Compare Insurance Quotes
About Capital Health Plan
Capital Health Plan (CHP) was founded in 1982 in Tallahassee, Florida by a group of local leaders whose goal was to provide local, affordable health insurance care options. Started with 75 doctors, the group has since grown to 550 doctors serving more than 125,000 members.
CHP serves a small, local area of Florida, specifically Calhoun, Franklin, Gadsden, Jefferson, Leon, Liberty, and Wakulla counties. As an HMO they are a managed care organization in which members have access to providers within the system, as well as a network of affiliated providers. As with all such plans, the network is more limited than that offered by a PPO.
CHP is also a Blue Cross Blue Shield Licensee, using the BCBS name and logo but operating as an independent company. Individual and family plans are sold through agents and brokers, and the company also offers employer-provided plans. The company writes several Medicare Advantage Plans.
CHP offers two Medicare Advantage plans to individuals as well as a Retiree Benefit plan offered through employers. The two available individual plans are Advantage Plus and Preferred Advantage. As with all CHP plans, both are HMOs, and both are zero-deductible plans.
Capital Health Plan Advantage Plus has a lower premium in return for higher co pays in some areas. Primary care visits have a $10 co pay and specialists a $40 co pay. Urgent care has a $20 co pay and emergency care a $75 co pay. There is also the option to use the company’s TeleHealth system for a lower $15 co pay – this involves an online streaming video visit with a doctor rather than going into the office.
There is a $200 per day co pay for inpatient hospital services for days one through five with a $1000 maximum out of pocket per stay. Dental, hearing, and vision services are all covered under the plan with an average $40 co pay, as are prescription drugs. Co pays are $3 for Tier 1, $7 for Tier 2, $45 for Tier 3 and $95 for Tier 4. Tier 5 is covered with 25% coinsurance up to $250.
Capital Health Plan Preferred Advantage has a higher premium and lower copays in some areas. Primary care visits are the same at $10, but specialist visits have a lower $25 co pay. Urgent Care and Emergency, as well as TeleHealth, carry the same co pays as the Plus plan. Inpatient hospital stays are handled differently, with a flat $300 co pay per admission for stays of up to five days. For longer stays, there is a $100 per day co pay for the sixth through the tenth day, with no charge thereafter. There is also an out of pocket maximum of $800 per stay.
This plan also includes dental, vision, and hearing services, but these have lower co pays across the board of $25. Part D prescription drug coverage is the same as the Plus plan, with the same co pays for each tier.
Capital Health Plan lists their monthly premiums for each of the plans clearly on the website: $35.50 for Advantage Plus and $98.60 for Preferred Advantage.
These are reasonable rates for HMO coverage, but as the company is small and limited to a few counties in a single state, we can’t provide a rate comparison to our usual sample. When comparing these rates other companies, be sure to note that HMO plans are usually more affordable due to the limited network of providers versus PPO plans.
Ratings and Reviews
We were unable to locate a Better Business Bureau record for CHP, which is unusual for a company of this size and type.
They do have an outstanding 5.0 overall rating from the National Committee for Quality Assurance (NCQA), which they have maintained for many years. This is a top rating for NCQA and very unusual. The overall rating as created based on a combination of ratings in specific areas of service.
The official Medicare rating for CHP is an overall 4.5 for 2017.
We did not locate any reviews, either negative or positive, of this company on the usual review websites. This is likely due to the fact that the company is small and very localized.
The Bottom Line
If you live in on the of the counties covered by CHP and you are comfortable with the limitations of an HMO, this might be a good option for Medicare Advantage coverage. The plans appear to offer a lot of coverage for a reasonable price, along with low co pays and extras not all plans offer such as dental and vision. The company has good ratings and find no reason to prevent a recommendation.
For a list of companies that we recommend, visit our Best Insurance Companies page.
Compare Insurance Quotes