Health Insurance Blog

Limited Benefit Plans have not been well received since their inception, many health insurers have resisted offering them, and there hasn’t been a strong customer demand for them either despite their low-cost.

Given the economic climate that we are facing across the country, these stripped down health plans have been generating more chatter than in past years.

There are several states that have passed legislation to allow for limited benefit plans to be offered that do not contain the entire list of madated benefits that major medical plans are required to provide

According to Statecoverage.net the list of states that allow for exceptions to state mandates are as follows:

1. Arkansas - The Health Insurance Consumer Choice Act of 2001 allowed health insurers and HMOs to offer health insurance plan options to consumers that include all, some, or none of the Arkansas coverage mandates; and requires certain disclosures to be made to consumers so they may make a fully informed choice of offerings.
2. Colorado - In 2003, the Colorado legislature passed HB 1164, which requires carriers in the small group market to offer one of three basic health benefit plans: Basic Health Benefit Plan without specified mandates; Basic High Deductible Health Benefit Plan; or Basic High Deductible Plan without specified mandates.
3. Florida - In 2002, the Florida legislature passed SB46E, which allowed a Health Flex Plan to be sold by insurers, HMOs, provider-sponsored organizations, and public or private community-based organizations as a pilot in areas of the state with a high uninsured rate.
4. Georgia - In 2005, Georgia enacted the Georgia Consumer Choice Benefits Health Insurance Plan Act which allows health plans to offer products without all of the state mandated benefit requirements.
5. Kentucky - In 2005, the Kentucky legislature passed HB278, the Small Business Insurance Relief Act, which creates a state-established basic health benefit plan to make insurance more affordable by tailoring benefits to specific needs.  Available to groups with less than 50 employees
6. Maryland - The Minimum Benefit Legislation (SB 570), enacted in 2004, requires carriers who insure > 10 percent of the covered lives in the small group market to offer a limited-benefit plan.
7. Minnesota - In 2005, the Minnesota legislature enacted a new law that allows health plans to sell “small employer flexible benefit plans” that do not include any of the benefit mandates (except maternity).
8. Montana - In 2003, the Montana legislature passed HB 384 which allowed for limited-benefit plans to be available to those who purchase health insurance in the individual market as long as they are notified which services are not covered and have remained uninsured for 90 days or more.
9. New  Jersey - In 2002, the New Jersey legislature passed legislation which required individual market carriers to offer a limited-benefit plan, called Basic and Essential Health Care Services Plan (B&E).
10. North Dakota - In 2001, the North Dakota legislature passed HB 1226, The Individual and Small Employer Health Insurance Act, which allows an insurance company to offer a basic health insurance policy to individuals and small businesses with 50 or fewer employees.
11. Texas - Beginning in 2004, Texas required all small employer insurance carriers to offer at least one plan offering all the mandated benefits by law, and at least one Consumer Choice Plan that may exclude or limit coverage of certain mandated benefits.
12. Utah - In 2002, the legislature passed HB 122, which permitted insurance carriers to offer coverage that is similar to what is covered under Utah ’s 1115 Medicaid waiver (Utah ’s Primary Care Network).
13. Washington - In 2004, Washington passed legislation redefining the small group market, changing group size to 2 to 50, from 1 to 50.

In an attempt to close the $11 Billion budget cap this year, the state of California is considering putting a freeze on Healthy Families, California’s state sponsored health insurance plan for children.

Nearly a million California children are enrolled in Healthy Families that would not have health insurance coverage otherwise.

The Healthy Families Program is $17 Million over budget, as enrollment is growing by 27,000 new children each month, largely due to the tough economic climate and growing unemployment.

Freezing enrollment in the program is clearly not a desired action to address the budget shortfall, and although President Elect Obama is making children’s healthcare a priority, a decision will need to be made regarding this programs solvency before he takes office in January.

Mark Farrah wrote a nice report on the Medicare Advantage marketplace in Pennsylvania.   In summary he found that the 30 health insurers offering Medicare Advantage Plans in PA had a 37% market penetration, one of the highest in the country.  Of the 30 health insurers, more than 20 were based in PA, including three separate Blue Cross Blue Shield member plans.

The Pennsylvania health insurance marketplace is divided into four distinct regions, Western, Southeastern, Central, and Northeastern, with many health insurers focused on specific regions within the state.  For instance, in Western Pennsylvania, there are 20 companies offering Medicare Advantage Plans, but Highmark, and UPMC enroll about 75% of the members in that region.

Statewide there are five health insurers that Mr. Farrah considers the “top tier” in the Medicare Advantage marketplace, and they represent about 75% of statewide enrollment.  They are

1. Highmark with 249,023 members, 30.4% market share
2. Independence Blue Cross with 149,525 members, 18.3% market share
3. Coventry Healthcare with 91,724 members and 11.2% market share
4. UPMC Health plan with 69,758 members and 8.5% market share
5. Aetna with 58,778 members and 7.2% market share

The Pennsylvania competitive landscape will go through drastic changes in 2009, as the two largest players, Highmark, and Independence Blue Cross will finalize there merger this year.  In combination they will insure over 400,000 members and nearly 50% of the market.

2008 was the fourth year that US News and World Report, released their annual ranking of commercial health insurance plans.  The results are in, and the following list is how US News and World Report ranks the top Indiana health insurance plans.

