Health Insurance Blog

Based solely on national market share, the “top”  (i.e. largest membership base) Medicare Supplement providers in the country in 2008-2009 were as follows:

1.  United Healthcare (driven by AARP contract) 29% market share

2.  Wellpoint  8%

3.  Mutual of Omaha 6%

4.  Health Care Services Corp.  5%

5.  Conseco 4%

As you can see, the five largest carriers account for 52% market share, and the remaining 48% is captured by dozens if not hundreds of smaller companies.

When Medicare Advantage and other Medicare products are factored into the mix, like prescription drug plans (PDP), the top four companies would be AARP, Humana, Wellpoint and Universal American respectively.

Anthem Blue Cross is delaying their proposed rate increase to their California individual health insurance customers after much criticism, and a request by the California Department of Insurance.

The proposed health insurance rate increase would have raised monthly premiums for some members by as much as 39%.  According to Anthem the rate increase represents anticipated medical costs.

Regulators do not believe the sizable rate increase is justified given how profitable parent company Wellpoint was in 2009.

Situations like these, where health insurance companies have been coming off record profits, and then request significant rate increases based on actuarial data are not endearing themselves to the American public, and to politicians looking to solve the country’s health care issues.

In what has been a roller coaster for all those involved and interested, the Wall Street Journal reports that the health overhaul bill once finalized need not include a Government-run health insurance option as long as other parts of the bill would fulfill the same goals.  However, one thing that will be required from the bill is the ability to hold health insurance companies accountable.

Keeping a public option out of the bill is a top priority for AHIP, whose members include CIGNA, WellPoint Inc. and Humana Inc. among other health insurance companies. The group also opposed the Senate bill because of new taxes on the industry, caps on administrative costs and other changes.

According to a recent research report written by Debra A. Donahue of Mark Farrah and Associates, the individual health insurance marketplace is growing.  As of the end of Q2 2009, national individual health insurance enrollment totaled about 9.7 Million, up from about 9.6 Million from the previous year.  This enrollment does not include those individuals enrolled in Medicare Health Plans, or other state sponsored Programs.  Part of this growth is being fueled by high unemployment rates and less people having access to group sponsored plans.

The report makes it crystal clear that Wellpoint is the largest and most dominant player in the individual health insurance marketplace, albeit partly due to their large geographic footprint, covering 15 states.

The top 5 health plans ranked by enrollment in individual health plans include:

1. Wellpoint - with enrollment of over 2.25 Million (23% market share)
2. HCSC (Health Care Services Corporation) - 670,000 (7%)
3. Blue Cross Blue Shield of Florida - 370,000 (4%)
4. Kaiser Foundation Health Plans - 344,000 (4%), down 12% from previous year
5. Humana - 336,000 (4%), up 28% from previous year

Humana increased the number of states it offered it HumanaOne individual health insurance plan from 15 states to 24 states in March 2008, which accounted for their large increase in enrollment.

Wellpoint and HCSC are both health insurance companies that offer Blue Cross Blue Shield Health Plans in multiple states.  Wellpoint includes 15 BCBS licensees, and HCSC 4.

Wellpoint has joined the health care reform fray, opposing the “public plan” backed by Obama and the Dems.  In the first quarter of 2009, Wellpoint spent over $1.2 Million lobbying the Federal Government and getting their message out.

In addition, the Wellpoint Institute of Health Care Knowledge,  recently released a report to dispell the notion that health insurance company profits are the culprit for rapidly increasing health care costs.  According to the report advances in medical technology, price inflation, and obesity are to blame.  Wellpoint cites research from PriceWaterhouseCoopers which states that only 3 cents from every health care dollar goes to health insurer profits.

Not surprisingly, Wellpoint, like many other private health insurance companies, is a supporter of expanding the individual health insurance market as a way to insure the 46 million uninsured Americans.

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.

Kevin Kingsbury from the Dow Jones Newswires reports that the Centers for Medicare and Medicaid Services have forbidden WellPoint from adding new members to its Medicare plans. Compliance problems were discovered in separate audits.

As of January 13th, WellPoint is suspended from selling Medicare Advantage (hospital and physician coverage under a private plan) and Medicare Part D coverage (which covers prescription drugs).

Almost 2 million people have bought the company’s Part D coverage, while 3.7% (1.3 million) of their members are seniors on medicare. This suspension will be in effect until WellPoint fixes its undisclosed issues. The decision was a shock to WellPoint, since it have spent the past 6 months working closely with CMS to correct its errors.

Reuters is reporting that Healthbase Online, a medical tourism facilitator, is engaged in a pilot program with Wellpoint to provide global health care coverage to Wellpoints members in Wisconsin.  Healthbase’s involvement in the pilot involves setting up all the medical & travel logistics.

Under the Wellpoint program, members who choose to have non-emergency elective procedures performed overseas, such as joint replacement, will have access to Joint Commission International accredited HealthCare providers in India.

The program would save members thousands of dollars in out-of-pocket costs.

As previosuly reported here in this blog, studies conducted by UCLA medical school have shown that patients who have procedures down overseas have a much greeater chance of experiencing complications or post-op infections.  Nonetheless there continues to be interest in the program in the name of saving money.  We will see if similar programs proliferate among other health insurance carriers, subsequent to this pilot program.

Jill Brown, the Managing editor of AIS Health.com, wrote a report about how Blue Cross Blue Shield (BCBS) member health insurance plans have been launching new individual health insurance products that are in line with new state mandates that are designed to make individual health insurance more affordable.  The underlying theme is that the weak economy has and will continue to spur sales of individual health plans, as many people lose employer-sponsored health coverage.

Specific examples of BCBS plans launching new health plans or making adjustments to  existing health plans include:

1. Blue Cross Blue Shield of Arizona who recently launched (Sept.) a suite of 5 new individual health plans with premiums as much as 40% lower than their existing individual health insurance offerings, while still offering up to $5 million in lifetime benefits.
2. Wellpoint is expanding their affordable “SmartSense” line of indivudual health insurance plans to Colorado in November, and they plan to add even more states over the next few quarters.  The SmartSense product line was piloted in California and Georgia and now makes up more than 50% of individual health insurance sales in California.
3. Horizon BCBS of New Jersey is making adjustments to their individual health plan pricing by taking advantage of a new law that allows them to use a applicants age in their rate calculations which should make the plans more affordable for younger individuals.

As alluded to in this report, many health insurance carriers accross the country, not just BCBS member health plans, will be offering new health plans for individuals, and making their health insurance rates more affordable.  It is a great time to compare rates and see what is available in your state.

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.