Whither we get health insurance for 2017?

[NW-Bound]

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.

 

[samclem]

Higher prices and less availability, a twofer.
Well, it looks probable that many areas will be getting that "single payer system" I kept hearing about. Or "Zero payer"?

 

[mamadogmamacat]

I am fortunate in that I have retiree medical through my former employer. Of course that could be dropped someday, but hopefully not until after I'm 65. In any event, what does this really mean, in practical terms? (sorry for the ignorance) If an insurer cannot sustain a business model in the ACA exchanges, are there not still off exchange policies available? And if so, is the problem one of affordability for the insured person (no subsidies)? or will the subsidies just be, effectively, still there in the form of a tax refund? My retiree medical is quite expensive, like a silver plan equivalent, but I am happy with it in that I have the same doctors as when i was employed.

 

[NW-Bound]

... what does this really mean, in practical terms? (sorry for the ignorance)

... are there not still off exchange policies available? And if so, is the problem one of affordability for the insured person (no subsidies)? or will the subsidies just be, effectively, still there in the form of a tax refund?...

I am still trying to figure this out. My current insurer, United Healthcare, is getting out of individual plans altogether, on or off the exchange. They will be doing group insurance only. I read somewhere they are doing this across all the US.

Aetna will be offering individual plans in just a few states. I think this is the same with other insurers such as Health Net and Blue Cross/Blue Shield.

If there is only one or two insurers, the choice may be limited in the doctors and hospitals being offered. Even if one wants to pay more in premium to get access to the better hospitals, he may not have that choice.

 

[gerntz]

The law is the law. It comes first.

 

[MichaelB]

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.

It's true, although a little more complex than as described in the BI article.

Here's the KFF brief that is appearing in local media across the country, as a basis for their own local reporting. Preliminary Data on Insurer Exits and Entrants in 2017 Affordable Care Act Marketplaces | The Henry J. Kaiser Family Foundation

It seems the better description of this issue of insurance coverage is: the rural population, both number of inhabitants and % of population, with only one insurer on the marketplace exchange is increasing sharply in 2017.

I am still trying to figure this out. My current insurer, United Healthcare, is getting out of individual plans altogether, on or off the exchange. They will be doing group insurance only. I read somewhere they are doing this across all the US.

Aetna will be offering individual plans in just a few states. I think this is the same with other insurers such as Health Net and Blue Cross/Blue Shield.

If there is only one or two insurers, the choice may be limited in what doctors and hospitals being offered. Even if one wants to pay more in premium to get access to the better hospitals, he may not have that choice.

You can't make that assumption. This analysts only focuses on policies available on the exchanges (with subsidy available). A second insurer in the market does not mean broader network coverage. Many insurers, especially Blue Cross, offer multiple network offerings. Even Kaiser is staying away from the broader conclusions, because we won't have specifics until October.

Still, this is a lousy situation for individuals in many locations across the country.

Edit to add: here's a short article from Vox on rural coverage that is more insightful than most Insurers are quitting Obamacare — and rural America will pay the price - Vox

 

[zinger1457]

From looking at the map it sure looks like most of the states with the least competition are also states that wouldn't mind seeing Obamacare crash and burn.

I will have only one carrier in ACA next year in my county in AZ and just read in the paper yesterday that Pinal County (south of Phoenix) will have no carriers in ACA.

 

[travelover]

From looking at the map it sure looks like most of the states with the least competition are also states that wouldn't mind seeing Obamacare crash and burn.

I will have only one carrier in ACA next year in my county in AZ and just read in the paper yesterday that Pinal County (south of Phoenix) will have no carriers in ACA.

This could be a good thing in the long run. It may force a better long term solution.


Sent from my iPad using Early Retirement Forum

 

[mamadogmamacat]

My PCP (an independent practice, not salaried with Kaiser, Wellstar, etc) actually sent out an e-mail listing what specific polices he is/will be accepting. Makes it a bit easier to choose among the limited options. Wish all my providers would do that. Wish you all who are affected the best of luck, and heath! Sure does not make me hopeful if I ever do get dumped by my retiree plan.

 

[mamadogmamacat]

meant health!...

 

[pb4uski]

I am still trying to figure this out. My current insurer, United Healthcare, is getting out of individual plans altogether, on or off the exchange. They will be doing group insurance only. I read somewhere they are doing this across all the US. ....

Before ACA, I was able to buy small group health insurance through my "business", an LLC that did no business other than provide employee health insurance to me and DW and paid dues to the local Chamber of Commerce, though which we got the health insurance. At the time, it was a bit cheaper than buying individual health insurance. When i formed the LLC I had intended to do some consulting here and there but found [-]goofing off[/-] retirement much more interesting.

I wonder if you formed a business and the business offered health insurance fully paid for by the employee whether you could access the small group market.

 

[NW-Bound]

...If there is only one or two insurers, the choice may be limited in the doctors and hospitals being offered. Even if one wants to pay more in premium to get access to the better hospitals, he may not have that choice.

... A second insurer in the market does not mean broader network coverage. Many insurers, especially Blue Cross, offer multiple network offerings. Even Kaiser is staying away from the broader conclusions, because we won't have specifics until October.

I recall that last year, I did not go for a plan with a less expensive insurer than United Healthcare because I wanted to get access to the better hospitals in my area. With competition and everything else being equal, you get more if you pay more.

Will see if I still have my choice of hospitals when I go looking for insurance for next year. No, I do not expect to be hospitalized anytime soon , but what is the point of buying insurance if you do not care what service you will get, if and when you get sick? I do not need any care right now, but I am not 30 anymore.

