Health Insurance Blog

TradingMarkets.com reports that Aetna health insurance has made improvements to NYC Community Plan, its slate of health care offerings for small business owners and their employees. The plan, launched one year ago, is intended to make New York health insurance more accessible for groups that are traditionally underserved. It’s currently available in the New York City boroughs of Brooklyn, Manhattan, Staten Island, the Bronx, and Queens. Hopefully, Aetna will soon introduce similar products in other markets.

Changes to the plan include:

• unlimited generic pharmacy benefits in a calendar year
• discounts on branded medications
• lower co-payments for hospital visits

With cooperation from doctors, hospitals, and other providers, Aetna has actually managed to lower premiums of small business health insurance to as little as $243 per month!

(Photo credit: fergusonphotography under CC 2.0)

Aetna Health Insurance and BayCare Health Systems have resolved a contract dispute that would have reduced health care access for over 300,000 patients in the Tampa, Florida area. Stephen Nohlgren of the St. Petersburg Times says that if BayCare and Aetna didn’t settle their issues, Aetna insurance would no longer be accepted by BayCare hospitals after the current contract expires on December 31st. Patients would then have had to deal with the scary prospect of scrambling for new hospitals and doctors.

As of this Wednesday both parties have reached a 3-year agreement that will keep the BayCare hospitals in Aetna’s network, Stephen reports. BayCare owns most of the major hospitals in the Tampa/St. Petersburg region; most notably the Morton Plant, St. Joseph’s, Mease and St. Anthony’s hospitals. Details about the deal haven’t been released, but this agreement will surely lessen the year-end worries of some Tampa health insurance consumers.

In the 2008 US News and World Report health plan rankings report, only three Oklahoma health plans were ranked.  In addition, none of the three fared particularly well.  The top ranked health plan for Oklahoma residents according to the report was Aetna Health, which ranked 174th nationally and only received two stars of a possible five in the categories of both prevention and treatment.

Customers were more kind to Aetna as they received 4 of 5 stars in comsumer assessment.  The 2nd and 3rd ranked plans were Pacificare of Oklahoma, and Global Health respectively.

Similarly, US News and Word Report’s ranking of Nebraska’s top health plans were very sparce as well as they only ranked 1 health plan, UnitedHealthCare of the MIdlands who ranked 137th nationally.

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.

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.

Revamping the maligned US health care system was a focal point of President-elect Barack Obama’s campaign, and he will now be tasked with making good on that promise amid a significant economic downturn.

Obama’s plan is to expand Government health programs as well as subsidize health insurance coverage for people who can’t afford it, and technology spending to computerize health records to save money.  This plan to fix the health care system is priority #2 behind only achieving energy independence through further developing alternative energy sources.

Many experts think that change will be incremental but not substantial right off the bat, with the focus on expanding existing programs that assist low-income families maintain health insurance for their families such as children’s health insurance programs, which currently subsidize health insurance for 6 million children across he country.  Expanding programs such as SCHIP and Medicaid would help the health insurers that run the plans, such as Wellpoint, and United HealthCare.  Alternatively, reducing reimburesements  to insurers for Medicare Advantage enrollees would hurt health insurance companies such as Humana and Aetna, who would likely make up the difference in the form of health insurance premiums and/or reduced benefits.

There have been several articles published within the last week, most notably in the New York Times regarding health insurance rates paid by women compared to rates paid by men.  The article used health insurance quote data gathered from such health insurance companies as Humana, Aetna, and Wellpoint as well as online health insurance marketplace ehealthinsurance.com, and state high-risk pools.

The article in the New York Times sites several examples of price discrepancies between women and men of similar ages for identical coverage levels at various health insurance companies.  The data is rather compelling as the health insurance rate differences are in the 30-50% range.  However, does anyone really believe that health insurance companies are unfairly setting rates artificially high for women?

The article mentions the comparatively high health care expenses for women during child bearing years, but later dispels this as the sole explanation siting that the wide range in premiums couldn’t possibly be justified by actuarial analysis.

It would have been a more compelling analysis, and further solidified the argument if the author went on to compare health insurance rates for a 60 year old man vs women, an age when men’s health issues become more prominent.

After a quick analysis comparing rates on ehealthinsurance.com, an elderly man can expect to pay about 5% more than an elderly women for identical coverage levels.  The results of this quick test were not quite the results that I was looking for that would invalidate the argument that women are being gouged on their health insurance rates.  But my gut feeling tells me that the disparity between a women’s and men’s expected health care costs in their mid 30s, for example, are indeed magnitudes apart, and health insurance  companies are appropriately planning for potential claims.

The department of insurance (DOI) in each state must approve health insurance premiums based on claims history, and actuarial analysis, and would not approve rates if the this analysis didn’t support the rates  they requested.

The Centers for Medicare and Medicaid Services (CMS) announced in a memo to health insurance companies that they have a plan to combat rapidly rising commissions paid out to insurance agents selling private Medicare Advantage plans.  Some health insurance companies are paying as much as $600 to an agent for an enrolled member. Three of the market leaders in selling Medicare Advantage plans include Aetna, Humana, and United Healthcare.

Rules that CMS put in place Sept. 15 to prevent “churning” (encouraging customers to enroll in a different plan each year so the agent can receive a higher commission associated with the first year of enrollment in a health plan) have had the unintended consequence of increasing agent commissions across the board.

It appears as if new changes will be put in place to correct this problem next year as both Senate Finance Chairman Max Baucus, as well as Pete Stark, who chairs the House Ways and Means Health Subcommittee have mentioned plans to cap commissions.  In addition, both Humana and UnitedHealth have weighed-in supporting CMS corrective action.

Aetna CEO Ron Williams recently called for health care reform to include a mandate to purchase individual health insurance.  He stated

“Some people can afford health insurance and choose not to be covered,” he said. “Others should get a tax subsidy or credits to purchase insurance.”

Williams went on to state that nearly 20% of uninsured Americans (9 million) earn more than $75,000 per year, and should be able to afford health insurance but choose not to.  Another 10% are college students.

Health care costs can be better controlled if more people are insured and if a health plans risk pool is more evenly distributed between healthy and sick individuals.  If Healthy people choose not to be covered because they don’t utilize the benefits, and only people who desperately need health insurance purchase it, the cost of coverage becomes much higher.

Williams also commented on Senator McCain’s health care proposal stating that while it contains some good points, the tax incentives it would clearly weaken the employer-sponsored health care system which is the backbone of the market.

Members of health plans across the country have loudly voiced their complaints when their health insurance company has rescinded their health insurance coverage after a serious illness.  Typically, a policy is rescinded when an insurer determines that the member lied or omitted key information when submitting their enrollment application

In response to this consumer backlash, Aetna claims that it rescinds far fewer individual health insurance policies than other carriers and has now set up a process whereby if their health policy does happen to get rescinded that can appeal to an independent panel of doctors.

According to Aetna internal records, they have only rescinded 165 policies out of 570,000 sold since 2005.  Aetna currently covers over 350,000 people through individual health insurance plans nationally.