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September 24, 2016

Health Care Trends

Capital Gains

Tallahassee-based Capital Health Plan is a rare bird in the health world: An HMO that has both held down costs and kept its customers happy.

Lilly Rockwell | 9/11/2012

Medicare explosion

Capital Health isn’t immune to the same challenges other insurers face in holding down costs as it complies with the new health care law. Some provisions won’t impact the company, such as eliminating lifetime limits on coverage. “We’ve never had lifetime limits or annual limits,” Hogan says.

Still, the law changes how much Capital Health can charge employers based on the age and gender of patients.

A major challenge for Capital Health is the growth in the number of its Medicare enrollees as the area’s population ages. In just six years, its number of Medicare enrollees has swelled from 5,000 to 13,300, and the company expects to see that number grow further. “The explosion of Medicare is really going to be very significant,” Hogan says. Tallahassee will need more internists — different from family physicians — who understand better how to treat an elderly clientele, he says.

Demand for Medicare is also fueled by Capital Health’s high rankings last year as a Medicare provider. “We’re pretty gratified, but not satisfied,” Hogan says of the growth and praise. “Any time you get satisfied, you can start slipping in terms of attention you need to pay. It’s still a small town, and it’s still a word-of-mouth town. You’re only as good as your last game.”

Tags: Healthcare, Insurance

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