Humana contemplating pullout of some markets next year

[Texas Proud]

I never pay anything before I get an EOB.... around here no medical providers demand it IME.... if a medical provider demanded that then I would walk out the door and go elsewhere.

This was the hospital... none around here will let you in unless you pay upfront... so that means you would chose not to have the procedure done...

Isn't it ironic that they don't seem to have the same cavalier attitude towards payment when its them who is owed the money?


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Oh yea.... pay right now or we will not let you in... but when it is time to give back money it is SLOW... or even no existent...

 

[Mulligan]

This was the hospital... none around here will let you in unless you pay upfront... so that means you would chose not to have the procedure done...







Oh yea.... pay right now or we will not let you in... but when it is time to give back money it is SLOW... or even no existent...

PB, must get to go to some softie hospital outfit...This has about been my only dealings with a hospital since I entered the world naked..But this outfit was not going to draw anything from me until I paid "the fee" upfront.


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[MBSC]

As reported in post #21, Aetna cancelled its 2017 ACA exchange expansion plans and would re-evaluate its participation in the 15 states they currently offer exchange plans.

Aetna has announced they will offer 2017 exchange plans only in Delaware, Iowa, Nebraska, and Virginia. They will continue to offer off-exchange plans in additional markets.

This currently leaves Pinal County, AZ (between Phoenix and Tucson) without an on-exchange plan for 2017.

Source: Aetna to Drop Some Affordable Care Act Markets - WSJ

 

[MichaelB]

Here is Aetna's announcement News Releases - Investor Info | Aetna

Aetna will reduce its individual public exchange participation from 778 to 242 counties for the 2017 plan year, maintaining an on-exchange presence in Delaware, Iowa, Nebraska and Virginia. The company will continue to offer an off-exchange individual product option for 2017 to consumers in the vast majority of counties where it offered individual public exchange products in 2016.

 

[gerntz]

I think in some cases the Insurance companies themselves are "gaming" the system. The insurance lobby is aggressively lobbying to go back to private healthcare for all, thus costing us (in my case) $4500 per month for my wife and me, as opposed to $1200 what we pay now before subsidies. Anyone that opposes healthcare for all and no pre-existing conditions needs their head examined. (Figure of Speech)

Well, we don't have healthcare (I'm assuming you mean insurance) for all now. I read like about 15% are still uninsured & some want to be uninsured by paying the non-insurance penalty - or tax as John Roberts calls it.

And we never had private healthcare for all previous to the ACA.

And no one knows what premiums would be in a totally private system, just what they were in the pre-ACA world.

 

[GTFan]

This currently leaves Pinal County, AZ (between Phoenix and Tucson) without an on-exchange plan for 2017.

This is the big problem, what do those people do??

 

[GrayHare]

This is the big problem, what do those people do??

The lack of exchange plans means they can buy insurance on the open market.

 

[explanade]

Is Aetna going off-exchange because they'd be able to charge more?

 

[marko]

Is Aetna going off-exchange because they'd be able to charge more?

This morning I heard they had lost $200MM last quarter due to high expenses from overly sick people and not enough healthy ones.

 

[ivinsfan]

Is Aetna going off-exchange because they'd be able to charge more?

This is interesting, does Aetna have figures that show low income on exchange customers are heavy claimers due to suppressed medical care when they couldn't afford insurance. Realistically low income people will have a major problem paying off-exchange premiums.

Now in MN Blue Cross is exiting ALL individual plans both on and off exchange.

 

[explanade]

Aetna is losing money?

Or just losing money on the individual market?

They have to be making money off group plans right?

 

[Mulligan]

This is interesting, does Aetna have figures that show low income on exchange customers are heavy claimers due to suppressed medical care when they couldn't afford insurance. Realistically low income people will have a major problem paying off-exchange premiums.

Now in MN Blue Cross is exiting ALL individual plans both on and off exchange.

That certainly is a smart "business move" (Im only talking business). You know darn well what you are suggesting is the reason behind it. I would be shocked if anyone from the company would publicly admit it. They are too smart for that.


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[ivinsfan]

Yes, it's a ballsy move on Aetna's part, if you know it and I know it, the regulators know it, the question is there anything they can do about it?

 

[Mulligan]

Yes, it's a ballsy move on Aetna's part, if you know it and I know it, the regulators know it, the question is there anything they can do about it?

I bet their lawyers said this..."yes we can legally do it..Just damn sure dont say its the subsidized poor people with their low deductibles fixing all their body parts they abused on our wallet and we are not taking it anymore."


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[ivinsfan]

If this catches on and spreads, I can see it undermining the entire ACA structure and causing havoc everywhere.

 

[Gotadimple]

And no one knows what premiums would be in a totally private system, just what they were in the pre-ACA world.

I'm not sure I understand this comment. The pre-ACA world was the totally private system. But: many were excluded from this system due to pre-existing conditions. Except if they were in a group plan (either through an employer or an association). But even those were totally private.

The individual market is fraught with problems.
* Actuaries needs to assess the claims that have been paid, and risk that the premium that submit to an insurance commissioner will be large enough to cover the cost of care.
* The private system will often remove itself from the competition to avoid a drain on its finances.
* That creates access to care problems as people cannot buy new coverage (cannot be seen by a healthcare professional), or afford the increased premiums as other carriers increase rates for perceived risks.

