Health Insurance Blog

More people are shopping for individual health insurance these days.  Golden Rule, says their sales are up 24% over the the past two months.  In addition, ehealthinsurance.com reports that submitted applications were up 18% in the 4Q, over 4Q in 2007.

Along with the increases in individual health insurance shoppers, health insurance rates have increased as well:

• About 80% of Anthem Blue Cross of California’s individual health insurance policy holders will receive double-digit rate increases shorty, and some will receive increases over 30% or more.
• Blue Cross Blue Shield of Michigan is seeking state approval to increase monthly premiums by 56%
• Lifewise raised rates in Washington by 17.6% effective January 1.  In addition, Blue Cross Blue Shield of Oregon raised rates for their Washington state members by nearly 30% on avg.

For perspective, group health insurance premiums increased by roughly 5% in 2008.

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.

The top North Carolina health insurance plans as ranked by US News and World report’s annual health plan ranking report are displayed below.  Of particular note is that a number of health insurers including the states oldest and largest health insurance company, BCBSNC, have chosen to not supply internal data that is required to provide accurate health plan rankings.  As a result, BCBSNC, as well other North Carolina health plans were not included in the 2008 rankings.

The top North Carolina health plans that particiapted in this report are

1. CIGNA Healthcare of North Carolina
2. Aetna Health of the Carolinas
3. UnitedHealthcare of North Carolina

Following up on a story reported a couple of days ago, UnitedHealth Group has agreed to pay $350 Million to settle a billing dispute related to out of network claims.  In addition, UnitedHealth pledged $50 Million and Aetna $20 Million to create a new database to determine our of network claims payment.  The previous database that was used was operated by Ingenix, a UnitedHealth subsidiary which was at the center of the dispute.

The Ingenix database, contained claims payment data that is contributed by health insurance companies.  The data is then used to set “usual and customary” charges for certain procedures, when members receive care outside of their network.

The lawsuit alleged that health insurance companies lowered the payment data when adding to the database, which allowed them to lower payments for future claims.  The patient would then be billed the difference.

An investigation by the New York Attorney General’s Office found that health insurers had underpaid by 10-28% as a result of the inaccurate data in the database.

Julie Appleby of USA Today reports that New York Attorney General Andrew Cuomo has reached an agreement with UnitedHealth Group that will protect policyholders against paying more than they should to see out-of-network doctors. While this immediately affects New York health insurance, the settlement could have far-reaching impact across the country.

UnitedHealth insurance used a subsidiary’s database (Ingenix)–as do many other health insurance providers nationwide–to determine how much doctors should be paid, through the insurers’ own reports of regional charges. Cuomo calls this a conflict of interest, and will establish a non-profit agency that will publicly post typical medical costs on a Website. UnitedHealth has agreed to donate $50 million to that agency.

On average, UnitedHealth underpaid out-of-network doctors by over 25%. Consumers suffer when doctors do not consider those incomplete reimbursements as full payment, since they have to cover the difference. The rules surrounding reimbursement of non-network care are often murky and confusing. According to Julie, Cuomo claims that many insurance plans don’t even tell consumers how much they’ll end up having to pay! 

Get UnitedHealth quotes for the second-largest health insurer in America.

This is very interesting: Vita Reed in the Orange County Business Journal says that a subsidiary of UnitedHealthCare called Prescription Solutions, which manages pharmacy benefits, is planning on introducing an e-prescription service. They are partnering with SureScripts-RXHub to do so. UnitedHealth got the California-based company as part of its acquisition of PacifiCare in 2005.

I predict this service will become very popular over the next several years. Imagine not having to drop off your prescription, because your pharmacy already recieved it online before you even left your doctor’s office! (Not to mention avoiding the issue of handwriting quality.) This deal will make this benefit available to more consumers. Currently, just 2% of doctors have adopted the system, according to the Washington Post. If it’s provided by a health insurance company, they might be more likely to use the technology.

(Photo credit: d70focus under CC 2.0)

Golden Rule, a United HealthCare company, is offering a unique insurance product.  The plan allows workers, who fear that they might get laid-off and subsequently lose their employer-sponsored health coverage, to pay a fee in order to be covered by a Golden Rule health insurance policy in case they lose their job and become uninsured.

The cost savings for the member would come into play when the monthly premiums required to be covered by Golden Rule would be substantially less than health coverage from COBRA.

For Example, COBRA replacement coverage for a husband and wife could cost $500-$800 per month, whereas similar coverage via the Golden Rule health plan would cost $385 per month once enrolled + $77 per month now for the right to access the plan later.

The plan is called UnitedHealth Continuity.  It is currently available in 25 states, and over time, Golden Rule plans to make it available in all 40 states where they currently do business.

The cost savings seem pretty speculative unless you would expect to be on COBRA for several months.  If you didn’t get laid off, you would be spending $77 a month for nothing, although I guess that is what insurance is all about….peace of mind.

Earlier this week, 6 health insurance companies in Florida signed contracts with the state to offer affordable health insurance to the uninsured in Florida.  The health insurance offerings vary, but in general are less than $100 per month.

The program championed by Florida Governor Charlie Christ is called Cover Florida, and will launch on January 5, 2009.  The plan was unanimously approved by the Florida Legislature and require no tax dollars to make it happen.

The six participating health insurers will offer 25 health plans options between them, and each with 2 different benefit levels (one focusing on catastrophic coverage & hospital coverage, and the other on preventive care).

Of the six health insurance companies only offerings by Blue Cross Blue Shield of Florida and United HealthCare are available in all 67 Florida counties.

The UnitedHealth Group is now offering UnitedHealth Continuity, a policy for those that already have health insurance but are worried that they may lose it in the future. These people may be considering early retirement, or may fear unemployment and the resulting loss of health care coverage. Reed Abelson says in the New York Times that applicants must pass a medical review before being accepted. However, many individuals who have been unable to get insurance on their own are those with pre-existing conditions. The Continuity plan doesn’t seem to be helpful for them.

The UnitedHealth Continuity policy charges members 20% of the current health insurance premium to reserve the right to future coverage, and varies due to age, gender, location, and level of coverage selected. The monthly fee is also subject to increase in the future. There is also the danger of the plan becoming a costly high-risk pool that attracts people more likely to develop serious conditions.

Reed also speculates that proposed health care reforms from the incoming Obama administration include a requirement that private insurers offer individual health coverage to everyone, no matter the state of their health. That type of law would make the new UnitedHealth guarantee unnecessary. The president of UnitedHealth’s individual insurance unit, Richard A. Collins, claims that political wrangling and legislative delays make the Continuity plan viable, at least in the short term.

UnitedHealth Continuity is currently available in 25 states in which UnitedHealth already sells individual insurance. It believes that it will soon be able to offer the Continuity plan in 15 more states.

(Photo credit: Shahram Sharif under CC 2.0)