Plan of CA 2/6 430 14.2 29.5 2,711 15.6 29.8 7.1

H0559 Pacificare of California, Inc. 4/9 6,585 11.4 30.4 89,360 8.9 40.0 3.5

H0562 Health Net 4/1 18,216 5.9 31.3 58,588 11.2 23.3 3.7

H0547 Aetna Health Plan of California, Inc. 10/11 20,424 3.6 39.6 26,859 5.4 37.2 3.1

H0583 Kaiser Foundation HP, Inc. 2/6 28,830 1.3 47.9 142,719 1.8 47.3 0.9

H0591 CaliforniaCare Health Plans 1/3 44 a a 650 43.9 35.8 10.2

H0594 Lifeguard, Inc. 1/3 173 a a 2,930 12.5 40.1 3.8

H0571 Chinese Community Health Plan 0/8 169 a a 174 a a a

H0599 California Physicians’ Services Corp. 0/6 36 a a 133 a a a

San Jose, CA PMSA

H0577 Prudential Health Care Plan of CA 2/6 553 13.4 39.2 2,711 15.6 29.8 7.1

H0594 Lifeguard, Inc. 1/3 2,216 12.2 45.4 2,930 12.5 40.1 3.8

(continued)

Page 39 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H0547 Aetna Health Plan of California, Inc. 10/11 2,575 12.2 31.9 26,859 5.4 37.2 3.1

H0580 FHP, Inc. 1/10 3,847 11.1 34.2 13,124 14.4 43.8 5.8

H0559 Pacificare of California, Inc. 4/9 20,098 7.6 37.5 89,360 8.9 40.0 3.5

H0562 Health Net 4/1 3,920 7.2 31.7 58,588 11.2 23.3 3.7

H0583 Kaiser Foundation HP, Inc. 2/6 18,221 1.1 42.6 142,719 1.8 47.3 0.9

H0591 CaliforniaCare Health Plans 1/3 164 a a 650 43.9 35.8 10.2

H0588 Cigna Healthcare of California 1/4 191 a a 859 21.9 40.4 7.9

H0599 California Physicians’ Services Corp. 0/6 19 a a 133 a a a

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 Plan of CA 2/6 338 8.9 40.0 2,698 22.7 35.5 8.6

H0543 Pacificare of CA, Inc. 11/4 6,036 7.6 44.8 284,714 7.3 33.1 4.0

H0564 CaliforniaCare Health Plans 3/4 127 a a 1,303 32.5 37.1 10.1

Santa Barbara-Santa Maria-Lompoc, CA MSA

H9030 FHP, Inc. 11/9 551 19.4 53.3 200,230 12.6 26.7 6.7

H0563 Health Net 4/1 6,679 12.3 13.5 50,913 13.6 22.0 5.1

H0543 Pacificare of CA, Inc. 11/4 9,712 7.3 35.0 284,714 7.3 33.1 4.0

H0564 CaliforniaCare Health Plans 3/4 220 a a 1,303 32.5 37.1 10.1

Santa Cruz-Watsonville, CA PMSA

H0559 Pacificare of California, Inc. 4/9 3,363 3.9 94.7 89,360 8.9 40.0 3.5

Santa Fe, NM MSA

H3204 FHP of New Mexico, Inc. 10/9 1,038 8.3 68.6 17,491 5.4 48.6 3.8

H3251 Lovelace Health Plan, Inc. 3/0 1,688 8.1 30.1 13,106 4.0 56.8 2.0

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 California, Inc. 4/9 1,362 18.4 32.3 89,360 8.9 40.0 3.5

H0566 Health Plan of the Redwoods 3/4 9,602 6.5 33.7 9,773 6.5 34.5 2.5

H0583 Kaiser Foundation HP, Inc. 2/6 7,870 1.3 52.0 142,719 1.8 47.3 0.9

H0580 FHP, Inc. 1/10 3 a a 13,124 14.4 43.8 5.8

Seattle-Bellevue-Everett, WA PMSA

H5052 Providence Good Health Plan of

Washington 3/7 9,381 9.4 33.9 16,004 7.9 39.8 2.4

H5005 Pacificare of Washington, Inc. 9/2 25,735 4.4 50.5 43,797 6.6 47.5 2.7

H5050 Group Health Coop. of Puget Sound 8/0 34,040 3.6 29.5 50,900 4.0 36.1 1.9

(continued)

Page 40 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H5055 Qual-Med Washington Health Plan,

