ACA Federal Marketplace updates

[ERhoosier]

Shok-
Glad you have been able to find good docs over the years who (presumably) participate in your HI. Unfortunately, many (inc me) have found it harder to find a good doc than a good mechanic. IMHO- Increasing market competition will likely result in providers & facilities moving in & out of networks more frequently, so having updated and accessible info on network info will be more important than ever.

 

[ShokWaveRider]

Shok-
Glad you have been able to find good docs over the years who (presumably) participate in your HI. Unfortunately, many (inc me) have found it harder to find a good doc than a good mechanic. IMHO- Increasing market competition will likely result in providers & facilities moving in & out of networks more frequently, so having updated and accessible info on network info will be more important than ever.

We have been lucky, but also out circumstances could be taken into consideration. And by the way I have fired a few docs in my time too.

Although I have a pacemaker and am on Blood pressure meds, I still manage to only go to the doctor 4 - 5 times per year. 2 of those are routing pacer checks the others may be to tweak my BP meds.

I guess if you go a lot you may want to see the same person. I still think for the most part it is the Blue pill vs Pink pill syndrome.

We all have our reasons. But we are so used to changing it does not bother me at all.

 

[ziggy29]

Shok-
Glad you have been able to find good docs over the years who (presumably) participate in your HI. Unfortunately, many (inc me) have found it harder to find a good doc than a good mechanic. IMHO- Increasing market competition will likely result in providers & facilities moving in & out of networks more frequently, so having updated and accessible info on network info will be more important than ever.

Indeed, I have had to drill it into DW's head to confirm a provider is "in network" before making an appointment. It's a bit of a hassle, as if finding a good doctor wasn't sometimes hard enough already...

 

[teejayevans]

Obamacare scores breakthrough on exchanges - Yahoo! Finance

Why it took them so long...I have way more confidence in ehealthinsurance.com than I do the Fed. of handling the customer end....
TJ

 

[ziggy29]

Obamacare scores breakthrough on exchanges - Yahoo! Finance

Why it took them so long...I have way more confidence in ehealthinsurance.com than I do the Fed. of handling the customer end....
TJ

They certainly have the experience and the framework to handle something like this, provided they can scale it up well with a lot more users starting on October 1. They can probably do it cheaper and more efficiently than creating a new bureaucracy to build and manage it.

I do think it needs to be reviewed periodically to make sure they are adequately serving the health insurance consumer and that their cut of the take remains reasonable and competitive.

 

[MichaelB]

Interesting. I wonder how this will affect the underwritten policies they sell. This might make it a bit more difficult for insurers to refuse to participate in the exchanges.

This will allow us to make direct comparisons of the user interface, information presentation, buying process, etc, for the same policy in the same state. That will be fun.

 

[samclem]

They [eHealth.com] certainly have the experience and the framework to handle something like this, provided they can scale it up well with a lot more users starting on October 1. They can probably do it cheaper and more efficiently than creating a new bureaucracy to build and manage it.

I do think it needs to be reviewed periodically to make sure they are adequately serving the health insurance consumer and that their cut of the take remains reasonable and competitive.

From the article:

The deal could also earn eHealth a lot of money. The online insurance giant gets an average premium of about 7 percent for the plans it offers on its website, in the form of commissions paid by the insurance providers who sell the plans.

There's no indication in the article of what is in this deal, but if insurers are required to spend 80% of premiums to pay medical expenses, and if they give 1/3rd of the remainder to eHealth in commissions, that leaves a pretty thin slice for the insurance companies to use in dealing with claims, dealing with providers, maybe giving a dividend to shareholders, etc. Perhaps the government is paying eHealth.com directly with the hundreds of millions of dollars HHS was given to perform this function.

 

[ziggy29]

From the article:
There's no indication in the article of what is in this deal, but if insurers are required to spend 80% of premiums to pay medical expenses, and if they give 1/3rd of the remainder to eHealth in commissions, that leaves a pretty thin slice for the insurance companies to use in dealing with claims, dealing with providers, maybe giving a dividend to shareholders, etc. Perhaps the government is paying eHealth.com directly with the hundreds of millions of dollars HHS was given to perform this function.

I could be wrong but I thought the usual arrangement for sites like this was a percentage of the premiums in the *first year*. In other words, a policy that has a total cost of $10K per year would net them $700 -- but only in the first year. If so and if people don't "plan hop" that often, it might not be a huge chunk in the grand scheme of things.

 

[Mulligan]

I could be wrong but I thought the usual arrangement for sites like this was a percentage of the premiums in the *first year*. In other words, a policy that has a total cost of $10K per year would net them $700 -- but only in the first year. If so and if people don't "plan hop" that often, it might not be a huge chunk in the grand scheme of things.

That was the first thought that hit my mind when I read the link...Great, another 7% slapped on top of my already soon to be bigger premium. It won't be an additional tax, it will be a "consumer convenience service charge" On a serious note, it did also make a reference to savings, so maybe it is one of those situations where on the technological end of things it costs some money, to save more money.

