Carilion Clinic signed up 258 people for its new Medicare health plan, significantly fewer than the health system's initial enrollment goal.

Carilion introduced the new insurance plan under the federal government's Medicare Advantage program in the fall with the initial hope of enrolling about 3,000 patients. But even with an advertising campaign that included newspaper ads, direct mailing, radio spots and billboards, the numbers fell short.

Because it is a Medicare option, the plan is open only to people 65 or older, or to people with a qualified disability. In Southwest Virginia, the plan is also available only to those who live in the eight-county region served by the Carilion health care system. The initial enrollment period was between Nov. 15 and Dec. 31.

Dr. Mark Werner, Carilion's chief medical officer, admitted Carilion would have liked to attract more patients. Still, he emphasized that he was comfortable with the outcome.

"We knew we would have a modest enrollment from the beginning," he said.

Werner added that the intensity surrounding national health care reform likely played a role in curtailing interest.

"I do think a lot of the very public health care reform debate going on throughout the fall season clearly affected people's interest in making changes in their health plans," Werner said.

It's all but certain that Medicare Advantage will be changed with any national health care reform. Proposals, which have been promoted by President Obama, include cutting the reimbursements that are paid to Medicare Advantage Plans.

"This particular program is going to be impacted by the changes," said Doug Gray, executive director of Virginia Association of Health Plans.

Carilion's campaign to enroll people in the plan also faced local obstacles.

Carilion's chief competitor, HCA Southwest Virginia, launched an advertising campaign of its own warning potential patients of some of the risks of signing up for the new plan.

The HCA ads were intended to inform patients that they could lose access to HCA doctors and facilities, including Salem's Lewis-Gale Medical Center, unless they pay large out-of-pocket expenses that can total thousands of dollars.

Other independent physician practices, such as Jefferson Surgical Clinic, ran ads to say that visits to their physicians would not be covered by the new Carilion plan.

Shannon Abell, director of senior services at the LOA Area Agency on Aging, said that Medicare Advantage Plans don't necessarily have a good reputation among seniors because patients are limited to a certain network of doctors.

"That's the problem, when you select a Medicare Advantage Plan, you are limited to where you can go," Abell said. "You have to find doctors and hospitals willing to accept the terms and conditions of the plan."

For Carilion's plan that means being restricted to Carilion hospitals and about 600 physicians who are participating in the network. While the plan includes about 130 physicians who are not employed by Carilion, there are still many more doctors in the area who are not part of the network.

The advantage is the enrolled patient often pays a very low monthly premium or no premium at all. Still, there are often co-payments associated with hospitalizations and doctor visits.

Gray said that Medicare Advantage Plans can offer some creative benefits that go beyond the basic medical benefits of a traditional Medicare plan.

This is Carilion's second attempt at offering an HMO, or health maintenance organization, plan. The health system offered a commercial managed-care plan for patients of all ages in the 1990s, but discontinued the plan in 2004 because not enough people enrolled.

This time, however, Carilion said it doesn't matter how many people are enrolled.

"We are fully committed to providing great care," Werner said. "We've structured the plan in a way where it is fiscally feasible and we can scale it to the number of patients we are caring for."

Some Medicare-eligible patients could still enroll during a special enrollment period that runs through March 31, but federal law limits who can select a new Medicare Advantage Plan during this time frame. Additionally, others could join the plan as they become eligible for the Medicare benefit.

Medicare Advantage Plans aren't particularly popular in Roanoke. In the city only about 2,700 people were enrolled in one of 16 available Medicare Advantage Plans during December, according to data maintained by the Centers for Medicare & Medicaid Services. In Roanoke County about 2,500 people were signed up for one of 15 plans offered in the county, according to the same data.

About 16,000 people are eligible for Medicare in the city and 14,000 in the county.

"I think it takes awhile for people to understand that options are available to them and to investigate them and change what they are doing," Gray said of the popularity of Medicare Advantage Plans. "Some of it is just word of mouth. I think all these changes take time for people to get used to them."

Abell said most people tend to use traditional Medicare and purchase a supplemental "Medigap" insurance policy for a monthly premium. Those who can't afford the supplemental policy often look at Medicare Advantage, he said, but noted that low-income individuals might qualify for assistance to buy a supplemental policy.