Inc. 2/11 117 a a 275 10.9 46.7 2.8

H5063 Options Health Care, Inc. 0/4 603 a a 974 a a a

Spokane, WA MSA

H5053 Qual-Med, Inland Northwest Division 3/7 1,852 8.9 31.1 2,250 8.2 33.7 1.6

H5066 Medical Service Corporation of E. WA 0/7 667 6.9 85.2 669 6.9 85.2 2.0

H5005 Pacificare of Washington, Inc. 9/2 1,258 6.9 49.4 43,797 6.6 47.5 2.7

H5052 Providence Good Health Plan of

Washington 3/7 2,828 4.5 37.0 16,004 7.9 39.8 2.4

H5069 Group Health Northwest 0/10 698 2.8 43.8 709 2.9 41.2 0.7

Stockton-Lodi, CA MSA

H0559 Pacificare of California, Inc. 4/9 6,810 7.9 48.8 89,360 8.9 40.0 3.5

H0583 Kaiser Foundation HP, Inc. 2/6 3,454 4.3 33.1 142,719 1.8 47.3 0.9

H0568 National Med, Inc. 3/1 1,618 3.5 29.8 11,152 5.1 33.9 1.7

H0586 Foundation Health, A California Plan 2/9 152 a a 12,319 11.6 30.6 4.5

Tacoma, WA PMSA

H5005 Pacificare of Washington, Inc. 9/2 6,432 16.9 30.3 43,797 6.6 47.5 2.7

H5052 Providence Good Health Plan of

Washigton 3/7 586 16.2 45.3 16,004 7.9 39.8 2.4

H5050 Group Health Coop. of Puget Sound 8/0 4,162 4.0 38.8 50,900 4.0 36.1 1.9

H5055 Qual-Med Washington Health Plan,

Inc. 2/11 93 a a 275 10.9 46.7 2.8

H5063 Options Health Care, Inc. 0/4 86 a a 974 a a a

Tucson, AZ MSA

H0354 Cigna HealthCare of Arizona, Inc. 4/0 1,827 15.5 25.4 29,459 6.8 40.3 3.4

H0351 Intergroup Prepaid Health Serv of

AZ, Inc. 4/8 10,010 7.3 38.3 39,571 8.5 44.0 3.2

H0303 FHP, Inc. 10/9 22,144 5.6 37.0 86,650 7.0 34.6 2.9

H0352 Partners Health Plan of Arizona, Inc. 4/5 16,005 4.4 45.8 18,974 5.1 50.1 2.1

H0307 Humana Health Plan, Inc. 8/7 97 a a 18,273 17.1 28.2 7.1

H0355 Blue Cross/Blue Shield of Ariz. 0/5 128 a a 600 a a a

H0356 Premier HealthCare, Inc. 0/5 4 a a 1,255 a a a

Vallejo-Fairfield-Napa, CA PMSA

H0562 Health Net 4/1 1,086 15.7 13.5 58,588 11.2 23.3 3.7

H0559 Pacificare of California, Inc. 4/9 3,677 11.7 41.9 89,360 8.9 40.0 3.5

H0583 Kaiser Foundation HP, Inc. 2/6 8,836 1.3 58.8 142,719 1.8 47.3 0.9

H0580 FHP, Inc. 1/10 12 a a 13,124 14.4 43.8 5.8

(continued)

Page 41 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

Ventura, CA PMSA

H0557 Foundation Health, A California Plan 4/7 2,468 27.3 27.5 8,344 28.8 33.9 9.7

