Universal Healthcare Question

[dandan]

I have a gentleman who had Universal Health care which as you know is no longer, he is now on hospice and wanting coverage. I am not sure what to put him on, I would think plan G but they indicated they want another MAPD with zero premium.... any thoughts?

 

[superdave]

MAPD with Part B reduction and low co-pays in Florida:

OPTIMUM

 

[yogooglethis]

MAPD with Part B reduction and low co-pays in Florida:

OPTIMUM

Good benefits but very sparse on specialist and hospitals at least in North Fl.Sort of like Universal was.

 

[BobbyMcGee]

My clients give good reviews to Wellcare Dividends. Giveback with pretty good network. Pretty much all the good Hospitals. 3 mos. of generics (MAIL ORDER) 0. Lower moop than most of these non-snp plans. Not a snip tho if that's what he is looking for.

 

[Guest]

United Healthcare hands down has a fabulous directory and quick claims pay

 

[Chazm]

Most clients that were on universal will not be impressed with UHC. They'll be looking at Optimum if they were on a SNP or WellCare, PCP, Coventry or PUP if not.

I was really surprised to see my April week 1 statement from optimum already paying on the 9 people that I switched over to them just before the end of march. That was fast. Can't say the same for the other 3 companies I put a few on.

 

[yogooglethis]

Most clients that were on universal will not be impressed with UHC. They'll be looking at Optimum if they were on a SNP or WellCare, PCP, Coventry or PUP if not.

I was really surprised to see my April week 1 statement from optimum already paying on the 9 people that I switched over to them just before the end of march. That was fast. Can't say the same for the other 3 companies I put a few on.

Many of the people on Universal Health Care in North Florida were on Quality Health Plans HMO that was suddenly liquidated in December 2011.Many of those people on QHP had switched from Humana as soon as they could which was the plan that CMS had auto enrolled those people who were on the MD Medicare Choice MA plan when it was suddenly liquidated in Oct 2008.

What do all those plans have in common? They all had ridiculously low co payments and often paid members to enroll with a rebate, referrals that somtimes took 3 months to get authorized and a rather limited neworks sometimes having to pay fee for service for some specialist ie. orthopedics because there wasn't any of them in the network.

Yes the Universal clientele is your hard core co pay shopper but I think most of these people finally get it because I am not gettingtoo much resistance when I show them the higher co payments of a plan like UHC I tell them how the plan has been pretty much the same since 2006 and that most of my customers , many who were the HMO low co payments hounds switching to different plans every year before enrolling in UHC PPO, stay on the plan year after year and I show them the always expanding list of providers that accepts the plan .

When I do get comments from prospects about the higher co payments of UHC PPO compared to the Universal plan they were on before I simply agree and say yes they had very low co pays and I understand they also gave you 96.00 back wow that was a great deal ! You know all of these MA plans get pretty much the same amount of money from the Guvment to operate and I always wondered how plans like Universal were able to give you all that and still make a profit and I just keep on going.

I think these people get finally get it and are happy to get a plan for the long haul .

 

[Chazm]

Universal was not getting the same amount though. That was their problem, they could never get to a 3 star rating. I'm not saying other companies won't go belly up but optimum is a 4 star company and pup is doing quite well financially and I don't see either of them closing anytime soon.
I do write UHC too and put a couple people per month on the plan though.

I'm not sure if you have UHC HMO in your area but I really like that plan. No referrals and it has the exact network as the ppo but with lower copays.

 

[BobbyMcGee]

Optimum is a very good choice.
Hard for a retired couple who are receiving $2400. in giveback money to switch. That's a lot of co-pays for Specialist visits. The systems set up for labs/xrays/mri's, etc. are the same places as the giants. Maybe 4 or 5 ambulatory surgery centers used by everybody.

I go to these specialists office, after checking on healthgrades, and see waiting rooms full of people with every kind of insurance. They will hopefully all get the best treatment available there. I'm not at all worried about how fast my insurance pays them. They've already accepted the plan's payment terms. Their problem.

Older people hate to change. If they have been seeing a Doc that's in a specific plan, they will most likely continue to do so. For many, they now have the best insurance plan they've ever had in their lives and can still get a refund on their Part B. My neighbor has UHC and I have a giveback and we still go to the mostly the same places. His Doc is in the same building as mine and we have all played golf together.

Is the UHC HMO better than the 4.5 star Humana HMO in Central Florida? CMS sez no with their star ratings, but no one is allowed to say so.

As always, go over every option with your client and let THEM decide. Lots of good choices out there.

 

[Chazm]

Optimum is a very good choice.
Hard for a retired couple who are receiving $2400. in giveback money to switch. That's a lot of co-pays for Specialist visits. The systems set up for labs/xrays/mri's, etc. are the same places as the giants. Maybe 4 or 5 ambulatory surgery centers used by everybody.

I go to these specialists office, after checking on healthgrades, and see waiting rooms full of people with every kind of insurance. They will hopefully all get the best treatment available there. I'm not at all worried about how fast my insurance pays them. They've already accepted the plan's payment terms. Their problem.

Older people hate to change. If they have been seeing a Doc that's in a specific plan, they will most likely continue to do so. For many, they now have the best insurance plan they've ever had in their lives and can still get a refund on their Part B. My neighbor has UHC and I have a giveback and we still go to the mostly the same places. His Doc is in the same building as mine and we have all played golf together.

Is the UHC HMO better than the 4.5 star Humana HMO in Central Florida? CMS sez no with their star ratings, but no one is allowed to say so.

As always, go over every option with your client and let THEM decide. Lots of good choices out there.

Star rating wise? No UHC has less stars but the UHC HMO has a much bigger network than Humana. I only write Humana if I'm in Orlando or Kissimmee. It's pretty bad in Polk county where I do most of my business.