Just remember that insurance is all about financing health care, not access to health care. They are mirroring the costs and health experiences of the population in general. Costs? Well that's been debated ad nauseum here. It is a complex problem we tried to fix with a simple solution - the ACA.

Rita

 

[ivinsfan]

I'm not sure I understand this comment. The pre-ACA world was the totally private system. But: many were excluded from this system due to pre-existing conditions. Except if they were in a group plan (either through an employer or an association). But even those were totally private.

The individual market is fraught with problems.
* Actuaries needs to assess the claims that have been paid, and risk that the premium that submit to an insurance commissioner will be large enough to cover the cost of care.
* The private system will often remove itself from the competition to avoid a drain on its finances.
* That creates access to care problems as people cannot buy new coverage (cannot be seen by a healthcare professional), or afford the increased premiums as other carriers increase rates for perceived risks.

Just remember that insurance is all about financing health care, not access to health care. They are mirroring the costs and health experiences of the population in general. Costs? Well that's been debated ad nauseum here. It is a complex problem we tried to fix with a simple solution - the ACA.

Rita

Well anyone with money can now buy off-exchange insurance as you mentioned many were excluded before ACA..so you are putting more high claims people on the off exchange program. So yes we don't what premiums will do in this circumstance as you said, the company will charge what is needs to not go broke.

 

[MichaelB]

If this catches on and spreads, I can see it undermining the entire ACA structure and causing havoc everywhere.

Not really. There are around 30 million people using "ACA plans", roughly split into similar sized groups of Medicaid expansion, on-exchange, and off-exchange. So far no insurer has announced plans to withdraw from the Medicaid markets, and there have been only a couple of announcements that affect off-exchange - most notably BCBS Texas and Minnesota.

The underlying issue here is having insurance markets broken up into many pieces, and insurers that are allowed to parse through all the pieces and choose some but not others. There are simple fixes for this, but they are not easy to accomplish. One would be to offer the US Federal Employee Insurance Benefit on the exchanges. Another would be to do away with the excessive market segmentation and have one large state risk pool - or even one large national risk pool.

 

[explanade]

So one of the alternatives to the ACA is to have insurers compete across state lines.

Well it sounds like insurers are or were in many states but now they're cherry-picking.

 

[ShokWaveRider]

I read this today. Hopefully is it good news for Florida. I also thought that 90% of Floridians get some kind of subsidy was interesting.

http://www.modernhealthcare.com/article/20160615/NEWS/160619946

 

[MichaelB]

I read this today.

http://www.modernhealthcare.com/article/20160615/NEWS/160619946

A snippet

The Affordable Care Act's exchanges have not been a bust for every health insurer. Florida's Blue Cross and Blue Shield affiliate made a profit of almost a half-billion dollars on the ACA's new individual plans last year.

 

[MichaelB]

So one of the alternatives to the ACA is to have insurers compete across state lines.

Well, currently any insurer can sell anywhere they choose. They only need to register with the State Insurance Commission and comply with all the state requirements. Allowing insurers to sell into states without complying with local regs isn't going to reduce the cherry-picking that's going on, but it might threaten the integrity of the local insurance marketplace.

 

[ShokWaveRider]

Michael:

It is still interesting, as Florida has more old fogies like us between the ages of 60 and 65 (as well as older of course) that in theory use more Health Services.

Where are the companies in other states going wrong?

 

[ivinsfan]

Not really. There are around 30 million people using "ACA plans", roughly split into similar sized groups of Medicaid expansion, on-exchange, and off-exchange. So far no insurer has announced plans to withdraw from the Medicaid markets, and there have been only a couple of announcements that affect off-exchange - most notably BCBS Texas and Minnesota.

The underlying issue here is having insurance markets broken up into many pieces, and insurers that are allowed to parse through all the pieces and choose some but not others. There are simple fixes for this, but they are not easy to accomplish. One would be to offer the US Federal Employee Insurance Benefit on the exchanges. Another would be to do away with the excessive market segmentation and have one large state risk pool - or even one large national risk pool.

I agree with what you say, but I'm not as confident as you are about the long term scenario.BCBS has no individual plans in MN in 2017. They have been my insurer of choice for almost 40 years.I still have my group small business plan, but will have 2017 income that would get me some assistance with premiums. So even the off exchange third are being affected by this. I can either stay with the small business deductible premium or go the ACA route and switch carriers, that is until I don't have one to choose from. What I can't do is change anything and still be BCBS, at any cost. They don't want me.

I would go with the national pool which makes area cherry picking impossible but I don't get to decided how it works.

 

[MichaelB]

Michael:

It is still interesting, as Florida has more old fogies like us between the ages of 60 and 65 (as well as older of course) that in theory use more Health Services.

Where are the companies in other states going wrong?

Interesting? Sure it is - it's an example of a a large insurer in a large state doing very well in the individual market. It leads one to conclude that one possible reason for some insurers decision to not sell in some marketplaces may be their own business management.

One thing that's different about the Florida individual market is that the major insurer, BCBS, has been extremely aggressive with price. Since 2014 their premiums have almost doubled for individual policies. What I don't get is that, if there are all these sick people consuming oodles of health care, why aren't the premiums of MediGap and Medicare Advantage starting to creep up as people age and move into Medicare.