Humana contemplating pullout of some markets next year

[GTFan]

Uh oh, we might be moving to Harken or someone else sooner than I thought. I'm sure their pending merger with Aetna has something to do with this, but it's not a sign of a healthy market when coupled with the crazy rate increases we've seen so far. Still early though.

Change is in the works for Humana ACA exchange participation - US News

 

[MBSC]

Humana has off-exchange plans this year in Virginia but did not submit anything for 2017. They're also taking away the ability to make recurring credit/debit card payments for their off-exchange plans to reduce transaction costs.

 

[MBSC]

Humana will not sell 2017 on-exchange plans in Alabama. UHC is also exiting Alabama leaving BCBS-AL as the only carrier unless a new one joins.

Humana is leaving the Tennessee off-exchange market but will offer on-exchange plans in 2017.

Humana is a midsize player in the PPACA exchange program, with about 554,300 individual members from the exchanges as of March 31.

The company offers exchange plans in 15 states and overlaps with UnitedHealth mainly in Southern states, including Alabama, Georgia and Tennessee, according to Cynthia Cox, who studies PPACA and private health plans at the Henry J. Kaiser Family Foundation. Regulators in Texas, Florida, Georgia, Louisiana and Missouri, all of which UnitedHealth is leaving, said Humana hasn’t told them of its plans.

Reference: Humana to leave Alabama, Virginia exchanges in 2017 | LifeHealthPro

 

[2017ish]

...

Humana is leaving the Tennessee off-exchange market but will offer on-exchange plans in 2017.

...

That's interesting. Wonder if the volume just wasn't there off of the exchange. The article didn't get into the rationale, and my limited understanding has been that (generally speaking) the loss ratios have been worse on the exchanges than off of them.

(Speaking as a Tennessean who plans to buy outside the exchange if the present system remains more or less intact....)

 

[ziggy29]

(Speaking as a Tennessean who plans to buy outside the exchange if the present system remains more or less intact....)

Oh, if you don't plan on getting any premium subsidy or cost sharing, and don't expect to be eligible for same within the next couple years, yeah, I'd absolutely go off-exchange.

 

[Gotadimple]

It is a business strategy to exit the market when another carrier announces they will not serve that market (i.e., UHC not participating in ACA health plans). This is especially true if the actuarial data for the ACA plans shows increased loss ratios when compared to off-exchange plans.

So, why should Humana stay in Tennessee if the loss ratios are higher and their approved rates won't cover the losses? This is not what the ACA was supposed to do, in theory, but market reality shows otherwise. But don't blame the ACA for this.

15+ years ago, an insurance commissioner in the state of Washington decided that the individual insurance rates were too high, and the benefits were too low. The commissioner refused all requests for rate increases and issued administrative rules requiring changes in benefits to provide more coverage. There were many carriers in the state, but the top three were local to the state.

One by one each of the top three stopped selling insurance to new members. The state went for over 18 months without significant access to individual health insurance, until the commissioner's term of office was over.

The point is it is a free market, and, businesses will make decisions that supports their bottom-line. I absolutely DO NOT INTEND this conversation to turn political: businesses employ people, and they are aware their actions affect families (of their clients and their employees).

 

[GTFan]

It's actually not a free market in the usual sense, it's a highly regulated one. And I'm talking about all insurance not just the ACA.

 

[ziggy29]

One by one each of the top three stopped selling insurance to new members. The state went for over 18 months without significant access to individual health insurance, until the commissioner's term of office was over.

The point is it is a free market, and, businesses will make decisions that supports their bottom-line.

As long as there are multiple businesses that would be willing to do business in a *competitive* market (i.e. no collusion or price-fixing) if it were reasonably profitable to do so, I agree. The health care market is so distorted and lacks transparency to the point that it's hard to know what to believe.

 

[MBSC]

Humana will not offer 2017 off-exchange plans in Kansas (1822 current members) and Wisconsin (6,639 current members). Humana does not have exchange plans in either state. 1825 current members in Virginia will be impacted.

 

[Gotadimple]

Humana will not offer 2017 off-exchange plans in Kansas (1822 current members) and Wisconsin (6,639 current members). Humana does not have exchange plans in either state. 1825 current members in Virginia will be impacted.

This is not a lot of membership given the population in these two states. So it appears they are not participating because they don't believe they can gain market share.

 

[MBSC]

The company interested in acquiring Humana may expand their exchange presence.

Aetna Inc. expects to continue selling Affordable Care Act exchange plans in 15 states, and the insurer said it may expand into new areas.

At least one state regulator, in Oklahoma, said it already had been informed that Aetna planned to begin selling exchange plans there in 2017.

However, Aetna emphasized that its exchange footprint wouldn’t be finalized until September, when insurers sign binding agreements to offer plans.

Reference: Aetna Not Withdrawing From Any Health-Law Insurance-Exchange States - WSJ

Humana will continue to participate in Michigan if they are granted their requested rate increases.

This year, the nation’s fifth-largest insurer offers the cheapest bronze and silver plans in Michigan’s largest market, including Detroit. But Humana has filed for a 50% premium hike for its low-cost silver plan. Meanwhile, Humana wants a 38% premium increase for its lowest-cost bronze plan.

Reference: http://www.investors.com/politics/policy/humana-seeks-50-obamacare-premium-hike-in-michigan/

 

[MBSC]

Humana made it official today. They are leaving the off-exchange individual market and reducing their on-exchange presence.

The company has also notified relevant DOIs of its intent to discontinue certain on-exchange Individual products across a number of geographies for 2017 and exit substantially all Affordable Care Act (ACA) compliant off-exchange Individual markets. As a result, the company’s 2017 geographic presence for its Individual offerings is expected to cover no more than 156 counties across 11 states, down from 1,351 counties across 19 states in 2016. Humana expects 2017 premiums associated with ACA-compliant offerings in the range of $750 million to $1 billion versus approximately $3.4 billion projected for FY16. The rate review and approval processes with the related states are ongoing.

