Whither we get health insurance for 2017?

[NW-Bound]

... The demand to stay [-]healthy and[/-] alive simply overwhelms the supply.

Fix it for you.

I forgot something. That is, the profit margin of health insurers may vary quite a bit between ACA plans and their other operations involving Medicare and Medicaid. I have seen reports saying they are making better money outside of ACA. If your business is making more money in one area than the other, would you not drop the money losing side to work more on the juicy side?

Makes me wonder how better they would do if Uncle Sam takes over everything. I should be buying their stocks. If you cannot beat them, then join them.

Oh wait! Who wants the insurers? I want to invest in the healthcare providers. That's where the bulk of money is flowing.

Oh wait again. Aren't most hospitals "non-profit" organizations? They manage to spend all the money, so there's no profit left. And they even have the gall to run charity drive.

Son of a gun! How can I join in the loot?

 

[nun]

As I understand it, Massachusetts is NOT currently single payer.

Vermont studied single payer really hard and despite a Democratic governor, the governor decided it was not economically sustainable and killed it.

Nope, no single payer in MA, but there was a lot of complaining when ObamaCare came in because it messed up the program already in place.

I'm very grateful that being an MA state early retiree I get a non-Medicare plan with a $300 deductible and $4k out of pocket max for $100/month. That should be the norm, then most people could afford the premium and not be afraid to go to the doctor because of large deductibles. Whether it's paid for by Government single payer or private health insurance, the basic problem in the US is that health care costs are simply too high.

 

[NW-Bound]

So, how is MA's program financed? How do they maintain the healthcare cost low enough to have a plan "with a $300 deductible and $4k out of pocket max for $100/month". I would love to get on one like that.

Pre-ACA for me, it was $10K deductible, which is also the max out-of-pocket, for the 2 of us, with a premium of $600+/month. This was in 2014. Of course, it did not cover existing conditions. My ACA plan is more expensive, but then it has to cover more due to the law.

 

[nun]

So, how is MA's program financed? How do they maintain the healthcare cost low enough to have a plan "with a $300 deductible and $4k out of pocket max for $100/month". I would love to get on one like that. I/quote]

The MA plan for state workers is just a very good employee/retiree plan and it's largely financed through taxation......although I worked for the Medical School and that pays for itself as it has a couple of profitable pharma spin offs. Still the state pays 80% of the premium and is big enough to negotiate good deals. If you have ACA coverage you get similar insurance as in other states with the high deductibles etc.......although MA does limit rate increases to inflation.

Pre-ACA for me, it was $10K deductible, which is also the max out-of-pocket, for the 2 of us, with a premium of $600+/month. This was in 2014. Of course, it did not cover existing conditions. My ACA plan is more expensive, but then it has to cover more due to the law.

Before I qualified for state retiree health insurance by reaching age 55 I had to pay the full premium...the state allows former employees to buy insurance at the fill premium for as long as they want....sort of COBRA without the time limit. So I was paying $500/month for the low deductible plan. I applied for ACA two years ago as I thought it might be less expensive, but was refused as my income was too low and was put on the MA Medicare plan. The thing is, there is that the state has a program to give subsidies to the poor if they have access to employer health insurance to keep them off Medicare.....the bottomline was that the state paid $450 of my $500 health insurance.....which was provided by the state in the first place. Now that I'm officially retired my premium actually went up by $50/month.

 

[karen1972]

One strange observation is that in NC, the 'group' plans only increased around 4% but the individual plans increased 15-20%. Which 15% isn't the end of the world but it does make one curious why the group plans didn't go up at the same rate.

I'm curious that NC now shows only 1 insurer as there were applications at least for a number of small insurers in addition to the big known ones...so did the small ones pull out too? we shall have to wait and see.

 

[MBSC]

One strange observation is that in NC, the 'group' plans only increased around 4% but the individual plans increased 15-20%. Which 15% isn't the end of the world but it does make one curious why the group plans didn't go up at the same rate.

I'm curious that NC now shows only 1 insurer as there were applications at least for a number of small insurers in addition to the big known ones...so did the small ones pull out too? we shall have to wait and see.

Group plans have a more stable risk pool leading to more stable rate increases.

The map in the link below provides a more accurate picture of 2017 NC exchange plans, with BCBSNC in all counties and Cigna in a few. They still have time to withdraw. The NC "small insurer" applications are for group plans and off-exchange plans, not on-exchange individual plans.

See counties where few insurers are participating in Affordable Care Act echanges - WSJ.com

 

[NW-Bound]

Thanks for the above map. It has a lot more details and info than the one I posted in the OP.

