Health Insurance Blog

Timothy P. Carney, a columnist with the Washington Examiner, recently penned an article about the pending health care reform proposals that are being debated.  Mr. Carney’s speculation is that the health insurance companies will win at the end of the day and their proposal will be accepted by Obama and his administration.

The health insurers plight has been championed by America’s Health Insurance Plans (AHIP), a trade group that has been more than $4 Million over the past 6 months lobbying for their cause.

The key points in AHIPs proposal include:

1. Health insurers must cover everybody who is willing to purchase health insurance coverage, regardless of pre-existing or other health conditions
2. Health insurers would agree to charge customers the same monthly premium regardless of age or health status
3. Health insurance would be compulsory - All Americans would be required to purchase and maintain health insurance coverage, whether via an employer group, Association, or an individual health insurance plan.
4. The Government would subsidize people’s health insurance premiums

Obama’s plan no longer calls for a “single-payer” environment, but rather a marketplace where the federal Government would compete with private health insurance companies for membership.

The heavy lobbying and campaign contributions put forth by health insurers make them very influential and in the end might help them get their way in this important health care reform debate.

Young healthy adults are attractive targets for health insurance companies.  Consequently some insurers tailor affordable health insurance plans at this segment of the population with individual health plans between $40 and $70 per month.

Two health insurers who offer such products are Aetna (Bodyguard) and Wellpoint (Tonik).  Keep in mind in order to keep monthly premiums low, the insurers have shifted a greater portion of the health care costs to the member, and thus higher out of pocket expenses should be expected.

In a nutshell, the trade-off is lower monthly premiums in exchange for paying a larger amount out of pocket.

These low-cost health plans might be right for you if you are healthy, don’t currently require any perscription drugs and don’t participate in excessively risky activities where severe accidents would be likely.

On Tuesday, Blue Cross Blue Shield of Michigan (BCBSM) announced the launch of a “patient-centered” medical home program (PCMH).  Through this program, BCBSM members who are enrolled in this program will have access to health care from their primary care physicians later at night and on weekends.  More than 1,000 physicians will be participating in the PCMH program making it the largest of its kind in the nation.

In the future, through the use of federal stimulus funds, BCBSM enrolled members will have access to their medical records online and be able to see their most recent medical tests results.

This PCMH program is part of Value Partnerships, a collection of collaborative initiatives among physicians, hospitals and Blue Cross Blue Shield affiliated health plans in Michigan.

More information about Michigan health insurance.

In the New York Post, Brendan Scott reported on shocking findings that New York City health insurance premiums have seen a significant increase over the past year, while many New Yorkers are already struggling economically. Here are some sobering statistics:

• From April 2008 to April 2009, the average monthly health insurance premium for a family has risen from $3,866 to $4,354; a 13% increase.
• Six out of the eight health insurers in the NYC area have increased their rates, including Aetna, Atlantis Health Plan, and Oxford Health Plans, Brendan says.
• Insurance companies blame the rate increases on an exodus of healthy policyholders leaving them with only the sickest (and costliest) patients, in addition to the state’s co-payment structure and high mandated coverage minimums.

On the bright side, Empire HealthChoice HMO actually decreased its premiums. Not to mention that patients who remained in-network for their health care pay less: a family who agreed to stick to in-network providers paid just $2,996 per month on average. That’s still a 12% increase over last year, but a significant savings nonetheless.

(Photo credit: bridgepix under CC 2.0)

The New COBRA Subsidy Bill that subsidizes COBRA payments for workers who have recently lost their jobs, is causing some difficulties for New York health insurance agents.   The subsidy pays for 65% of an eligible  workers COBRA health insurance premiums for up to 9mo.

However, COBRA health coverage, and subsidy, do not apply to employer groups of fewer than 20 employees. For these groups, the New York continuation of coverage program (sometimes called mini-Cobra) applies. Under the “mini-COBRA” program, health insurance companies fund the subsidy and seek reimbursement from the government.

