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HMO firm plans seminars to explain coverages

With two HMO companies pulling out and new ones coming in, seniors are anxious for information and to sign up for a new plan.


© St. Petersburg Times, published October 27, 2000

With the expiration date and premium increases fast approaching on their prescription drug coverage, seniors in Hernando and Pasco counties are clamoring for more information from Medicare HMO companies approved to enter these counties on Jan. 1.

Officials with Well Care Health Plan in Tampa say they plan to hold seminars in both counties to help seniors sign up for benefits. They are expected to release the dates and locations for those seminars within the next two weeks.

Well Care particularly emphasized the need for the presence of salespeople to sign up residents in Hernando County, where 10,000 seniors and disabled people are being dropped by the last two Medicare HMO companies in town at the end of the year.

The announced departure of those two companies unleashed a ground swell of panic this summer by seniors in Hernando fearing the loss of prescription drug coverage, which is not included under traditional Medicare.

"We will be there seven days a week, 24 hours a day, if we have to," said Stephen Dunn, vice president of sales and marketing for Well Care.

Last week, the federal Health Care Financing Administration (HCFA) approved Well Care to enter Hernando and Pasco counties on Jan. 1. Enrollment will begin Nov. 1.

UnitedHealthcare was approved by HCFA at the end of September to enter Hernando County at the start of the new year.

But United does not plan to hold seminars in Hernando County. Instead, seniors and disabled residents may call (800) 973-6467 and leave their names and addresses, said company spokeswoman Patt Reed. A salesman at that number said seniors can call another number for a shorter waiting period: (888) 403-5811. After Nov. 6, United will then mail forms and information for seniors to use to sign up for benefits and mail back to the company.

Some Hernando seniors, who have been waiting anxiously for more information from both companies, are angered by United's mail-in system.

Senior citizens need help sorting through confusing documents to choose the best plan, said Marie Nielsen, vice president of Florida Citizens to Keep HMOs, a grass-roots group in Hernando fighting for long-term change to Medicare.

"For those real elderly seniors, sometimes you need to explain two or three times until they understand the plan. It's confusing," Nielsen said.

"If they have a question, are they going to get a human voice at the other end? And that's going to be difficult for them. They'd rather come out to a seminar and ask their questions."

Reed said the package of information sent to Hernando seniors will include additional phone numbers to reach a salesperson.

United decided to use the mail system instead of seminars to save money, she said.

"Marketing directly to any population is an expensive undertaking," she said. "We have to work within the money the federal government gives us to care for these people."

The cost of postage was less than renting a hall for seminars and paying salespeople to staff them all day, she said.

"We are keeping our administration costs down so we can pay claims, which is very important to us," she said. "It's not right to bring a program that offers more benefits if you can't pay claims."

In Hernando County, United is offering no premium and a $500 annual limit on what it will pay for prescription drugs. Its copays are $8 for generic drugs a month and $40 for brand name.

Of the two Well Care plans being offered in Hernando County, the first charges no premium, while the second charges $59 a month. The limit on what the company will pay for prescription drugs is $187 a quarter, or $748 a year, for both plans. On the first plan, the copayment on monthly prescription drugs is $7 for generic and $40 for brand names, while the second plan with the premium charges $7 for generic and $30 for brand name prescription drugs.

In Pasco County, where other Medicare HMO plans exist, the first Well Care plan offers no premium, and the second one offers $79 monthly premium. The first plan offers $7 copay in generic prescription drugs a month with no annual cap on what the company will pay and $20 for brand name drugs. The second plan offers $5 for monthly generic prescription drugs with no annual cap, and $15 copay for brand name drugs.

Pasco seniors are just as impatient for more information from Well Care as Hernando seniors.

Constance Brown of Holiday has tried unsuccessfully to contact Well Care, which she wants to join at the end of the year. She now is enrolled with Humana, which is pulling out of Hernando in 2001 and increasing its premiums in other counties from $19 a month to $179. Its plan with no premium does not cover any brand-name drugs.

Brown said her family will not be able to afford three premiums, each at $179 a month, for herself, her husband and her mother. They also will not be able to afford brand-name drugs.

"My mother alone would be a couple hundred dollars a month," she said. "I can't pay $179 a month and then pay for brand-names besides."

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