 

[MichaelB]

My recollection is the insurers will pay a 2% fee to the exchanges. If so, any additional charge by e-health would make the policy cost more. It seems unlikely this agreement will result in a higher price for the same policy.

 

[ziggy29]

My recollection is the insurers will pay a 2% fee to the exchanges. If so, any additional charge by e-health would make the policy cost more. It seems unlikely this agreement will result in a higher price for the same policy.

And even if it *were* 7% (which I don't they'd get in a larger and more captive audience), it is probably only for the first year. Or else they get it on an ongoing basis but only as long as the policy is in force (meaning they wouldn't profit more from plan-hopping).

It may be a model like the cruise lines and tour operators have with travel agents (and what airlines and hotels *used* to have). The price is the same whether you use them or not, but if you use a marketer like a travel agent (or perhaps this site), a percentage of the first-year premium is eaten in commission.

The airlines and hotels no longer use this model, but cruise lines (mostly) still do.

 

[Htown Harry]

I do think it needs to be reviewed periodically to make sure they are adequately serving the health insurance consumer and that their cut of the take remains reasonable and competitive.

I certainly agree.

One question I have relates to this quote from the CEO.
EHealth Wins Approval to Sell Obamacare Health Plans - Bloomberg

EHealth collects about 7 percent of monthly premiums as commission for the plans it sells now, Lauer said. Carriers will probably negotiate a lower commission for plans sold in government exchanges because “the risk is a little bit more unknown,” he said.

Under the agreement with the government, EHealth must offer customers any plan available on the federal exchanges, regardless of whether it has a commission agreement with the carrier.

“I’m happy to enroll someone if we don’t get a commission for it,” Lauer said.

So, why would an insurer pay ehealth_.com a commission? Or, said another way, what will the commission-paying insurer get for his money?

I worry that the expected the easy-to-navigate comparison features, cost comparison tables and handy links to individual plan details will only be data from the "preferred" providers paying the commissions.

EDGAR posted the agreement between HHS and ehealthinsurance.com.
EDGAR Pro
It's very high-level, and doesn't say much about data presentation requirements.

The agreement does reference CFR requirements for brokers, so I dug a little more.

These are the basic requirements. I feel a little better, since the highlighted language requires that data from all exchange-approved plans be available.

Perhaps I'm being too skeptical, but I'd feel even better if there was something in the contract or the regs explicitly requiring the data for all the plans to be consistently presented.

45 CFR 155 : EXCHANGE ESTABLISHMENT STANDARDS AND OTHER RELATED STANDARDS UNDER THE AFFORDABLE CARE ACT [ 45 CFR 155 ] : (PUBLIC WELFARE [ 45 CFR ])

§ 155.220 Ability of States to permit agents and brokers to assist qualified individuals, qualified employers, or qualified employees enrolling in QHPs...

(c) Enrollment through the Exchange. A qualified individual may be enrolled in a QHP through the Exchange with the assistance of an agent or broker if—
(1) The agent or broker ensures the applicant's completion of an eligibility verification and enrollment application through the Exchange Web site as described in §155.405;
(2) The Exchange transmits enrollment information to the QHP issuer as provided in §155.400(a) to allow the issuer to effectuate enrollment of qualified individuals in the QHP.
(3) When an Internet Web site of the agent or broker is used to complete the QHP selection, at a minimum the Internet Web site must:
(i) Meet all standards for disclosure and display of QHP information contained in §155.205(b)(1) and (c);
(ii) Provide consumers the ability to view all QHPs offered through the Exchange;
(iii) Not provide financial incentives, such as rebates or giveaways;
(iv) Display all QHP data provided by the Exchange;
(v) Maintain audit trails and records in an electronic format for a minimum of ten years; and
(vi) Provide consumers with the ability to withdraw from the process and use the Exchange Web site described in §155.205(b) instead at any time.

§ 155.205 Consumer assistance tools and programs of an Exchange.

(b) Internet Web site. The Exchange must maintain an up-to-date Internet Web site that meets the requirements outlined in paragraph (c) of this section and:
(1) Provides standardized comparative information on each available QHP, including at a minimum:
(i) Premium and cost-sharing information;
(ii) The summary of benefits and coverage established under section 2715 of the PHS Act;
(iii) Identification of whether the QHP is a bronze, silver, gold, or platinum level plan as defined by section 1302(d) of the Affordable Care Act, or a catastrophic plan as defined by section 1302(e) of the Affordable Care Act;
(iv) The results of the enrollee satisfaction survey, as described in section 1311(c)(4) of the Affordable Care Act;
(v) Quality ratings assigned in accordance with section 1311(c)(3) of the Affordable Care Act;
(vi) Medical loss ratio information as reported to HHS in accordance with 45 CFR part 158;
(vii) Transparency of coverage measures reported to the Exchange during certification in accordance with §155.1040; and
(viii) The provider directory made available to the Exchange in accordance with §156.230.

c) Accessibility. Information must be provided to applicants and enrollees in plain language and in a manner that is accessible and timely to—
(1) Individuals living with disabilities...

