Capital Health Plan Medicare Insurance Review & Complaints: Health Insurance (2024)

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Capital Health Plan is a Blue Cross Blue Shield (BCBS) licensed health insurance company serving seven counties in Florida. They mainly write group health insurance plans for employers, as well as offering Medicare Advantage plans.

This Capital Health Plan Medicare review will help you decide if it’s the right company for you. We’ll discuss how to get Capital Health Plan Medicare quotes and the company’s reputation.

But before you decide to buy Capital Health Plan Medicare insurance, be sure to compare your options.

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What is Capital Health Plan?

Capital Health Plan was founded in Tallahassee, Florida, in 1982 by a group of local leaders looking to provide residents with an affordable and accessible health plan. Today the plan serves more than 135,000 members in seven counties: Calhoun, Franklin, Gadsden, Jefferson, Leon, Liberty, and Wakulla.

Capital uses the BCBS shield name and license but operates independently. They run two Capital Health Plan (CHP) Health Centers to serve their members exclusively with a broad array of specialties. Their network across all counties includes more than 450 providers.

Capital’s major medical health plans are aimed at employers looking for group coverage and state employees for whom they provide coverage. They also write several Medicare Advantage plans.

Read more: Blue Cross Blue Shield Medicare Insurance Review & Complaints: Health Insurance

What Medicare Advantage plans are offered?

All of Capital’s Medicare Advantage plans are HMO plans, with three offered to the general public and two Retiree Advantage plans offered either through private employers or through the State of Florida to its employees.

The CHP Silver Advantage plan is the company’s $0 premium plan. It has no deductible, and copays are $10 for primary care and $50 for specialist visits.

The CHP Advantage Plus plan has no deductible and copays of $10 for primary care and $40 for specialist visits. Inpatient hospital visits have a copay of $250 per day for the first five days. This plan includes dental, vision, and hearing coverage as well as prescriptions. Tier one drugs start at a $3 copay.

The CHP Preferred Advantage plan also has no deductible, and copays are $10 for primary care and $25 for specialist visits. Inpatient hospital stays have a flat fee of $300 per admission, with no copay until day six, at which point there is a $100 per day copay through day ten. Dental, vision, and hearing are also included, and again prescription drug coverage starts at $3 for Tier one drugs.

The remaining two plans are only available through an employer. These Retiree Advantage plans can be offered either through a private company or the State of Florida, but they cannot be purchased by individuals. The plans appear to be the same as those offered in the individual market, however.

Are the rates competitive?

So what Capital Health plan advantage makes it better than other insurance products? The rates are listed on the Summary of Benefits and appear to be the same across all counties. Silver Advantage, as noted, is a $0 premium plan with no additional premium on top of the regular cost of Medicare. Advantage Plus has a monthly premium of $35, and Preferred Advantage costs $97 a month. These are on top of your regular Medicare premiums.

Since these rates are limited to a small geographical area, it is difficult to compare them to other companies. They are only comparable to other Florida insurers covering the same region.

Capital Health Plan Medicare Claims Process

Ease of Filing a Claim (Online, Over the Phone, Mobile Apps)

Capital Health Plan (CHP) offers a streamlined and convenient claims process for its Medicare insurance plans. While specific details may vary depending on the plan and the nature of the claim, CHP typically allows policyholders to file claims online through their secure website. This online option provides a hassle-free way to submit claims, saving you time and effort.

Average Claim Processing Time

The average claim processing time with Capital Health Plan is generally efficient. Due to the HMO nature of their Medicare plans, most claims are handled directly by the network of healthcare providers, reducing the need for manual claims processing. As a result, policyholders can expect timely reimbursement for covered services.

Customer Feedback on Claim Resolutions and Payouts

While there is limited information available regarding customer feedback on claim resolutions and payouts for Capital Health Plan Medicare insurance, the company’s strong reputation and high ratings from trusted sources such as the National Committee for Quality Assurance and Medicare suggest that customers are generally satisfied with their claim experiences.

Positive ratings indicate that CHP is committed to providing reliable and efficient claim resolutions.

Digital and Technological Features of Capital Health Plan Medicare

Mobile App Features and Functionality

Capital Health Plan offers a user-friendly mobile app that allows policyholders to access important information and manage their accounts on the go. The app provides features such as easy access to policy details, claims tracking, and even the ability to find nearby network providers. This mobile app enhances the overall customer experience by providing convenient tools at your fingertips.

Online Account Management Capabilities

CHP’s online account management platform is designed to simplify the management of your Medicare insurance. Policyholders can log in to their secure accounts to view policy documents, check claim statuses, and update personal information. This online portal offers a seamless and efficient way to handle various aspects of your insurance coverage.

Digital Tools and Resources

In addition to the mobile app and online account management, Capital Health Plan provides a range of digital tools and resources to support its policyholders.

These resources may include educational materials, information on healthcare providers, and tools to help you make informed decisions about your health. The availability of these digital resources contributes to a more informed and empowered healthcare experience.

Does CHP have positive ratings and consumer reviews?

Strangely, the Better Business Bureau (BBB) page for Capital Health Plan states that the company is not rated because they have been in business for less than six months. The last time we reviewed this company, we could not find a BBB record at all. There are no complaints or reviews with the BBB.

The National Committee for Quality Assurance gives Capital’s Medicare plans an overall 4.5 star rating out of five, which is excellent but down from the 5.0 rating the company had the last time we checked. Still, it is among the best-rated in the state.

The official 2020 rating from Medicare for Capital Health is 4.5 stars, which again is excellent and has been maintained from our last review.

There is not much out there regarding customer reviews of this health plan. That is likely because they are a regional insurer, but also points to a good reputation since a lack of complaints is usually positive.

What’s the bottom line?

Capital Health Plan is a good health coverage choice if you don’t mind the limits of an HMO and aren’t looking for a long list of plans to choose from. This healthcare provider has a very good reputation based on trusted consumer surveys, and they have maintained high rankings for many years. If you’re in the health care service area and looking for Medicare Advantage, CHP is worth comparing to your other options.

Affordable Capital Health Plan Medicare insurance might be your choice after you’ve done your research, but let us help you consider other options. Just enter your ZIP code below to get started and find other providers in the United States.