Medicare deadline looms amid Lee Health insurance changes

With two of Southwest Florida’s most prominent healthcare systems announcing major insurance plan changes in the last two months, many thousands of patients in the region have been left scrambling to make sure they will still be covered when Jan. 1 arrives. 

Approximately 50,000 patients could be affected by Lee Health’s decision to end its in-network contracts with UnitedHealthcare for specified commercial and Medicare Advantage plans effective Jan. 1, while Naples Comprehensive Health says fewer than 400 patients will be affected by its decision to no longer accept Cigna/HealthSpring Medicare Advantage and Wellcare Medicare Advantage plans. 

The potential change at Lee Health would not eliminate patients’ UnitedHealthcare insurance coverage, but it would leave the system, its physician groups and other services out of network, potentially affecting access to care and out-of-pocket costs. Medicare Supplement (Medigap) plans are not affected by the change, while UnitedHealthcare Exchange/Marketplace plans are already considered out of network. 

Certain continuity-of-care exceptions could still apply, according to Lee Health, along with emergency care. 

“Federal law requires emergency care to be available regardless of whether the hospital is in your insurance plan’s network,” according to information posted on leehealth.org. 

For those covered by a UnitedHealthcare Medicare Advantage plan, the situation has special urgency. The insurer’s contract with Lee Health is set to end Jan. 1, but Medicare’s annual open enrollment period ends Dec. 7, meaning patients may have to make coverage decisions without knowing whether the healthcare system and insurer will ultimately reach an agreement. 

Dr. Nariman Heshmati, chief clinical officer for Lee Physician Group and Ambulatory Care Services, said the decision to end in-network contracts with UnitedHealthcare “was not made lightly” and was made with a focus on the long term. 

“This has been going on for years, and this is about our ability to build, to deliver care to our patients,” Heshmati said. “If Lee Health had stayed in network, maybe we could have avoided some disruption today in care, but that wouldn’t help us for how we’re going to provide care tomorrow, next year and ongoing. 

“We need a partnership with every payor that allows us to provide high-quality care that doesn’t result in delays, that doesn’t result in barriers to patients receiving that care.” 

In a statement posted on its website, Lee Health said it was announcing the change “to give patients and families the maximum flexibility and time needed to evaluate their healthcare options for 2027 and beyond.” 

In an Oct. 6 statement on its website, UnitedHealthcare said its top priority “is to reach an agreement with Lee Health that preserves network access to the health system.” 

First steps for Medicare Advantage patients  

While the dispute continues, Brian Franklin Jr., an insurance broker and business development director with Cape Coral-based Earp Enterprises Companies, says Medicare Advantage patients should document their current and anticipated healthcare needs before evaluating premiums, benefits or other insurers. 

Franklin said that patients should start with a detailed inventory that includes: 

• All current prescriptions. 

• All essential doctors and specialists, including each physician’s affiliation, whether with a private practice, Lee Physician Group or another hospital-affiliated practice. 

• Preferred hospitals and healthcare systems, especially if continued access to Lee Health is important to the patient. 

• Known or anticipated treatments or procedures in 2027, including surgeries or follow-up treatments. 

• Recurring healthcare services, including specialist visits or other services that could be affected by a network change. 

• Current healthcare costs, including premiums, prescriptions, deductibles, copays and coinsurance, to compare the total financial impact of another plan rather than basing a decision on premiums alone. 

He said the inventory helps patients and their advisers forecast potential needs, “not to the point of perfection, but to the point where we have a general idea of how things are going to be.” 

Franklin also recommends that Medicare Advantage beneficiaries pay attention to documents that Medicare and other insurers send by mail or email. 

“Many of our Medicare-eligible neighbors, they get so much mail and so many documents and emails that they stop reading,” he said. “But among the advertisements, there is really great information, mostly sent out from Medicare themselves or their broker or agent, that are specific to them and can help clarify any changes.” 

Angelina Washington of Fort Myers is currently covered by a UnitedHealthcare Medicare Advantage plan, and she said in an interview that continuity of care is her biggest concern. 

Washington, who qualifies for Medicare Advantage because of disabilities related to several chronic health conditions, said she is creating her own healthcare inventory, even though she remains hopeful that Lee Health and UnitedHealthcare will resolve their differences. 

“I have to not only think about my regular doctors, but doctors that I see quarterly, annually or semi-annually to make sure that all those doctors are going to be on whatever plan I need to go on,” Washington said. 

She said she is encouraging others to pay attention to the upcoming deadline and the importance of being prepared. 

“At the end of the day, you’ve got to have a backup plan in case they really don’t figure it out,” she said. “You have to know what you’re getting ready to do by January.” 

Washington said part of her concern stems from the fact that Lee Health’s footprint extends beyond hospitals and emergency rooms. 

“Some people are being kind of lackadaisical about it, and I don’t think they realize how much of an impact this change could have in our area,” she said. “Lee Health is not just about hospitalizations: it’s your doctors and your pharmacy. It is testing — your MRIs, your CTs, your breast examinations you get every year. 

“And I think some people are just sitting by the side hoping that it’s not going to happen.” 

SHINE program provides insurance counseling 

Seniors looking for guidance as they navigate upcoming changes can explore resources available through Florida’s SHINE program — Serving Health Insurance Needs of Elders — through the Florida Department of Elder Affairs and local area agencies on aging. 

SHINE, at floridashine.org, provides free health insurance information and confidential counseling to Medicare beneficiaries, their families and caregivers. The program can be reached at 800-963-5337.