Medicare Plan Fights State Order
Ultimate Health Plans, a scrappy little company north of Tampa, is offering Medicare HMO deals that sound too good to be true: no premium, no deductible, free gym membership and even cash back.
What's not to like? Ask the Florida Office of Insurance Regulation, which suspects the company lacks sufficient funds to pay claims for its 3,000 members. OIR issued a suspension order Oct. 2, but it was placed on hold when Ultimate invoked its right to a hearing. It can take months, sometimes years, for the hearing process to unfold.
Meanwhile, Ultimate is signing up new Medicare members in Pasco, Hernando and Citrus counties for 2015 during open enrollment, which began Oct. 15 and lasts until Dec. 7.
Prospective members would not know about the state's worries; the pending suspension is not mentioned on the federal government's list of plans by zip code at Medicare.gov. Attracted by the price tag -- or lack of one -- beneficiaries can enroll in an Ultimate plan just by clicking on the "enroll" button.
Last week, Health News Florida reported that the federal website lists Florida Medicare plans that are under suspension, without any mention of it. Two such suspended plans, DayBreak and Sunrise, are sponsored by the Coral Gables company Florida Healthcare Plus.
Saying Florida Healthcare Plus lacked sufficient surplus, the state blocked new enrollment, although the 11,000 current members are allowed to remain in the plans if they wish. Medicare beneficiaries who try to enroll in the plans find out they can't when they call.
There is no such roadblock for Ultimate Health Plans, which was founded just two years ago and operated only in Hernando County in 2014. "We're a really small plan, hoping to grow very quickly," said Chief Financial Officer Terrence Sleap. (Editor's note: This name was misspelled in an earlier version.)
The OIR suspension order says that as of the end of August, Ultimate reported a surplus of $1.7 million. It was supposed to have a minimum of $1.875 million, the order said.
CFO Sleap said officers of the Spring Hill-based company think the OIR order was based on an error or misunderstanding. "We were never in a deficit situation," he said, predicting that the dispute will dissolve within a couple of weeks, long before it would go to a hearing.
Sleep said the company is owned by Dr. Medhat Reheem, a board-certified anesthesiologist who operates a pain clinic in Brooksville. He was not in the clinic Monday, a staff member said, and could not be reached.
The Summary of Benefits for Ultimate plans (page 5) shows an impressive list of extras for people who select the company's plan. The cash-back offer that makes plans like Ultimate Premier and Ultimate Elite HMOs so attractive to many Medicare beneficiaries involves the $104.90-a-month "Part B" premium that Medicare usually deducts from beneficiaries' Social Security checks.
In some Florida counties, the competition for enrollees is so fierce that HMOs offer part or most of the Part B as a rebate, and have for years. But it's unusual to see a rebate of the entire $104.90 a month.
--Health News Florida is part of WUSF Public Media. Contact Special Correspondent Carol Gentry at email@example.com. For more health news, visit HealthNewsFlorida.org.