This could be a good thing in the long run. It may force a better long term solution.

In other words, it may get worse before it gets better. Hope this will happen before too long. I doubt that though.

Before ACA, I was able to buy small group health insurance through my "business", an LLC that did no business other than provide employee health insurance to me and DW and paid dues to the local Chamber of Commerce, though which we got the health insurance. At the time, it was a bit cheaper than buying individual health insurance. When i formed the LLC I had intended to do some consulting here and there but found [-]goofing off[/-] retirement much more interesting.

I wonder if you formed a business and the business offered health insurance fully paid for by the employee whether you could access the small group market.

I dunno. I am lazy now, and do not want to even go through the motion of pretending to have a business.

 

[MichaelB]

If you're not expecting premium assistance, there may still be some plans offered directly by the insurers.

 

[Mulligan]

If you're not expecting premium assistance, there may still be some plans offered directly by the insurers.

That is they way it is for me. My present carrier is dropping out of exchange, but it still providing off exchange insurance for us non subsidized payers. Still it will be interesting if not depressing what my rate increase will be.


Sent from my iPad using Tapatalk

 

[MichaelB]

That is they way it is for me. My present carrier is dropping out of exchange, but it still providing off exchange insurance for us non subsidized payers. Still it will be interesting if not depressing what my rate increase will be.


Sent from my iPad using Tapatalk

You might be able to see their rate increase request here https://ratereview.healthcare.gov

 

[Mulligan]

You might be able to see their rate increase request here https://ratereview.healthcare.gov

Thanks, Michael. It shows all, but some are being pulled since they decided to withdraw from exchange. I cant really determine where exactly my plan resides in their various requests. But overall most are not in the worst end. Appear to be in 10%-20% range.


Sent from my iPad using Tapatalk

 

[MichaelB]

Thanks, Michael. It shows all, but some are being pulled since they decided to withdraw from exchange. I cant really determine where exactly my plan resides in their various requests. But overall most are not in the worst end. Appear to be in 10%-20% range.

Same with me. We won't know until Oct if our insurer - Humana - will offer an off-exchange policy for our county. If they don't, the only option I'll have will the the BCBS, at about 2X the premium I'm currently paying.

 

[Mulligan]

Same with me. We won't know until Oct if our insurer - Humana - will offer an off-exchange policy for our county. If they don't, the only option I'll have will the the BCBS, at about 2X the premium I'm currently paying.

What kind of surprised me was the rate requests ask for the exchange
plans that they withdrew from. They were about 15%. It wasnt like they were asking for 50% to make up for massive losses, so some kind of corporate level decision was made to yank them, and based on rate request it may not have been on losses here anyways.


Sent from my iPad using Tapatalk

 

[NW-Bound]

Nice info! Thanks, Michael.

It shows Blue Cross/Blue Shield is asking for a rate increase of 74.41% in AZ! Holy moly.

My insurer, UHC, is indeed gone next year. Health Net and Humana are asking around 30%, but not sure that these are ACA plans.

By the way, it appears that some of the rate increase requests are for group insurance, so not all the info pertains to ACA plans.

 

[MichaelB]

The healthcare.gov link shows rate requests, not approvals. It's not always easy to align those entries with the specific policies in each state.

Good point, Mulligan, that some of those requests are not consistent with all the complaining by insurers about losing money. One insurer that has made money on individual policies and received lots of press about it, BCBS of Florida, has raised rates more than 30% each year since day 1. The policy I have cost about 10% less in 2014 (vs the BCBS BlueCard). Next year, if still available, it will be around half. Humana was not denied rate increases in Florida, it got the increases it requested.

One thing for sure, though, is that there isn't much discussion or media scrutiny about poor management or business strategy among the insurance companies.

 

[UtahSkier]

My plan has a rate request of 35%! What do I win?

Not much to discuss about poor management or business strategy. My plan states they have 137000 subscribers. Average 2016 premium is 231 pmpm and average paid claims are 324 pmpm.

Clearly an unsustainable business model. With little ability to reduce payment to providers, the plan must raise prices or cease business activities.

 

[hesperus]

We here in Colorado are going to be voting this november for a state single payer plan, similar to that done in Massachusetts. With the Affordable Care act in a death spiral (in my opinion), I do hope it passes, although there are conflicting studies as to how sustainable the program would be. Even though colorado has a progressive voting record, I think this one will be defeated, unfortunately.

 

[pb4uski]

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.

 

[NW-Bound]

My plan has a rate request of 35%! What do I win?

Not much to discuss about poor management or business strategy. My plan states they have 137000 subscribers. Average 2016 premium is 231 pmpm and average paid claims are 324 pmpm.

Clearly an unsustainable business model. With little ability to reduce payment to providers, the plan must raise prices or cease business activities.

That average premium of $231 per member per month seemed incredibly low, but then I forgot that the much higher rate that I am paying does not apply to families with younger kids. Older folks pay more, but they consume even more!

Yes, people still unknowingly blame insurers for the high premium, and while insurers are no saint, they are not the root cause of the problem. I saw recently that insurers make only 2.5% on the money they take in, and in California a state regulator recently said that ACA plans make 1.5% for insurers.

What businesses make 1.5% of gross? Only grocers have net profit margins that low.

 

[UtahSkier]

I think my plan makes 9.9%. The problem here is basic supply and demand. The demand to stay healthy and alive simply overwhelms the supply. The suppliers simply name their price and its a "take it or leave it" situation. The EpiPen is a recent example.

There is no ability to control pricing by suppliers.