Wellmark Iowa withdrawing from ACA market

GTFan said:
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-insurance/company/ambetter/
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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."
 
GTFan said:
BCBS is only staying in the rest of GA (as the sole provider) after lots of arm-twisting by the state, apparently.
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Heard that there's intra-state politics, with some people in southern GA happy to see Atlanta fare worse.
 
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 said:
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.
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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
 
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?
 
explanade said:
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?
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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.
 
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.
 
explanade said:
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?
Click to expand...

rodi said:
I'm not sure how the insurance premiums actually correlate to the healthcare costs... I'm pretty sure some of it is market driven.
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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.
 
Sojourner said:
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.
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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.
 
GTFan said:
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.
Click to expand...



This hasn't happened to us (yet) but if it does, we will ask our PCP about a "concierge" arrangement and/or cash payment. Not sure we'd do it but we've both been with him 20+ years and would really hate to give that history up.
 
Scuba said:
This hasn't happened to us (yet) but if it does, we will ask our PCP about a "concierge" arrangement and/or cash payment. Not sure we'd do it but we've both been with him 20+ years and would really hate to give that history up.
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I would consider that kind of arrangement with my PCP, too, but that doesn't solve the problem of having to purchase an ACA-compliant healthcare plan. Since I'm in good health and still fairly young (late 40s), it wouldn't make sense financially to pay for a concierge plan with my PCP and also pay for separate healthcare insurance.
 
I don't think I have ever seen a company get a 0.6 rating from it's customers and stay in business. they must be really bad.
 
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