Health Insurance Blog

The Massachusetts health insurance mandate, passed in 2006 in an attempt at health care reform, is facing some unexpected challenges during this recession. Steve LeBlanc of the Associated Press says that increasing unemployment rates will make more people unable to fulfill the insurance requirement. Failing to buy health insurance will result in up to $1,000 in fines per tax year (taken from tax refunds), although the sentence is often waived. In 2007, only about 1% of the Massachusetts population did not buy health insurance, but experts predict that number will increase due to consumers focusing on other priorities.

While insurance is completely free for the poor and subsidizes plans for people making up to 300% of the poverty level, private individual health insurance can still be out of reach. The state does cover health insurance costs for as long as someone is collecting unemployment benefits, which helps those who have been laid off. However, the influx of new applicants to subsidized plans is expected to cost $800 million in the new fiscal year’s budget, an increase of $60 million.

Steve reports that some legislators believe the current law is unrealistic given current economic conditions and should be waived for the newly unemployed, but Democratic Governor Deval Patrick vows to continue the program and cut other spending to balance the budget instead.

Bobby Caina Calvan from the Sacramento Bee reports that the state of California has settled with Anthem Blue Cross regarding its cancellation of individual health insurance policies. The settlement requires that the insurer reinstate coverage for those whose policies were unfairly rescinded between 2004 and 2008, regardless of any medical conditions they may have. Qualified consumers will be contacted over the next three months via phone. In addition, Anthem Blue Cross must reimburse $14 million worth of out-of-pocket health expenses paid by these consumers.

The California health insurance company also has to pay a $1 million fine to the Insurance Department, with an extra $2 million tacked on if they fail to change their policies, Bobby says.

The New York State legislature has approved an increase in health insurance taxes to reduce the budget deficit, according to Alphonso O’Neil-White in the Buffalo News. Approximately $350 million worth of “patient services surcharges” and “covered lives assessments” (among other names for the fees) will be added to the already expensive cost of New York health insurance. There might be more to come: the upcoming budget for 2009-2010 looks to include about $420 million in new health insurance taxes and surcharges.

Alphonso states that the average NY State family pays anywhere from $900 to $1,500 per year of their health care premiums solely on these taxes! Also, these taxes make employers increasingly unable to afford to provide health insurance to their employees. More people will become uninsured and have to search for individual health coverage as a result.

Blue Cross and Blue Shield of North Dakota (BCBSND) has come to an agreement with local hospitals that they will not lower reimbursement payments, reports Retha Colclasure of KFYR Bismarck. In order to save money, the insurer had sought to reduce payments to health care providers without contract renegotiations. The North Dakota Insurance Department blocked such a move.

Decreased payments from insurance companies make hospitals tighten their budgets, possibly resulting in fewer services being offered. For example, St. Alexius hospital would have suffered a $300,000 monthly deficit, Retha claims. Sometimes, hospitals may even refuse to treat patients under certain insurers because of what they consider inadequate compensation. Thankfully, North Dakota health insurance customers will no longer have to worry about that.

Erin Allday from the San Francisco Chronicle recently reported on a proposal from the S.F. Attorney General that would eliminate bias in health insurance rates. Health insurance companies claim that they should be allowed to charge women under 55 more for health insurance than men, since they are more likely to suffer from some chronic illnesses and visit doctors for preventative care more often.

While 12 states ban or restrict the practice of gender rating, California does not. Women who buy individual health plans in California pay up to 39% higher premiums than men, according to Erin. The city of San Francisco is getting involved because women end up going to city clinics or emergency rooms because they can’t afford health insurance, costing the government money. 

A spokesman from America’s Health Insurance Plans, an industry group, states that gender rating is not discriminatory since women use more services. In addition, older men pay more for health insurance than older women. However, the Equal Employment Opportunity Commission prevents women from being charged more for their premiums based solely on their gender.

The National Women’s Law Center report found that women nationwide pay up to 48% more for health insurance than men, excluding maternity coverage. Maternity coverage is the most obvious factor that could drive up the cost of women’s health insurance.

It has been proven that preventative health care (check-ups and screenings) ends up costing insurance companies and society less in the long run. Should younger women be punished for taking responsibility for their well-being?

(Photo credit: Adria Richards under CC 2.0)

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.

Blue Cross Blue Shield of Vermont, the state’s largest health insurer, is under fire from People for the Ethical Treatment of Animals (PETA) due to its policies, according to CBS NewsChannel 5. PETA wants providers of Vermont health insurance to vary health insurance premiums based on an individual’s diet, charging meat-eaters higher rates and offering discounted rates to vegetarians and vegans. They claim that meat consumption is associated with diseases that end up raising insurance rates for everyone, but there is conflicting evidence of that.

Kevin Goddard, a vice president at BCBS Vermont, responds that state law does not allow insurance providers to vary rates based on factors including diet, age, gender, or medical history. However, the Vermont state legislator is now considering reforms that would allow insurers to offer different levels of premiums to individuals depending on their lifestyles; people who take better care of themselves health-wise (which is a comination of many different factors) would pay less.

Another way to save on your premiums is to get multiple health insurance quotes. You might be able to find a better deal, regardless of your eating habits!

(Photo credit: Derek Purdy under CC 2.0)