Holy mackerel! My county is going from 8 insurers down to 2. And it's a large market with 126,000 insureds, not some bitty counties with a few hundred enrollees.

 

[nun]

Thanks for the above map. It has a lot more details and info than the one I posted in the OP.

Holy mackerel! My county is going from 8 insurers down to 2. And it's a large market with 126,000 insureds, not some bitty counties with a few hundred enrollees.

If insurers are pulling out of markets because they can't make money when most people seem to think that their product is very expensive and provides little value what does that say about the basic cost of health care.....it's simply too expensive for most people to afford.

It takes a lot for a healthcare cost bubble to burst as most people will spend money to stay alive and be healthy, but it's getting beyond that now and the crash will be nasty.

 

[MBSC]

Holy mackerel! My county is going from 8 insurers down to 2. And it's a large market with 126,000 insureds, not some bitty counties with a few hundred enrollees.

That sounds like Maricopa County, AZ. Phoenix Health Plans announced Thursday they are dropping out of the 2017 AZ exchange leaving Cigna as the only on-exchange option in that county.

Reference: https://www.thehertelreport.com/phoenix-health-plan-latest-to-quit-the-2017-him/

 

[NW-Bound]

OMG!

That article was on Sep 1st. I searched and even the local newspaper talked about it just yesterday, Sep 2nd. The short article concludes with this:

"Phoenix Health Plans decided its financial risk would be too great to be one of two remaining marketplace options in the nation's fourth most populous county."

What makes us so special? Too many sick people here?

Oh well, that makes my shopping for insurance very simple then. Eventually, it is going to be even simpler.

 

[pb4uski]

In Vermont we have only had two individual health insurers for many years, BCBS and MVP so I'm not sure if a reduced number of carriers is a death knell, especially with minimum loss ratio requirements. Recent rate increases have been relatively modest compared to many parts of the country.

 

[travelover]

In Vermont we have only had two individual health insurers for many years, BCBS and MVP so I'm not sure if a reduced number of carriers is a death knell, especially with minimum loss ratio requirements. Recent rate increases have been relatively modest compared to many parts of the country.

I'm not sure more insurers is a good thing. The insurer negotiates the rates from the medical providers and drug companies. The larger share of the market the insurer has, the more leverage it has to get a good rate. By law, the insurer must spend 80% of premiums on patient care, so they are seemingly limited in what they can charge in premiums.

 

[NW-Bound]

... The larger share of the market the insurer has, the more leverage it has to get a good rate. By law, the insurer must spend 80% of premiums on patient care, so they are seemingly limited in what they can charge in premiums.

Ah, that's a glimmer of hope.

I am a strong believer in the capitalist mantra that people are motivated by financial gain. If the insurer makes money by fighting for me, it is a lot better than to pray that they have a nice heart.

 

[samclem]

I'm not sure more insurers is a good thing. The insurer negotiates the rates from the medical providers and drug companies. The larger share of the market the insurer has, the more leverage it has to get a good rate. By law, the insurer must spend 80% of premiums on patient care, so they are seemingly limited in what they can charge in premiums.

Or, perhaps it is the other way around. With the exchange market to themselves, they can price policies as high as the regulator will allow (without losing market share to a competitor). And, because the regulators will be reluctant to drive out the very last insurer selling on the exchange, they are likely to be agreeable to requested rate increases. Yes, the insurer could theoretically use their power to negotiate lower rates from providers, but providers will still have the (vast) majority of patients who get their care from employer-sponsored, group, and Medicare plans, so the lone exchange insurance company still might have little ability to get lower rates. And, why should they even try? They will get 20%, the health care providers get 80%--their interests are best served if the while bill gets larger over time (even if driven by increasing payments to providers) because their 20% will get larger.
It's unlikely individual patients shopping for medical care will/can drive down prices for that care--the conditions for "price shopping" (time, availability of actionable information, etc) generally don't exist. But it would not be impractical for consumers, given sufficient information, to choose between a few insurers based on cost and quality, and the insurers (or insurer-provider entities) could do the nuts-and-bolts work of improving quality and reducing costs. But, the present system isn't designed to make that happen.

 

[MichaelB]

Ah, that's a glimmer of hope.

I am a strong believer in the capitalist mantra that people are motivated by financial gain. If the insurer makes money by fighting for me, it is a lot better than to pray that they have a nice heart.

I would say your most probable glimmer of hope is an off-exchange polic directly with the insurer. That, until you either reach Medicare age, or your state insurance regulator finds a way to improve coverage. Not so easy in a state with low population density.

 

[NW-Bound]

OK. From hope, back to despair.

I looked at United Healthcare, but they are really out of individual insurance market, on or off exchange.

