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WUSF News Staff
Health News Florida
Thu March 28, 2013
What Universal HMO Customers Need to Do
Nearly half of Universal Health Care customers -- those enrolled in one of Universal's Medicare plans -- need to act immediately if they want to protect themselves from the possibility of unexpected expenses next month.
If they switch plans by Sunday, March 31, they will be fully covered under their new plan as of Monday, April 1. If they don't, the federal government will automatically enroll them in traditional Medicare. If they had prescription-drug coverage under Universal, they will be automatically enrolled in a drug plan.
Here's why the date matters: In traditional Medicare, patients who don't have a supplemental insurance policy (such as one from AARP-United Healthcare) must pay 20 percent of most outpatient expenses and a hefty portion of any inpatient charges. Confusingly, many services provided at a hospital -- even if the patient is in a bed -- are billed at the outpatient rate. So the risk can be substantial.
Those who wait until next week to switch plans will have to wait until May 1 for the new coverage to take effect.
Medicare beneficiaries can switch plans online at www.medicare.gov or by calling 1-800-MEDICARE. For advice, they can call a volunteer at SHINE (for Serving Health Insurance Needs of Elders) at the Elder Helpline,800-963-5337. Usually it is necessary to leave a message, to be returned. A list of counseling sites in each county can be found at this website.
Universal Health Care already faced a state takeover on April 1, after being declared insolvent and accused of financial mismanagement and possible fraud. On Thursday morning, federal agents armed with a subpoena raided the St. Petersburg headquarters and ushered all but about 20 member-services employees out, the Tampa Bay Times reports.
Universal, founded in 2003, had about 100,000 members as of last month -- some had switched plans in the fall during open-enrollment after federal health officials advised them to because of Universal's poor ratings on quality. While the company had some members in other states, most are in Florida.
About 40,000 of the members were on Medicare, and 60,000 on Florida Medicaid.
After Health News Florida asked Wednesday what members were supposed to do, given the pending shutdown this weekend, the Centers for Medicare and Medicaid Services sent an e-mail. It contained the information on the "special election period" for plan-switching, noted the importance of the dates, and added the toll-free number.
It also said: "CMS is committed to helping affected beneficiaries understand what is happening with their benefits in the short and long term."
As for Medicaid, the joint state and federal program for certain groups of low-income people, those in Universal will either be moved to other HMOs or to fee-for-service Medicaid, according to the state Agency for Health Care Administration.
Swift action to switch plans isn't as crucial for Medicaid patients because the state pays nearly all of the bill no matter what kind of plan they're in. The state agency's release said information is available at www.ahca.myflorida.com or by calling one of two toll-free numbers.
Universal's Medicaid members in the "Reform counties" --Broward, Baker, Clay, Duval and Nassau -- can call 1-866-454-3959 (press 1 for English, then 2 for a person); or change plans online at http://www.FlMedicaidReform.com/index.html.
Those in other counties were instructed to call 1-888-367-6554 (press 1 for English, then 3 to speak to a person); or change plans online at http://www.Medicaid Options.net/default.aspx.