Health Insurance Blog

Women of child-bearing age (19 to 55 years old) pay more for health insurance than men, says Linda A. Firestone, Ph.D in the Sun-Sentinel. A typical woman’s policy includes maternity coverage, which accounts for the gender disparity in insurance rates. Since the majority of American adult women eventually have children, health insurance with maternity coverage makes sense for them–especially if there are pregnancy or birth complications.

Group health insurance plans (for example, those provided by employers) in Florida do not allow women to opt out of maternity coverage. If a woman does not plan to have children, she can choose to buy one of many individual health plans, which allow her to opt out of maternity coverage. In fact, many insurance providers (such as Humana), no longer offer maternity coverage in their plans. Insurance specialist Larry Wides says the cost savings from a group plan tend to cancel out the reduced premiums resulting from the elimination of maternity coverage.

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.

Humana recently announced the introduction of their portfiolio of individual health insurance plans for Nevada residents, called HumanaOne.  The HumanaOne portfolio of individual health insurance plans has been made available to 25 other US states since 2007 and has been very well received.

The 25 states where HumanaOne has been previously made available include Alabama, Arizona, Arkansas, Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee, Texas, Utah, Virginia and Wisconsin.

HumanaOne health plans are designed for

1) self-employed entrepreneurs

2) small business employees who aren’t provided employer sponsored coverage

3) part time workers,

4) college students and

5) early retirees

HumanaOne health plans are available through insurance agents and brokers, as well as directly to consumers online or by phone.

Bloomberg.com reports that premiums for medicare drug coverage will rise more than 20% on average from 2008 to 2009.  This expected rate increase is on the heals of another 20%+ rate increase from 2007 to 2008.

Among the largest medicare drug plans, AARPs MedicareRx is increasing rates by 8% while Humana’s PDP Enhanced plan is raising premiums by 64%.

According to health insurance companies such as Humana, the volatility in premiums charged for these drug plans can be blamed on inaccurate forecasting of drug costs.  Humana’s PDP plan’s premiums have quadrupled since its inception in 2006.  While most senior citizens tend to stick with the same drug plan that they are already enrolled in, the volatility in prices has made it important for seniors to shop around for the best rate.  For 2009 there are nearly 1,700 government approved prescription drug plans, and every Medicare enrollee in the country (except for Alaska) has a plan available to them at a monthly cost of less than $20 per month.

Nationally, about 16 million Americans enroll in a standalone medicare drug plan such as AARPs MedicareRX, as opposed to obtaining drug coverage through a comprehensive health care plan such as Medicare Advantage.

Humana recently announced the launch of a new online tool to assist shoppers who apply for individual health insurance through HumanaOne.

The new PlanPointer tool can be found on www.Humana-One.com in most states where Humana offers individual health insurance plans.  The tool guides health insurance shoppers in selecting, personalizing and applying for a health insurance plan that fits their needs.

Applicants basically answer four basic questions regarding

1) monthly premiums

2) benefit levels

3) prescription-drug coverage, and

4) their interest in a health savings account (HSA)

As applicants answer each question, the list of matching health plans narrows - sorted with the most relevant plans on top.

This PlanPointer tool is a great tool to help users select an individual health insurance plan that fits their needs, with the only limitation being that it onlt provides HumanaOne options, and not individual health plans offered by Blue Cross Blue Shield or Aetna for example.