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.

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.

United HealthCare Group announced the introduction of new individual health insurance plans being offered by their subsidiary Golden Rule Insurance Company.  The New health plans will initially be available in a twenty state footprint*, with more states to be added in the future.  The plans will be marketed under the UnitedHealthOne brand.

The new health plans are designed to give the customer more choices and control over their health care spending.

Health insurance shoppers who enroll in these new plans will have

• new co-insurance and deductible choices
• a 24 month rate guarantee option
• preventative care for the HSA plan options
• a new HSA plan with direct billing options

* Alabama, Arizona, Arkansas, Florida, Iowa, Illinois, Indiana, Maryland, Michigan, Mississippi, Missouri, Nebraska, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas and Wisconsin, as well as the District of Columbia.

In the recently released US News & World Report commercial health plan rankings (which takes into account both customer satisfaction and a number of different healthcare related measures such as disease prevention), The top 10 Wisconsin health insurance plans were ranked as follows.

1. Group Health Cooperative of South Central Wisconsin - driven by very high scores in both disease prevention and treatment
2. Security Health Plan of Wisconsin
3. Unity Health Plans
4. Network Health Plan
5. Dean Health Plan
6. Medical Associates Health Plan
7. WPS Health Plan
8. Medica - Serving Wisconsin, Minnesota, South Dakota, and North Dakota
9. United HealthCare
10. Humana

Not all of the Wisconsin health plans listed above offer individual health plans (non-group health coverage), if you are a Wisconsin resident and shopping for a health plan for you and your family, you can find more information about Wisconsin health plans for individuals here.

A recent study undertaken by online health insurance marketplace ehealthinsurance.com found that individual health insurance can indeed be affordable if you shop around.

Specifically, the study of more than 225,000 individual and family health plans purchased through their site found that the average monthly premium to insure an individual was $158, and more than half of those underlying policies had a monthly premium of less than $130!  When insuring a family, the average monthly premium was $366 with more than half paying less than $300 per month.

To build on a previous health insurance study that was blogged about here, women paid more for their health insurance coverage, 18% more to be exact.  On average women paid $171 per month while men paid $145 on average.

Other findings:

• 60% of children’s health plans had monthly premiums of less than $100.  These do not include state sponsored and subsidized children’s health plans which have income limits for qualification.
• Regionally the Midwest was the cheapest region with average monthly premiums of $130, followed by the West region ($150), South ($154), and Northeast ($239)
• Average monthly premium for HSA health plans was $133

To date, more than thirty states have set-up high-risk pools to address the issue of the those who go without health insurance coverage because they are deemed “uninsurable” by private health insurance companies.

For many of these “uninsurables” these high-risk pools are their only means for acquiring health insurance, because they don’t have access to an employer-sponsored health plan, and as mentioned above, private health insurers won’t cover them because of a pre-exisitng condition such as diabetes, depression, or high-blood pressure.  About 175,000 people nationally are covered under these high-risk pools and that number should grow as more states launch similar programs.

High-risk pools are generally similar to health plans offered by private health insurers, but in some cases may offer more limited benefits.  However, the costs for these health plans are pretty steep ( 1.5 to 2 times that of similar private health plans which is understandable due to the expensive nature of the customers medical conditions that drive people towards these plans to begin with.

Despite their high cost, these state run health plans are a very important instrument for individuals with health conditions and as a last resort, they should certainly be considered a favorable option to going without health insurance altogether.

If cost is a concern, you should first see if you qualify for individual health insurance from a private health insurer, and then look to high-risk pool as a last resort.

States that currently have high-risk pools include:  Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Florida, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Dakota, Oklahoma, Oregon, South Carolina, South Dakota, Texas, Utah, Washington, Wisconsin, Wyoming.

A brief prepared by Mark Farrah, ranks health insurance companies across the nation based on their enrollment of individuals & families in non-group health plans, i.e. individual health insurance.

In the private health insurance marketplace there are an estimated 17 million individuals enrolled in non-group health insurance coverage purchased directly from insurance companies, although only just over 11million in membership was captured in this analysis which relied on NAIC and CA Dept of Managed Care Data.

Major medical health insurance plans make up the vast majority of non-group health plans, but limited benefit plans make up a material portion and are growing in popularity as health insurance premiums continue to outpace wage increases.

The brief found that 229 health plans were offering major medical health coverage to individuals & families.

The rankings were as follows:

1. Wellpoint/Anthem (BCBS in 11 states)      21% market share
2. HCSC (BCBS in 4 states)                              7%
3. BCBSNC                                                      4%
4. BCBSFL                                                       4%
5. Regence (BCBS in 4 states)                         4%
6. United HealthCare                                     3%
7. Aetna                                                         3%
8. Humana                                                     3%
9. BCBSMN                                                     2%
10. Assurant                                                    2%
11. Other (219 companies)                            46%

In the limited Benefit Plan marketplace, United American maintains a dominant position with 70% market share.

The most surprising finding in the major-medical health insurance rankings is that Blue Cross Blue Shield of North Carolina as the 3rd highest membership across the country, covering over 350,000 individuals with their Blue Advantage offering for individuals despite covering a service area that is limited to the state of North Carolina.

Gary Bolt, and Bruce Allen deserve much praise for their work managing the individual direct sales unit at BCBSNC.

AP reporter Kevin Freking weighed on on McCain’s health care proposal and how the encouraged interstate shopping for health insurance might effect the market.  Mr. Freking’s take is that the interstate shopping would clearly benefit younger healthier Americans that are healthy enough to purchase health insurance from a health insurance company in a state that has few consumer protections and thus can offer individual health insurance at a much lower cost. However, as healthy individuals from heavily regulated states (such as New York) begin buying health plans across state lines from states that do not require mandated benefits they don’t need, the health coverage from the heavily regulated states will continue to spiral upward in cost, as the only customers who will continue to purchase from those states are the ones who have no choice due to their health conditions, and who are very expensive to insure.

McCain has acknowledged the need to help the chronically ill folks who could be left behind without government assistance and has proposed a guaranteed acceptance health plan run by the state and governed by a board representing health insurance companies, businesses and consumers.  Health insurance rates would be capped at 150% of the standard plan sold in the state.  This plan would essentially build on programs running in 34 states already as of the end of 2007.

As a comparison of  the competing health care plans, McCain’s plan focuses on changing the tax code to expand health coverage, particularly the individual health insurance marketplace, while Barack Obama’s plan aims to subsidize the cost of health insurance for low-income families so that they could afford to purchase coverage.

Both health care plans have their warts, and both plans have their critics.

Things you should consider when shopping for a health insurance plan for you and your family.

Make sure your family doctor or any specialists that you typically use or plan to use in the future are in the network.  Co-pays and co-insurance percentages will be higher to utilize service from out of network doctors.  Some health plans may not provide any out of network benefits.

If possible, research your health care spending done in previous years and figure out what you might need going forward (i.e. if you see that you rarely if ever require prescription drugs, it might not make sense to enroll in a health plan that includes prescription drug benefits if the additional expense is high.)

If your health care utilization is typically low, and your family is in good health, a high-deductible health plan might be a good option.

If your spouse has health insurance coverage through his or her employer, check to see if the portion on the monthly premium that the employee pays is more or less than what you would pay with your employer sponsored plan or individual health insurance plan.

Does the health insurance plan offer a wellness plan, or alternative medicine discounts which could save you money.

You can shop and compare individual health insurance plans here at healthinsurancesort.com.   Some other resources that might be useful include your state department of insurance, or if age 65 or older, www.medicare.gov.

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.