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Medicare takes back QHP members

(Updated 6 p.m.) In an unusual move, federal health officials are returning 10,000 Florida enrollees in a defunct HMO to the traditional Medicare program on Dec. 1 instead of shifting them to a different HMO.

The Centers for Medicare & Medicaid Services announced late Tuesday that members of Quality Health Plans, or QHP, will be able to see their usual doctors; however those doctors will bill the Medicare program for the treatments.

At the same time, the QHP members will be automatically enrolled in the Florida Walmart prescription drug plan administered by Humana Inc.. They will receive letters from Humana next week explaining what to expect.

CMS said in a release that any of those affected who want to go back to an HMO or change their drug plans will be able to do so. Medicare's open enrollment period for 2012 -- which closes Dec. 7 for most beneficiaries -- will be extended to Feb. 29 for the erstwhile QHP members.

No explanation was immediately available from CMS for the decision. Humana, which as the largest Medicare contractor in Florida usually receives members of liquidated Medicare HMOs, was also reticent.

It's not clear whether Humana tried to get the HMO enrollees but had to settle just for the drug-plan members. Government premiums and company profits are much higher for Medicare HMO members, on average, than for drug-plan members. 

Humana released a statement saying: "We are pleased to be assigned Quality Health Plan's Medicare Prescription Drug Plan members. Humana's Part D plan with Walmart remains the lowest-priced national Medicare drug plan with a monthly premium of only $15.10 a month. We always try to work collaboratively with CMS."

At a hearing Thursday in Tallahassee, Circuit Judge Terry P. Lewis signed the order turning over assets of the Tampa-based company to the state Division of Financial Services. The next day, Humana spokesman Mitch Lubitz confirmed  that Humana was in talks with CMS about a possible takeover of QHP members, most of whom are in Florida. 

Humana has a long history of taking in members from bankrupt plans. The most dramatic example was in 1987, when it bought International Medical Centers (IMC) and acquired 170,000 Medicare subscribers in Florida as well as a number of clinics for $40 million.

In the 2008 liquidation of another Tampa plan, MD Medicare Choice, Humana acquired 16,000 members.

Humana, based in Louisville, also grew by buying smaller plans that weren't bankrupt but wanted to sell. One example was Metcare Health Plans in West Palm Beach, which added 7,300 members in 13 Florida counties. Another was CarePlus in 2004, which added 50,000 members from South Florida.

Humana has more than half a million Medicare members in Florida -- about 425,000 in HMO-style Medicare Advantage plans and more than 100,000 in prescription drug plans. Humana also has 250,000 members in commercial health-plan contracts and 80,000 in sales to individual members.

Florida's insurance department, which reports HMOs separately from other types of insurance, said Humana's HMO enrollment of 568,000 in Florida last year made it the largest. It was also the most profitable at $330 million, as the Sun-Sentinel reported.

--Health News Florida is an independent online publication dedicated to public-interest journalism. Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.


Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.