Wellmark Iowa withdrawing from ACA market

[athena53]

I'm in MO, near KC and every year I've had to switch carriers. Retired in 2014, switched for 2015 when my carrier offered only a crappier, more expensive version, same for 2016 and 2017. Current one, Humana, just announced they're dropping out of the Exchange for 2018. Thank heaven I turn 65 early next year.

I agree with earlier posts on group vs. exchange coverage. Group policies cover at least a primary insured (the employee) healthy enough to come to work most days, probably covered by insurance most of their lives. Many of the newly- insured through ACA are used to ignoring symptoms till they have to go to the ER and aren't used to preventative testing and healthy eating/living. On average, a different population.

[samclem]

Quote:

Originally Posted by explanade Maybe the only way insurers would be interested in the individual market would be if the group market isn't so profitable for them. It may take removing the tax advantages for employer-provided health care in order for the individual markets, especially in more sparsely-populated regions, to have a chance.

Maybe just require that any company selling group policies in a state must also offer individual/exchange policies
Rates on the exchange must, say, be the same for a 45 YO as their average group rate for all policies sold, they could vary per age and tobacco use per the existing Marketplace rules.
In times past this might have been seen as unconstitutional, an infringement on freedom of association (what biz is it of the govt to get between two parties engaged in sale of a legal product?) and an intrusion of the federal govt into state issues. But, we seem to be beyond all those nitpicking concerns in our present national "dialogue."

[MRG]

Quote:

Originally Posted by athena53 I'm in MO, near KC and every year I've had to switch carriers. Retired in 2014, switched for 2015 when my carrier offered only a crappier, more expensive version, same for 2016 and 2017. Current one, Humana, just announced they're dropping out of the Exchange for 2018. Thank heaven I turn 65 early next year. I agree with earlier posts on group vs. exchange coverage. Group policies cover at least a primary insured (the employee) healthy enough to come to work most days, probably covered by insurance most of their lives. Many of the newly- insured through ACA are used to ignoring symptoms till they have to go to the ER and aren't used to preventative testing and healthy eating/living. On average, a different population.

I just had dinner with a guy from KC that I'd worked around most of my career. He and I retired a year apart and shared many notes. Some about healthcare.

He said last year he couldn't figure out how to make his situation work under ACA and went to the group market. He and his wife are a group of two(potentially an adult child too) under her existing business tax id number.

She's a independent person with a small business, has a tax id but no LLC etc, I guess he's a consultant(or spouse?). He said it was simple, easy, and on the up and up.

[GTFan]

Quote:

Originally Posted by explanade It may take removing the tax advantages for employer-provided health care in order for the individual markets, especially in more sparsely-populated regions, to have a chance.

Well yeah, lots of us have said that here over the years. Probably one of the biggest obstacles to getting the individual markets fixed.

[MichaelB]

Quote:

Originally Posted by samclem Maybe just require that any company selling group policies in a state must also offer individual/exchange policies

+1

And / or, require an company selling publicly funded insurance (Medicare, Medicaid, CHIP) to offer individual policies.

[MBSC]

Anthem Blue Cross will leave parts of California in 2018.

Quote:

Monthly premiums for California health insurance plans sold under the Affordable Care Act will rise by an average of 12.5% next year. About 10% of people enrolled through Covered California will also have to look for a new plan, as Anthem Blue Cross plans to end its coverage in most of the state. State officials said Tuesday that Anthem will continue providing coverage only in Santa Clara County and parts of Northern California and the Central Valley. The average rate increases vary by region. An average 7% increase in San Francisco County compares with 13% in Los Angeles and 10% in Orange County. Source: Covered California premiums will rise 12.5%, and Anthem Blue Cross cuts coverage - LA Times

[explanade]

Yup, I got the email from Anthem Blue Cross a couple of hours ago. I'm covered under one of their exchange plan.

I'm also in one of the counties that they will remain in.

It's odd, premiums in Northern CA are higher than those in Southern CA, because there are more providers or bigger provider networks in Southern CA.

That's a lot of customers they're giving up down there.

[Scuba]

Thank goodness we have a pre-ACA plan with Anthem Blue Cross in So CA. We received a letter telling us their decision to pull out of ACA plans in our area does not affect us, at least for 2018. Interestingly, about 2 months ago we got a letter from Anthem advising us that the state of CA had determined their rates for our plan to be unreasonable, and that if we wished we could cancel and go to a Covered CA plan instead. So glad we didn't do that! None of our docs accept Covered CA plans anyway.

[GTFan]

BCBS said yesterday that they are pulling out of the Atlanta market for 2018, citing continued regulatory uncertainty. But in return the AJC said that Ambetter will be entering the metro counties left by BCBS, which will again leave us with two insurers (Kaiser is the other and they're staying).

BCBS is only staying in the rest of GA (as the sole provider) after lots of arm-twisting by the state, apparently.

I hope that Ambetter picks up our Wellstar network of local doctors and hospitals, otherwise we may end up with Kaiser next year.
However, user reviews of Ambetter are horrible. They're running the low-end Peach State health plan here now.

https://bestcompany.com/health-insur...pany/ambetter/

[Sojourner]

Quote:

Originally Posted by GTFan BCBS said yesterday that they are pulling out of the Atlanta market for 2018, citing continued regulatory uncertainty. But in return the AJC said that Ambetter will be entering the metro counties left by BCBS, which will again leave us with two insurers (Kaiser is the other and they're staying). BCBS is only staying in the rest of GA (as the sole provider) after lots of arm-twisting by the state, apparently. I hope that Ambetter picks up our Wellstar network of local doctors and hospitals, otherwise we may end up with Kaiser next year. However, user reviews of Ambetter are horrible. They're running the low-end Peach State health plan here now. https://bestcompany.com/health-insur...pany/ambetter/

Wow... what a disaster. I'm on BCBSGA right now, so I guess I'm one of the lucky ones who'll get to switch to Kaiser or Ambetter next year.