Then, I looked at Aetna next. Their Web site asks "If you have existing conditions, mark off as many of the following afflictions as applicable". What the heck? I thought they cannot ask about preexisting conditions anymore, after ACA. Still, I proceeded up to the point they said "Fill in your address and phone number, so that we can contact you". I clicked off their Web page at that point.

Have not tried other insurers.

 

[EastWest Gal]

With insurers dropping out of individual health insurance market, and my corner of the wood not being exempted, some of us will not have much of a choice next year, if any!

I just saw this following map showing that 6 entire states are down to one or fewer insurers for 2017. Fewer? Like in zero?

Holy moly, this can't be right! What are we going to do?

The map below comes from this Web site: See this map of Obamacare's insurance-competition problem - Business Insider.

Somebody, please tell me that they have a mistake, and this is not true.

They need a public option in a hurry if there are no other options. Otherwise we all would be breaking the law and it wouldn't be our fault.


Sent from my iPhone using Early Retirement Forum

 

[NW-Bound]

Breaking the law or not, all I want is to get healthcare if and when I need it (do not need any now). And the way the healthcare providers are gouging their patients, the only way to avoid ridiculous prices is to get protection from an insurance company.

It feels like paying the Mafia for protection, but that is the only option one has. Sad!

 

[MichaelB]

OK. From hope, back to despair.

I looked at United Healthcare, but they are really out of individual insurance market, on or off exchange.

Then, I looked at Aetna next. Their Web site asks "If you have existing conditions, mark off as many of the following afflictions as applicable". What the heck? I thought they cannot ask about preexisting conditions anymore, after ACA. Still, I proceeded up to the point they said "Fill in your address and phone number, so that we can contact you". I clicked off their Web page at that point.

Have not tried other insurers.

They cannot deny you insurance because of pre-existing conditions, or charge you more. You still will have to wail 'til Nov 1, when open enrollment begins, to know who will be selling policies for 2017.

 

[NW-Bound]

I am more mad than worried at this whole mess.

 

[NW-Bound]

They need a public option in a hurry if there are no other options. Otherwise we all would be breaking the law and it wouldn't be our fault.

Having seen enough ineptness and indifference of bureaucrats and politicians, I prefer a solution involving private enterprises, but somehow it's elusive.

 

[travelover]

..........Yes, the insurer could theoretically use their power to negotiate lower rates from providers, but providers will still have the (vast) majority of patients who get their care from employer-sponsored, group, and Medicare plans, so the lone exchange insurance company still might have little ability to get lower rates. And, why should they even try? They will get 20%, the health care providers get 80%--their interests are best served if the while bill gets larger over time (even if driven by increasing payments to providers) because their 20% will get larger.
.........

Really good points. I guess the key is to have some competition in a region, but not so much that it dilutes the insurance companies' ability to bargain.

 

[nun]

Having seen enough ineptness and indifference of bureaucrats and politicians, I prefer a solution involving private enterprises, but somehow it's elusive.

The solution is only elusive in the US. Other countries have come to a range of solutions involving single payer to regulated private insurance, but they have an advantage over the US because their costs are usually at least half for equal or better outcomes.

Healthcare is simply too expensive in the US.

 

[MBSC]

That sounds like Maricopa County, AZ. Phoenix Health Plans announced Thursday they are dropping out of the 2017 AZ exchange leaving Cigna as the only on-exchange option in that county.

Update: It appears Centene (Ambetter) will be the sole exchange carrier for Maricopa County, AZ (Phoenix) instead of Cigna.

Centene Corp. is seeking regulatory approval to sell ACA marketplace health insurance in Maricopa and Pima counties next year. Centene said it wants to sell health-maintenance organization plans under the "Ambetter" brand.

Cigna now says that it doesn't expect to offer its own marketplace insurance in Maricopa County.

With Centene's decision to offer marketplace insurance in Arizona next year, Cigna officials said the insurer no longer plans to sell individual plans next year. Instead, Cigna Medical Group will be a medical provider for consumers who purchase Centene's plans in Maricopa County, Cigna officials said.

Reference: New 'Obamacare' insurer comes to Maricopa County as another exits

 

[samclem]

When will the Mexican public healthcare provider, the Secretariate de Salud, apply to offer exchange plans to Arizona residents in underserved counties? The Mexican government would make money (based on prevailing US health insurance prices, copays, etc) and Arizonans would finally have a "public option." Yes, some creative methods would need to be employed to get patients to the existing providers (until Mexican clinics could be set up in Arizona), but that seems to be a minor problem when considering the long-term win-win aspect of this proposal. Logistics aside, the metric is "getting people covered," the actual provision of quality medical care is generally considered a separate issue.