Apparently there is mass confusion among these small employer groups, the health insurance companies are supposed to be paying but they are still trying to get a handle on the situation.

For more information there is guidance on this situation at www.ins.state.ny.us.

The Iowa house passed a stripped down version of health insurance reform that was passed by the Senate in March.  The parts of the bill that passed the Senate that were carved out were 1) the authorization for small businesses and non-profits to buy into the government health plan and 2) a provision that to create a state commission to help uninsured Iowa residents find affordable health coverage.

The bill increases income limits for eligibility into the Hawk-I program to 300% of the federal poverty level (or $64,000 for a family of 4.

The goal of the bill is to provide Iowa health insurance to 30,000 children in the state of Iowa that are currently uninsured.

Michigan’s largest health insurance company, Blue Cross Blue Shield of Michigan (BCBSM), is making changes to their individual health insurance portfolio, which in some cases will cost Michigan residents as much as $600 per month while also having to pay higher out of pocket costs.

In the end of last month, BCBSM closed some of their old individual health plans to new members including Blue Value and Care Blue. The new Michigan health insurance plans offered by BCBSM include:  Individual Care Blue Plus, and Flexible Blue II.  In addition, previously offered plans: Young Blue Adult PPO, Option A, and Option C will remain open to new members.

BCBSM appointed insurance agents are unhappy about the product changes as they believe that the pricing will make it much more difficult for them to sell the health plans.  In addition, the commission structure has been revised for the new plans which will compensate them less for enrolling members with severe medical conditions.

Building on yesterday’s post about being Health Insurance Caution below are 7 points made in the referenced Consumer Reports article which are tell-tale signs that your health insurance plan might be junk.

1. Limited Benefits - Never purchase a limited benefit plan.  They are not worth the money
2. Low Coverage Limits - health insurance policies with limits at $25,000 or $10,000 are inadequate to properly protect you in case of a serious accident or illness
3. Affordable Health Plans- not sure I agree with this point?  affordability is relative right?  There are definitely some individual health insurance plans that might be more affordable vis-a-vis other health plans.
4. No coverage for specific procedures etc.things -  If something is not listed, most likely it is not covered
5. Ceilings for Some Health Care Categories - If you have to accept limits on some services, be sure your plan covers hospital and outpatient medical treatment, doctor visits, drugs, and diagnostic and imaging tests without a dollar limit.
6. Out of Pocket Costs with No Cap - Avoid plans that don’t mention your maximum out of pocket costs before the health plan will cover 100% of expenses
7. Random Gotchas - such as not covering the first day of a hospital stay.
   

The Early Show (CBS) ran a segment on Hazardous Health Insurance.  The plot of the segment was that with the growing number of uninsured in America, more and more people are purchasing individual health insurance, and according to a Consumer Reports story many of these individual health plans have major coverage gaps that can be hazardous to your health.

One of the major pitfalls that the Consumer Reports story pointed out was spending limits on vital care.  CBS medical correspondent Jennifer Ashton stated that you should make sure that your health plan covers everything including diagnostics, imaging tests, in-patient and outpatient care and rehabilitation.

Ashton also warned that health insurance premiums that sound too good to be true probably are, and advisies health insurance shoppers to read the fine print, as your enrollment in a health plan is a contract and the details are very important.

Support is growing for a proposed health care system overhaul that would require all Americans to maintain health insurance coverage.

The mandate, which is being proposed by insurance industry leaders has received support from an coalition of doctors, hospitals, nurses, business, consumer, and insurance groups which have agreed on a set of ideas for reform, which also include the health insurance mandate.

The aforementioned coalition is called the Health Reform Dialog, and includes AARP, American Hospital Association, and the U.S. Chamber of Congress among other influential groups.

President Obama, who initially was not a supporter of such a mandate seems to be softening his stance, mentioning in a White House question-and-answer session on Thursday that the issue will be “part of the debate.”