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Crowd soaks up HMO plans' details

About 400 people gather to question the federal agency that oversees Medicare.


© St. Petersburg Times, published November 1, 2000

BROOKSVILLE -- The crowd was just as big and with almost as many questions. But gone were the placards, crying and shouting when about 400 Hernando County seniors and disabled residents packed the Florida National Guard Armory on Tuesday to get more information on new Medicare HMOs.

The session was held by the Florida Department of Elder Affairs, which released details on the benefits offered by Well Care Health Plan and UnitedHealthcare starting Jan. 1.

"Use your health history as a guide to choose these options," Tom Reimers, director of the department's SHINE program, told the packed hall after seniors were provided booklets listing United's plan and Well Care's two plans. SHINE stands for Serving Health Insurance Needs of Elders.

"We wanted to put this in your hands so you could compare apples to apples and oranges to oranges," Reimers said. Two more meetings will be held in the same place Wednesday, at 10 a.m. and 1:30 p.m. The first Wednesday meeting will be taped and replayed on Channel 19 at 11 a.m. and 3 p.m. Friday; at 4 p.m. and 9 p.m. Saturday; 7 a.m. and noon Sunday; and 7 a.m. Monday.

Company representatives were not at Tuesday's meeting. The information came from the federal agency that oversees Medicare and granted approval to Well Care and United the past two months.

The approvals followed the announced withdrawals by Humana and AvMed Health Plan, who are pulling out at year's end, dropping 10,000 seniors and disabled residents, some of whom stormed public meetings in protest.

At Tuesday's meeting, Reimers went over some of the plans, telling seniors to judge them based on things they need most, such as doctors' appointments, hospital stays or prescription drugs.

United's plan carries no premium; prescription drug co-payments are $8 for generic medicines a month and $40 for brand name drugs with a $500 yearly limit on what the company will pay for all medication. A visit to a primary-care doctor costs a $15 co-payment; a visit to a specialist is $20.

Hospital stays cost $150 a day for an unlimited amount of time.

Under Well Care's plan that does not charge a premium, co-payments on prescription drugs are about the same as United's, at $7 for a month's supply of generic pills and $40 for brand name. But the annual limit on what the company will pay for prescriptions is higher but limited to $187 every three months. That could make a difference to patients who need a lot of medicine at one time in the year because unused money can't be carried to the next quarter.

Co-payments for a primary care doctor's visit is a little less at $10 each; for a specialist, it's the same, at $20 each.

Hospital stays cost differently from what Well Care first released, according to the HCFA numbers and Well Care officials contacted Tuesday. For the plan without a premium, a patient would pay $150 a day up to $600 for each hospital stay. Then the company would pick up the cost. United's co-payment is the same but does not limit what the patient will pay.

The second plan Well Care is offering charges a $59 monthly premium. But its prescription drug co-payments are slightly less than the other two plans, $7 for a monthly supply of generics and $30 for brand-name drugs. Its $187 quarterly limit is the same as the first plan.

On doctor's visits, Well Care's second plan is cheaper than the other two: a $5 co-payment for a primary-care visit and $15 for a specialist.

The hospital stay is different from the other two, also. Patients pay a $200 co-payment for each hospital stay for unlimited days for each stay.

Although some seniors left the meeting happy with the details provided in the booklet, others said they wanted more.

"We come to these meetings and don't have the information we need," said Mary DiMaggio of Glenlakes, as she left with her husband, John, who has been visiting his doctors sometimes every day to treat his cancer.

United is not holding seminars to enroll residents, but will mail them forms after they call (800) 973-6467.

Well Care is planning seminars on 15 days. The dates, times and locations are as follows: at the Knights of Columbus at 10470 Spring Hill Drive, Monday, Nov. 13, Nov. 20 and Nov. 27. There will be three seminars on each of those days, at 9:30 a.m., 12:30 p.m. and 3:30 p.m.

The second location is the VFW Lodge at 15166 Spring Hill Drive. The dates are Nov. 8, Nov. 15, Nov. 22 and Nov. 29. The times on each of those days are 9:30 a.m., 12:30 p.m. and 3:30 p.m.

The third location is the Spring Hill Civic Association Community Center at 1202 Kenlake Ave, Spring Hill. The dates are: Monday from 9 a.m. to noon; Nov. 7 from 12:30 p.m. to 5 p.m.; Nov. 13 from 12:30 p.m. to 5 p.m.; Nov. 14 from 12:30 p.m. to 5 p.m.; Nov. 27 from 9 a.m. to 5 p.m.; Nov. 28 from 12:30 p.m. to 5 p.m.; and Dec. 4 from 9 a.m. to noon. For information, call (888) 888-9355.

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