zations (HMOs) licensed to do business in the state, only 12 participate in TSECMMP. The enrollment level in 4 of those 12 plans accounts for 75 percent of total enrollment in HMOs.

TSECMMP was established by general statute by the North Carolina legislature in 1982. In 1986, it began offering its first HMO options to plan members. TSECMMP covers 533,000 people, 67,000 of whom are eligible for Medicare. Only 3,000 of those 67,000 people have chosen to join 1 of the 12 HMOs (less than 5 percent penetration). There is an expectation that the level of penetration will increase as more active employees (nonretired) enrolled in managed care become eligible for Medicare. Currently, 27 percent of all TSECMMP enrollees participate in some type of managed care plan.

TSECMMP markets to all of its members, be they active or retired, with the same materials and provides them with the same benefits. All beneficiaries receive a booklet, "It's Your Choice," which is published every year and which provides basic information about the plans, including benefits and health plan telephone numbers. If a beneficiary is interested in a particular plan, it is up to him or her to call that plan and request additional information. Marketing materials are screened by TSECMMP. The state of North Carolina has attempted to make it fairly simple to compare information about different plans. The benefits are standardized, and copayments are regulated by state law. HMOs may offer additional benefits, such as vision or dental coverage; however, the benefits offered through TSECMMP tend to be more generous than those typically offered by HMOs to their other customers.

Lessons Learned

TSECMMP uses its retired employees to help pensioners and active employees with the decision-making and enrollment processes during its annual open-season enrollment period. The training of retirees across the state to become information counselors works well for TSECMMP. It has found that its beneficiaries work well with these counselors because the counselors have had practice in making the same decisions that the beneficiaries are facing.

North Carolina has found that many of the plans that initially signed up to provide care under TSECMMP dropped out after the first couple of years. The plan's administrator advised HCFA that as competition among the Medicare+Choice plans begins to take place, it is likely that quite a few of the health plans will end up leaving the federal program as well. Of the plans that remain after the initial phase of competition, only a few will have enrolled most of the market share.

To a great extent, TSECMMP relies on its participating health plans to provide detailed information on services that they provide to beneficiaries. This public-private partnership has worked well for the state, saving personnel and resources.

Federal Employees' Health Benefits Program*

FEHBP is the largest health plan in the country, with about 9 million covered lives. FEHBP currently has approximately 4 million actual contract holders, split evenly between ac-


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