Source: Humana | Investor Relations | News Release

 

[audreyh1]

Wow - man! That's incredible really - pulling out of the off exchange individual markets completely!

And to drop from 1351 to 156 counties- they are really shutting down the on-exchange stuff too.

I don't think we'll have an HSA compatible plan anymore then.

 

[Dreaming of Freedom]

What happens if there are no ACA-compliant insurance plans (off or on the marketplace) left in your area? Do you still have to pay the penalty? Will there be any other health insurance plans available in the new void?

 

[GTFan]

Wow - man! That's incredible really - pulling out of the off exchange individual markets completely!

And to drop from 1351 to 156 counties- they are really shutting down the on-exchange stuff too.

I don't think we'll have an HSA compatible plan anymore then.

Very concerning when two of the biggest players in the biz (UHC and Humana) are now substantially exiting the market.

 

[MichaelB]

What happens if there are no ACA-compliant insurance plans (off or on the marketplace) left in your area? Do you still have to pay the penalty? Will there be any other health insurance plans available in the new void?

So far there are no regions that are completely uncovered. Alaska is probably the most difficult marketplace right now. The fragmented state based insurance market does not help this at all.

The Humana announcement is a disappointment. Strange that it coincides with the Dept of Justice announcement that it will sue to block it's acquisition by Aetna.

In Florida, while BCBS and Aetna raised their policy premiums by >75% (over 3 years) Humana raised theirs by less than 20%. This leaves only one insurer in Fl that offers nation-wide coverage, BCBS. The premium will be >50% more expensive, but we'll have no other choice. better than nothing. (I guess) Good thing DW hits her Medicare birthday this year.

 

[Bamaman]

Without major changes, the ACA is destined for complete failure.

Insurance companies are businesses and they are not designed to be money losing organizations. They have to pull out when the market will not accept huge price increases.

What gets me is that there are many medical people and even a few politicians that know exactly what it would take to make the system work. But they're not talking.

 

[GTFan]

Well single payer would work since we already have that with Medicare, and we'll probably get there someday if/when the ACA collapses. It's not like there are many realistic alternatives at this point given the expectations that people now have for guaranteed coverage.

Humana leaving GA would mean there is exactly one insurer (Harken) that covers the massive conglomerate of docs and hospitals in this area, WellStar. And Harken is basically just a UHC experiment that is also having to jack rates substantially in 2017.

 

[NW-Bound]

Our friend Nemo2 in the north says in another thread regarding his aneurysm that his problem is not about the payer, but the lack of providers.

Anyway, I recently received a letter from United Healthcare saying they are getting out of my state next year. Darn. I'll have to go shop again in a few months.

Soon, there will be no shopping. One does not have to pay anything, but also gets no healthcare. That settles that. One less worry, when one has no choice, no decision to make. Party on.

 

[travelover]

.............
Soon, there will be no shopping. One does not have to pay anything, but also gets no healthcare. That settles that. One less worry, when one has no choice, no decision to make. Party on.

Full circle. Before the ACA, if you had a pre-existing condition you might well find that no one wanted to insure you, but it kept rates lower for the well.

 

[MBSC]

Aetna released their quarterly earnings today and made the following announcement.

Aetna said Tuesday it is canceling plans to expand into more states next year and will reassess its involvement in the 15 states where it currently offers coverage on the individual exchanges. It expects to lose $300 million (pre-tax) on its Obamacare business this year.

"...in light of updated 2016 projections for our individual products and the significant structural challenges facing the public exchanges, we intend to withdraw all of our 2017 public exchange expansion plans, and are undertaking a complete evaluation of future participation in our current 15-state footprint," said CEO Mark Bertolini in a second-quarter earnings statement.

Source: Aetna latest insurer to question Obamacare's future - Aug. 2, 2016

 

[easysurfer]

What happens if there are no ACA-compliant insurance plans (off or on the marketplace) left in your area? Do you still have to pay the penalty? Will there be any other health insurance plans available in the new void?

Had the same thought. Since there is no public option, what happens if the private insurers all decide not cost effective and walk away?

 

[ExFlyBoy5]

Well single payer would work since we already have that with Medicare, and we'll probably get there someday if/when the ACA collapses. It's not like there are many realistic alternatives at this point given the expectations that people now have for guaranteed coverage.

Humana leaving GA would mean there is exactly one insurer (Harken) that covers the massive conglomerate of docs and hospitals in this area, WellStar. And Harken is basically just a UHC experiment that is also having to jack rates substantially in 2017.

I think this is whole point of ACA...it was destined to fail...and thus, single payer will kick in.

Since you are in Georgia, you are as aware as I am that almost everything around here is either owned by Wellstar or Northside. Almost all the local "small" docs and their practices have been swallowed whole by WS and NS. The only real exception is Emory...but as I understand, they *really* limit the insurance they accept.

 

[RockyMtn]

GF had Cigna year 1 and we had nothing but problems. Year 2 was Blue Cross/Blue Shield of Arizona. Now they are pulling out of AZ. Guess it is back to Cigna. Yikes!

 

[MichaelB]

Had the same thought. Since there is no public option, what happens if the private insurers all decide not cost effective and walk away?

When the ACA was still being legislated there was some discussion about opening the Federal Employee Health Benefit program to areas where there was inadequate private insurance.

The problem is, these insurers - BCBS, Aetna, Humana, UHC, etc - all continue to participate in all these states, but are limiting themselves to group, Medicaid and Medicare. The individual markets are too granular, segments are too small.