1. CIGNA Healthcare of Ohio - was the top rated health plan in Indiana, as their service area covers portions of both Ohio, Indiana, and Kentucky
2. Anthem Blue Cross Blue Shield of Indiana - received the highest rating by customers
3. Aetna Health
4. CIGNA Healthcare of Indiana
5. CIGNA Healthcare of Illinois - serving both Indiana and Illinois
6. United Healthcare of Kentucky - serving both Indiana and Kentucky
7. United Healthcare of Illinois - serving both Indiana and Illinois
8. Humana Healthplan of Kentucky - serving both Indiana and Kentucky

Compared with other states, the overall ranking score (scale of 1 to 100) for Indiana health plans were lower than the other states that we have blogged about so far, with the top plan scoring only an 83.

Wellpoint became the latest health insurance company to dabble with a medical tourism program.  Under this new Wellpoint pilot, members can travel to India to have some surgeries done.

Wellpoint would not only save thousands on medical costs, but they would also gain leverage in negotiatons with doctors.

Blue Cross Blue Shield of South Carolina, and Aetna have already launched medical tourism programs and both CIGNA and United Healthcare are currently researching the proposition.

Continuing on our series of top state health plans, as determined by US News and World Report, in conjunction with the NCQA, below are the top health plans in Michigan for 2008.

Only 8 Michigan Health Insurance Plans were included in the ranking, so this list is a top 8 list as opposed to top 10.

1. Grand Valley Health Plan
2. Priority Health
3. HealthPlus of Michigan
4. Health Alliance Plan of Michigan (HAP)
5. Physicians Health Plan of Mid-Michigan
6. Blue Care Network of Michigan
7. Total Health Care
8. Physicians Health Plan of Southern Michigan

It is interesting to note that the Michigan health plans listed here, do business only within the state of Michigan, wheras the top 10 health plans in Illinois by-and-large operated in multiple states.

US News and World Report’s 2008 ranking of the top Illinois Health Insurance Plans are listed below.  Based on 1) consumer surveys and 2) success in preventing and treating illness compared with average plan.

1. PersonalCare Insurance of Illinois (conducting business exclusively in Illinois)
2. Health Alliance Medical Plans (Illinois, Iowa)
3. CIGNA Healthcare of St. Louis (Illinois, Missouri)
4. Medical Associates Health Plan (Illinois, Iowa)
5. United Healthcare plan of the River Valley (Illinois, Tennessee, Iowa, Virginia
6. OSF Health Plans (Illinois)
7. United Healthcare of the Midwest (Illinois, Kansas, Missouri)
8. United Healthcare of the Midlands (Illinois, Nebraska, Wisconsin, Iowa)
9. CIGNA Healthcare of Illinois (Illinois, Indiana)
10. United Healthcare of Illinois (Illinois, Indiana)

You’ll notice, on this top 10 list, there are 4 distinct United Healthcare plans listed as well as 2 CIGNA health plans.  This generally results from various regional health plans being responsible for a service area that covers specific MSAs, or specific regions within a state or states.

Blue Cross Blue Shield and Aetna are noticably absent from this list

A recent study undertaken by online health insurance marketplace ehealthinsurance.com found that individual health insurance can indeed be affordable if you shop around.

Specifically, the study of more than 225,000 individual and family health plans purchased through their site found that the average monthly premium to insure an individual was $158, and more than half of those underlying policies had a monthly premium of less than $130!  When insuring a family, the average monthly premium was $366 with more than half paying less than $300 per month.

To build on a previous health insurance study that was blogged about here, women paid more for their health insurance coverage, 18% more to be exact.  On average women paid $171 per month while men paid $145 on average.

Other findings:

• 60% of children’s health plans had monthly premiums of less than $100.  These do not include state sponsored and subsidized children’s health plans which have income limits for qualification.
• Regionally the Midwest was the cheapest region with average monthly premiums of $130, followed by the West region ($150), South ($154), and Northeast ($239)
• Average monthly premium for HSA health plans was $133

As promised we will be breaking the US News and World Report health plan rankings down into the state level, to account for differences in health plan regulations, and mandated benefits in each state which can skew results.

According to the report:

The top 10 Ohio Health Plans are:

1. Summacare
2. Anthem Blue Cross Blue Shield of Ohio
3. Paramount Health Care
4. Medical Mutual of Ohio
5. CIGNA Healthcare of Ohio
6. The Health Plan of the Upper Ohio Valley
7. Aetna Health of Ohio
8. Kaiser Foundation Health Plan of Ohio
9. UnitedHealthcare of Ohio
10. Humana Health Plan of Ohio

We will be posting the top 10 health plans in each state over the next several weeks (3-5 states per day), so check back frequently if you don’t see your states health insurance rankings listed yet.

US News and World Report recently released their health plan rankings for 2008, based on NCQA Data collection and analysis.  The 4th annual rankings provided via the collaboration between US News and the NCQA, aims to help health insurance shoppers select quality health plans.  Costs will likely always be one of the most if not the most important factor to shoppers when considering a health plan, but this report seeks to make factors such as preventing and treating illness, as well as customer service more transparent to health insurance shoppers.

The top 10 Commercial Plans according to their analysis were:

1. Harvard Pilgrim Health care
2. Tufts Associated HMO
3. Harvard Pilgrim Health care of New England
4. Grand Valley Health Plan
5. Geisinger Health Plan
6. Health New England
7. Anthem Blue Cross Blue Shield of Connecticut
8. Group Health Cooperative of South Central Wisconsin
9. Blue Cross Blue Shield of Massachusetts
10. CIGNA Healthcare of New Hampshire

126 health plans refused to furnish performance related data and were unable to be included in the analysis, the three largest of such plans were Blue Cross Blue Shield of Texas, Blue Cross Blue Shield of North Carolina, and Wellpath Select.

Check Back later for regional rankings that will be posted later in the week, as the US News national rankings seem to favor the New England region as a result of more stringent mandated benefits in that region of the country which skew results.