Health Insurance Blog

J.D. Power and Associates rating of the top health plans for the South East Central region lists two health plans tied for the top spot for 2009 - Anthem Blue Cross Blue shield of Kentucky and BlueCross BlueShield of Alabama.

CIGNA & Humana finished close behind while still receiving designation as being among the nations best.

Aetna & Blue Cross Blue Shield of Tennessee were rated as “about average” while  United HealthCare and Blue Cross Blue Shield of Mississippi were rated below average.

JD Power and Associates recently released their 2009 Health Plan Ratings.  The ratings are based on the results of a study which includes responses from more than 33,000 members of private health insurance plans.   The members were surveyed online in December 2008 and January 2009.

More than 130 health plans were included in the study which breaks down the results into 17 distinct regions across the country.  The study itself examined seven key factors:

1. Health coverage and benefits
2. Provider choice
3. Health information and communication
4. Health insurance claims processing
5. Statements
6. Customer service, and
   
7. Approval processes

Some of the Health insurance plans that ranked highest in their respective regions included…Anthem Blue Cross and Blue Shield of Kentucky , BlueCross BlueShield of Arizona, Health Alliance Plan (HAP), Humana, Kaiser Foundation Health Plan, and Medical Mutual of Ohio among others.

Over the next few weeks we will be providing more of the regional results from this study.

John Dorchner reports in the Miami Herald that the state might consider a bill that would require gender equity in Florida health insurance premiums. Florida’s insurance consumer advocate Sean Shaw is looking to team up with a congressperson that would sponsor legislation that would ban the practice of gender rating. Women pay higher premiums than men, even when you exclude maternity coverage.

For example, a Blue Cross Blue Shield of Florida policy for a 30-year-old in Miami costs $246 for a man and $291 for a woman. Insurers claim that women use more health care services and are more likely to keep up with regular screenings; some believe that’s a perverse incentive to forgo preventative care.

However, due to that higher level of utilization, older women are in better health and have lower health insurance premiums than their male counterparts. Using the BCBSFL example above, a 60-year-old Miami woman pays a monthly premium of $593, while a man of the same age pays $644.

A recent research brief written by Deborah Donahue of Mark Farrah and Associates provides commentary on the recent growth of Medicare Advantage Plans.

According to the report more than 225,000 americans enrolled in Medicare Advantage plans during the most recent open enrollment period, and total enrollment stands at roughly 10.5 Million nationally.

The top 10 Medicare Advantage carriers (in terms of enrollment) maintain just over 60% market share, of which Humana and UnitedHealth Group maintain more than half (30% market share between them).

The 10 Largest Medicare Advantage Organizations

1. UnitedHealth 16% Marketshare
2. Humana 14%
3. Kaiser Foundation Health Plan 9%
4. Wellpoint 4%
5. Coventry Health Care 4%
6. Aetna 4%
7. Blue Cross Blue Shield of Michigan 3%
8. Health Net 3%
9. Highmark 3%
10. Wellcare Health Plan 2%

In addition, 9 new Medicare Advantage Organizations began doing business in 2009 and 6 ceased operations.

Other health insurance plans for seniors include Medicare Supplement plans.

The top four providers of Florida health insurance recently met to discuss health care under a Barack Obama administration, says Jeremy Cox of the Jacksonville Times-Union. Representatives from Humana, UnitedHealth, Blue Cross Blue Shield of Florida, and Aetna were in attendance.

The insurers believe that President Obama should enact a health insurance mandate for all Americans if, as they predict, he will require insurers to cover individuals with pre-existing conditions. They think that the cost will be prohibitive for carriers otherwise. At the moment, Obama has not publicly supported a mandate, and how exactly one would be carried out is unknown. He has supported a role for the private sector in universal health care, but that role will most likely be a change from the current market.

Instead of the plans Obama and congressional Democrats have proposed for health care reform, the insurance companies would prefer that the government focus mainly on enrolling eligible but currently uninsured individuals in federal-run programs like Medicaid and Medicare, Jeremy says. While the insurance companies agreed that greater coverage is a priority, they claim the task of covering other Americans should be left to them through innovative new plans.

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.