I'd have no problem with Kaiser except my PCP -- who I really like and have been going to for years -- isn't in their network. And I'm betting he won't be in Ambetter's network either, judging by the absolutely scathing user reviews of this company. Oh well, it is what it is. I guess healthcare costs were always one of the biggest red flags for the RE crowd, so it was unreasonable for me to assume I wouldn't be affected by this at some point.

[ExFlyBoy5]

Quote:

Originally Posted by GTFan BCBS said yesterday that they are pulling out of the Atlanta market for 2018, citing continued regulatory uncertainty. But in return the AJC said that Ambetter will be entering the metro counties left by BCBS, which will again leave us with two insurers (Kaiser is the other and they're staying). BCBS is only staying in the rest of GA (as the sole provider) after lots of arm-twisting by the state, apparently. I hope that Ambetter picks up our Wellstar network of local doctors and hospitals, otherwise we may end up with Kaiser next year. However, user reviews of Ambetter are horrible. They're running the low-end Peach State health plan here now. https://bestcompany.com/health-insur...pany/ambetter/

I took a look at the link you provided and wow...a ZERO point 6 rating from users? That is awfully bad. I guess the summary tells it all, "Ambetter is somewhat of a last resort, in many ways."

[explanade]

Quote:

Originally Posted by GTFan BCBS is only staying in the rest of GA (as the sole provider) after lots of arm-twisting by the state, apparently.

Heard that there's intra-state politics, with some people in southern GA happy to see Atlanta fare worse.

[rodi]

I heard on the news this morning that San Diego county premiums for exchange plans will go up 13% on average. Kaiser is the biggest insurer in the county and is only going up 6-11%, but Molina - the 2nd biggest is going up a lot more.

I expect my insurance to go up more than 11%... because I'm of an age (55) where every year comes with a hefty age-related increase. Kids will probably stay about the same.

[rodi]

Quote:

Originally Posted by rodi I heard on the news this morning that San Diego county premiums for exchange plans will go up 13% on average. Kaiser is the biggest insurer in the county and is only going up 6-11%, but Molina - the 2nd biggest is going up a lot more. I expect my insurance to go up more than 11%... because I'm of an age (55) where every year comes with a hefty age-related increase. Kids will probably stay about the same.

I mispoke. San Diego is going up 11.5% (a percent less than the statewide average.) Molina (2nd biggest insurer in the county) is going up 18-31%. Kaiser Permanente is going up between 6 and 10%. Glad I'm on Kaiser.

And Anthem BC/BS is leaving the county. That effects 4300 San Diego county residents.

Cost Of Covered California In 2018 Will Depend On Insurance Plan | KPBS

[explanade]

Really hard to figure out how they decide to leave a certain county over others.

It's populous and affluent so why leave? Maybe the average age of the people who were enrolled were too high?

[rodi]

Quote:

Originally Posted by explanade Really hard to figure out how they decide to leave a certain county over others. It's populous and affluent so why leave? Maybe the average age of the people who were enrolled were too high?

I know that, in general, insurance is much more expensive in Northern CA than in Southern CA. This is true of employer plans as well as exchange plans. I remember being shocked that the same Kaiser Permanente plan (same deductibles, same employer) was almost double for the employee contribution for the NorCal employees compared to SoCal employees. I assume that if Anthem can charge more in NorCal - they are more likely to be profitable. I'm not sure how the insurance premiums actually correlate to the healthcare costs... I'm pretty sure some of it is market driven.

[explanade]

I don't know about San Diego but I know the LA area has more providers. That's why premiums were lower there.

I would think that with the Medical Loss Ratio, I don't think Anthem would be able to arbitrage a higher premium area into more profits, since they have to spend the same percentage of the premiums for claims.

[MichaelB]

Quote:

Originally Posted by explanade Really hard to figure out how they decide to leave a certain county over others. It's populous and affluent so why leave? Maybe the average age of the people who were enrolled were too high?

Quote:

Originally Posted by rodi I'm not sure how the insurance premiums actually correlate to the healthcare costs... I'm pretty sure some of it is market driven.

Not much evidence to support that view, especially with regard to hospital pricing. My guess is insurers choose some counties and leave others because they can. The individual insurance market is heavily over-segmented, and this allows insurers to identify small pockets of very high cost individuals and just skip those locations completely.

[GTFan]

Quote:

Originally Posted by Sojourner I'd have no problem with Kaiser except my PCP -- who I really like and have been going to for years -- isn't in their network. And I'm betting he won't be in Ambetter's network either, judging by the absolutely scathing user reviews of this company. Oh well, it is what it is. I guess healthcare costs were always one of the biggest red flags for the RE crowd, so it was unreasonable for me to assume I wouldn't be affected by this at some point.

Yeah that's the real issue for the wife and I, having to switch all of our docs when going to Kaiser. I've heard good things about them here and am willing to make the switch myself but the wife is having a lot harder time coming to grips with that.

We'll have to wait and see this November I guess.

[MBSC]

Anthem Blue Cross Blue Shield will not offer exchange plans in Virginia next year. They will sell off-exchange plans only in Scott and Washington counties, and the city of Bristol, VA. Grandfathered plans are not impacted.

Reference: Anthem pulls out from healthcare exchange in Virginia in 2018 - NBC12 - WWBT - Richmond, VA News On Your Side