H9030 FHP, Inc. 11/9 3,666 20.1 19.4 200,230 12.6 26.7 6.7

H0523 Aetna HP of California, Inc. 10/5 960 16.4 33.8 55,036 11.5 26.5 5.0

H0563 Health Net 4/1 2,999 12.1 28.7 50,913 13.6 22.0 5.1

H0543 Pacificare of CA, Inc. 11/4 13,726 6.1 37.4 284,714 7.3 33.1 4.0

H0524 Kaiser Foundation HP, Inc. 9/4 2,104 2.3 52.1 169,003 2.9 55.5 2.8

H0564 CaliforniaCare Health Plans 3/4 31 a a 1,303 32.5 37.1 10.1

H0576 Prudential Health Care Plan of CA 2/6 131 a a 2,698 22.7 35.5 8.6

H0554 CareAmerica Health Plans 6/2 49 a a 38,358 17.1 27.5 9.0

H0581 Cigna Healthcare of California 2/6 187 a a 13,496 15.9 32.6 8.6

H0545 Inter Valley Health Plan, Inc. 10/7 3 a a 13,112 10.4 15.2 3.7

Visalia-Tulare-Porterville, CA MSA

H0559 Pacificare of California, Inc. 4/9 385 19.0 98.6 89,360 8.9 40.0 3.5

H0570 Health Net 3/2 141 a a 4,248 47.7 19.5 4.9

H9030 FHP, Inc. 11/9 76 a a 200,230 12.6 26.7 6.7

H0584 Kaiser Foundation HP, Inc. 1/11 35 a a 5,790 4.0 64.7 2.0

Yolo, CA PMSA

H0586 Foundation Health, A California Plan 2/9 343 9.3 34.4 12,319 11.6 30.6 4.5

H0562 Health Net 4/1 3,111 3.4 65.7 58,588 11.2 23.3 3.7

H0583 Kaiser Foundation HP, Inc. 2/6 1,348 1.5 5.0 142,719 1.8 47.3 0.9

Yuba City, CA MSA

H0562 Health Net 4/1 1,126 7.0 79.7 58,588 11.2 23.3 3.7

H0583 Kaiser Foundation HP, Inc. 2/6 96 a a 142,719 1.8 47.3 0.9

Yuma, AZ MSA

H0303 FHP, Inc. 10/9 27 a a 86,650 7.0 34.6 2.9

H0352 Partners Health Plan of Arizona, Inc. 4/5 9 a a 18,974 5.1 50.1 2.1

H0356 Premier HealthCare, Inc. 0/5 532 a a 1,255 a a a

Others, Not in an MSA

H0303 FHP, Inc. 10/9 539 24.3 55.7 86,650 7.0 34.6 2.9

H2931 Health Plan of Nevada, Inc. 11/6 575 12.5 94.4 24,892 55.5 8.5 8.3

H0609 FHP of Colorado, Inc. 10/6 461 10.8 98.0 40,369 7.0 44.1 3.0

H0562 Health Net 4/1 651 9.5 93.5 58,588 11.2 23.3 3.7

H3805 Pacificare of Oregon 10/11 5,833 8.6 87.6 35,938 8.2 43.3 2.7

H3857 SelectCare Health Plans 2/2 1,566 7.9 63.7 1,800 8.2 61.9 2.3

H9047 Providence Health Plans 9/10 912 7.7 67.1 24,208 3.8 49.9 2.7

(continued)

Page 42 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
Appendix II 

Medicare Risk HMO Voluntary

Disenrollment Rates, 1996

Within metropolitan areas Overall contract statistics

HCFA

contract # Plan name

Plan

age

yrs./

mos.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Average

monthly

enrollment

Vol.

rate

FFS as

% of

vol.

Rapid

rate

H5005 Pacificare of Washington, Inc. 9/2 3,225 6.6 80.3 43,797 6.6 47.5 2.7

H0352 Partners Health Plan of Arizona, Inc. 4/5 2,314 6.3 51.7 18,974 5.1 50.1 2.1

H5050 Group Health Coop. of Puget Sound 8/0 2,950 6.0 47.8 50,900 4.0 36.1 1.9

H0568 National Med, Inc. 3/1 448 5.1 87.0 11,152 5.1 33.9 1.7

H0351 Intergroup Prepaid Health Serv of

AZ, Inc. 4/8 6,924 4.7 73.5 39,571 8.5 44.0 3.2

H5052 Providence Good Health Plan of

Washington 3/7 3,084 4.2 71.5 16,004 7.9 39.8 2.4

H9003 Kaiser Foundation HP of the NW 11/9 3,780 3.6 51.8 32,390 5.1 52.6 2.9

H3251 Lovelace Health Plan, Inc. 3/0 741 3.1 52.2 13,106 4.0 56.8 2.0

H3858 SelectCare Health Plans 1/3 1,952 2.8 80.0 8,353 4.9 64.1 2.6

H1230 Kaiser Foundation HP, Inc. 10/8 3,370 1.1 81.6 13,795 2.0 81.1 1.2

H0570 Health Net 3/2 1 a a 4,248 47.7 19.5 4.9

H0581 Cigna Healthcare of California 2/6 36 a a 13,496 15.9 32.6 8.6

H0615 Qual-Med, Inc, Denver 8/5 9 a a 7,383 14.0 21.6 3.6

H9030 FHP, Inc. 11/9 137 a a 200,230 12.6 26.7 6.7

H0559 Pacificare of California, Inc. 4/9 139 a a 89,360 8.9 40.0 3.5

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 6.6 100.0 2.6

H3204 FHP of New Mexico, Inc. 10/9 53 a a 17,491 5.4 48.6 3.8

H0630 Kaiser Foundation HP of Colo. 11/1 192 a a 32,721 4.4 31.3 2.3

H0584 Kaiser Foundation HP, Inc. 1/11 103 a a 5,790 4.0 64.7 2.0

H0583 Kaiser Foundation HP, Inc. 2/6 141 a a 142,719 1.8 47.3 0.9

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, Inc. 0/4 47 a a 974 a a a

aThis plan either had an average enrollment of less than 250 or was in operation 6 months or less.

(101532) Page 43 GAO/HEHS-98-142 Medicare HMO Disenrollment Rates
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