ST. PETERSBURG — Over the last few months, Helen Brown, 89, cracked three ribs, broke her ankle and stayed in a hospital after a fainting spell. Universal Health Care paid all her bills.
But reports of serious financial problems at the St. Petersburg-based insurer made her reconsider her options. Thursday, as federal agents raided Universal headquarters, she shared her experience.
"When I knew the end was coming, I figured it was time to look for a new plan," said Brown, of Pinellas Park. "Oh, my God, it's been a nightmare figuring out what to do."
Brown's first call this week was to a consumer group, which helped her sort through the ratings for other Medicare plans. She eventually settled on a Coventry offering with similar benefits to her old plan.
Brown is among thousands who already have fled Universal. But as of Thursday, about 10,000 seniors in Pinellas, Hillsborough, Pasco and Hernando counties still were in Universal plans and have limited time to reassess their options.
Effective Monday, Universal's Medicare plans will be liquidated and existing customers could face unexpected expenses.
The Tampa Bay Times spoke to experts about common questions and concerns:
I have a Medicare Advantage plan through Universal. What do I do?
Do not panic. Even if you do nothing, you still have health insurance. The federal government plans to automatically enroll Universal customers into the original Medicare program and a drug plan considered comparable to your current benefits.
But this could mean heavy out-of-pocket costs for office visits, medications and hospitalization.
What's the difference between original Medicare and Medicare Advantage?
Medicare Advantage plans are privately run alternatives — usually a HMO or PPO — that can offer lower out-of-pocket costs, but may limit members to certain providers. People with expensive medical conditions, or who want treatment at a top-notch specialty clinic, may be better off with original Medicare, along with supplemental insurance to cover out-of-pocket costs.
I need some time to research my options. Is that a problem?
Yes and no. If you don't enroll in a new Medicare Advantage plan by Sunday and instead get benefits under original Medicare, you could face a steep hike in expenses if you need care. That's because if you elect a new Advantage option in April — Monday is April 1 — it won't start until May 1.
According to the consumer advocates at Florida SHINE (Serving Health Insurance Needs of Elders), the financial stakes are considerable: If you stay with original Medicare you could be responsible for paying 20 percent of the fee for doctor visits and $1,184 if you have to go to the hospital. Additionally, the drug plan you are assigned may have a $325 deductible. And unless you have other government assistance, you may have to pay the $104.90 monthly premium for Medicare Part B outpatient care.
That's a lot of financial exposure. Who can help me sift through my options?
Due to the Good Friday holiday, the SHINE hotline is closed until Monday. So here's what its counselors suggest: Call your doctors (provided their offices are open) and find out what other Medicare Advantage plans they take. At the very least, you can gather a list of your medications, or collect your pill bottles. Pull out your red, white and blue Medicare card. Then call the Medicare hotline at 1-800-633-4227. With this information, someone should be able to walk you through your options. If you're internet-savvy, or have a friend who is, you can plug your information into an online form to compare plans and even switch to a new plan on the Medicare website: www.medicare.gov.
What if I make the wrong decision?
If you pick a new Advantage plan by Sunday, you're in it for the rest of the year. But if you wait to consider your options, you can pick a new Advantage plan by May 31, said Andrea Gary, spokeswoman for the Florida Department of Elder Affairs. (But you face potentially higher costs during the time you're on original Medicare, as described above).
If you do wait, SHINE volunteers, whose advice is free and unbiased, can help you determine the best option for your medical needs. The SHINE hotline is 1-800-963-5337.
What if I have Medicaid coverage through Universal?
Medicaid patients won't face the extra costs Medicare patients must consider. Call the Florida Agency for Health Care Administration at 1-888-367-6554 for your options.