Archive for the ‘Wellcare’ Category

Here is a link to the story from NASDAQ.  Products included are the Sterling Life Medicare Supplement and the Windsor Medicare Advantage book of business.  Generally, these deals take 6 or more months to close, so don’t look for any changes this AEP.


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Here is the story for the Tampa Bay Business Journal.

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Wellcare posted a $36.9 million loss for the first quarter of 2009.  The loss was due to higher Medical Expenses, one time charges and lower investment income.

Last week Wellcare announced that they would be exiting the Private Fee for Service Medicare Advantage Marketing in 2010.  Although management doesn’t segment out PFFS versus Networked MA versus PDP, it’s pretty safe to say in listening to the call that the Medical Loss Ratio (MLR) on the PFFS was a contributor to WellCare exiting the PFFS business in 2010.  PDP was not performing as well as they hoped, but they figured they could fix this in their 2010 bid.  Network MA products seemed to be performing the best.  The overlap between PFFS plans and Network plans is minimal (10-15%).  WellCare remains under CMS Marketing restrictions with hopes of being able to market Networked MA plans and PDP for 2010.

They also announced that  they had settled the Government investigation relating to their Medicaid program.

Finally, they announced that they would pay off their Loan Credit Facility on time later this week.

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Here is an article which covers the story.

Wellcare currently has approximately 110,000 members in its Private Fee for Service plans.  Wellcare will continue to cover these members through December 31st, 2009.  These members will have the option of electing another Medicare Advantage plan in their area during the Annual Election Period which runs from November 15th through December 31st, 2009.

If they elect another Medicare Advantage plan, it will be effective on January 1st, 2010.  If they do not make an election, they will be automatically re-enrolled in original Medicare as of January 1st, 2010.

Those members with Prescription drug benefits in their Wellcare plan will need to elect a Stand Alone Part D plan (PDP) during the Annual Election Period in order to have coverage with a January 1st, 2010 effective date assuming they wish to return to Original Medicare and need Prescription coverage.  If they are electing a Medicare Advantage plan, they can choose a plan which includes Prescription Drug benefits.

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CMS Letter to Wellcare

I had a large number of agents ask me for the “official” letter from CMS to Wellcare, so here it is: 


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Wellcare, which is currently under investigation by the FBI and Florida authorities for Medicaid Fraud, we ordered to stop enrolling new members in it’s Medicare Plans (HMO and PFFS) as well as Part D plans.  Abby Block, Medicare’s chief notes, “. . .Wellcare was one of the worst overall performers of all plans”.

Allegations of use of forged enrollment applications, providing misleading information to members and member complaints that are three times the national average.

“The sanctions were imposed after repeated meetings failed to get the company to improve its performance and after alleged violations of marketing and grievance-handling rules.”  According to Block.

The sanctions take affect on March 7th.

Wellcare’s stock price fell as much as 30% in after hours trading.

The sanctions do not affect it’s current Medicaid business.

Insurance agents who are currently selling Wellcare will not be able to sell this product on March 7th until further notice. 

Insurance agents can compare Medicare Advantage plans in every county in the United States using our Medicare Quote Engine.  This is a free online web tool for Insurance Agent Use Only.  You can register for instant access by clicking here.   You can view all of the carriers we represent by clicking here.

Agents currently selling Wellcare can contact April Ford at our office for alternative products during this shut down.  Click here to e-mail April.

This was the second company which was ordered to stop enrolling new customers thus far in 2009.  Wellpoint was ordered to stop enrolling new members on January 12th, 2009 and remains under sanctions as it seeks to improve it’s claims and billing processes.

Here is the complete story from Bloomberg.

Here is the story from the Tampa Bay Online Blog.

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Yesterday’s 50%+ drop in stock price seems to revolve around a myriad of issues:

  1. Debt is coming due in 6 months as they are in default on $153.2 million loan facility.  Company is working with Goldman-Sachs to raise capital.  This is problem is compounded by #’s 2, 3, 4 and 5 below which may create difficulty in obtaining the funds or getting the funds with unfavorable terms.
  2. Criminal investigation now compounded by “whistle-blower” allegations which are costing money to defend.
  3. Turmoil in the credit markets and weak economy.
  4. Wellcare has not filed a financial report since October of 2007 which may jeopardize their listing on the stock exchange as well.
  5. Announcement that they are being hit by unanticipated costs in their Medicare drug plans and PFFS plans which is increasing their Medical Loss Ratio (MLR) by 200 to 400 basis points.

Here is the Bloomberg article. 

Here is the AP story

I don’t act as an FMO for this company, but I know a lot of agents do write Medicare Advantage for them.  In spite of their troubles, they increased enrollment in the past 12 months by 50% from 160,000 to 240,000 as of 9/30/08.  Their products are competitive which is what makes them attractive. 

This stock peaked at over $122/share a little over a year ago, now trades for less than $10/share.

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We are EXTREMELY PLEASED to announce that Medicare Quote Engine (www.MedicareQuoteEngine.com) has been updated with ALL 2009 Medicare Advantage Plan data.  We are in the testing phase at this point, so please be patient!

This means, that for 2009, we will have:

  • 113,005 Medicare Advantage County/Plan combinations,
  • 12,581 Special Needs Plan County/Plan combinations and
  • 2,565 Stand Alone Part D Plan State/Plan combinations.

Essentially, you will be able to see every Medicare Advantage product that exists for 2009.  Additionally, we are adding new query capabilities to allow you to retrieve the plan types you are looking for.

Due to this massive expansion, we had to change some of the displayed information.  For those companies which we are contracted with, we will provide a link to the product page (https://ritterim.pbwiki.com/Ritter+2009+Medicare+Advantage+Products) for you to drill down and see very detailed product features.  For those companies where we do not have contracts to market, we will not link or will simply link to their homepage.

We are hopeful that we will be able to provide additional details on plan design features for these 125,000+ combinations before the November 15th AEP season begins, however, we cannot be certain.  In the meantime, you will have the resources to research your primary counties.

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Bloomberg (8/18, Pollack, Olmos) reported, “WellCare Health Plans Inc. will pay $35.2 million in an agreement with U.S. prosecutors in a Medicaid fraud investigation, the company said in a filing” with the Securities and Exchange Commission. But, WellCare said that the agreement does not “settle the case or limit the U.S. government and state of Florida from making further claims in their continuing investigation.” According to the filing, the payment includes “an estimated $24.5 million owed” to “the government for Medicaid mental health claims from 2002 to 2006 by two of its Florida subsidiaries.” The remaining $10.7 million will be held in escrow during the investigation. In the meantime, WellCare “remains unable to file quarterly reports because of the investigation,” according to the filing. On July 21, when WellCare restated its earnings for “the periods from 2004 through June 30, 2007,” the insurer “lowered its net income by $28 million.”

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