(2) Individuals who are limited English proficient...

 

[bUU]

So, why would an insurer pay ehealth_.com a commission? Or, said another way, what will the commission-paying insurer get for his money?

Exposure to consumers who can be directed to the website through commercial advertising through means that perhaps the exchanges aren't going to stoop to.

 

[Htown Harry]

Exposure to consumers who can be directed to the website through commercial advertising through means that perhaps the exchanges aren't going to stoop to.

Or that the federal exchanges can't afford to run...

The business side of the fall sign-up scramble will be fascinating. In the big picture of this massive change, the objective is to increase the aggregate number of individuals signing up with health insurers. From an individual company's perspective, however, the objective is to sign up a pool of new customers with a profitable risk profile relative to the premiums charged. Healthy customers is what they want.

One marketing scenario that meets the insurer's objectives and might have a payoff worth paying the commission is that ehealthinsurance would pledge to skew their marketing to the "young invicibles" and other groups less likely to bring high claims rates. There is already an inherent tendency in that direction, given young people's greater comfort and experience in online purchasing.

 

[ziggy29]

One marketing scenario that meets the insurer's objectives and might have a payoff worth paying the commission is that ehealthinsurance would pledge to skew their marketing to the "young invicibles" and other groups less likely to bring high claims rates. There is already an inherent tendency in that direction, given young people's greater comfort and experience in online purchasing.

So the strategy would be to sign up at places marketing to these "young invincibles" and not the ones advertising in AARP Magazine?

 

[Mulligan]

So the strategy would be to sign up at places marketing to these "young invincibles" and not the ones advertising in AARP Magazine?

I guess we need to wish them luck in snagging the young ones. If they don't buy into the concept of paying more to subsidize us older ones, we may be in for some additional "rate shock" a year from now.

 

[Brat]

Education loans are not dischargeable in bankruptcy, why not the same approach for health care expenses for those who do not buy health insurance? That should inspire the young invincibles!

 

[teejayevans]

Education loans are not dischargeable in bankruptcy, why not the same approach for health care expenses for those who do not buy health insurance? That should inspire the young invincibles!

I think that's because people found a loophole, just after graduating they would file for bankruptcy (obviously they didn't have any $ and maybe no job yet).
A better way is to refuse treatment unless you have HI or $ up front ...but I'm pretty sure that wouldn't fly.
TJ

 

[Mulligan]

I think that's because people found a loophole, just after graduating they would file for bankruptcy (obviously they didn't have any $ and maybe no job yet).
A better way is to refuse treatment unless you have HI or $ up front ...but I'm pretty sure that wouldn't fly.
TJ

Teejay, you are such a heartless person! You cant just not give a person treatment....Me being of kinder heart would treat them, then extoll some physical punishment on them and warn them to expect the intensity to be greater the next time you come in without insurance. During my formative years, pain seemed to be the best motivator for me to conform to the rules.

 

[samclem]

During my formative years, pain seemed to be the best motivator for me to conform to the rules.

Or, loss of freedom would hit pretty hard. We've got this sequester going on, surely the federal government has some work that needs to be done. All the person would owe would be the payback hours for the cost of their treatment. Compute it at the hourly wage rate of the median taxpayer (since that would be roughly the number of hours his fellow taxpayers had to work to pay for his treatment. Fair. ). That MRI after the fight in the bar? Could be a lot of hours in the sun picking up trash in a national park.
On a more serious note--I do think there are appropriate carrots and sticks available to encourage people to have insurance, even without direct government fines. Having no medical insurance should definitely be a factor in computing a credit rating (that should get the attention of some "invincibles", since credit scores affect everything from loan rates to the cost of other types of insurance). And potential employers should have access to this information (is a person reliable and responsible if they won't even get subsidized health insurance? Will they be as healthy on the job if they aren't able to get affordable treatment?).
The taxpayers of this nation are paying a lot of money to assist people with getting insurance. The folks who already were covered and liked their coverage are in many cases sacrificing, too--losing that coverage for coverage that they may find to be an inferior value. Given all this, it's not unreasonable to ask the uninsured to take responsibility for themselves, and for the failure to do so to have real consequences.

 

[Htown Harry]

So the strategy would be to sign up at places marketing to these "young invincibles" and not the ones advertising in AARP Magazine?

That's my theory, anyway.

If the insurance companies have a say, look for the tables at the mall to be set up in front of REI or the Gap, not Lane Bryant or the Rockport store.

 

[Brat]

Or near a NIKE Factory Store.

 

[MichaelB]

Lots of members are finding these health care threads useful, so lets keep this thread focused on PPACA updates and news.

 

[Htown Harry]

The office of the Assistant Secretary for Planning and Evaluation (ASPE) at Health and Human Services prepared the projections that the Congressional Budget Office has used in scoring the benefits and costs for the ACA.

They have recently published a report that evaluated the state exchange premiums that have been published so far. (We've had individual threads or sub-threads that have discussed each as they were released.)

It's the first account I've seen that puts all of the published-to-date metal plan premiums side-by-side.

As one might expect, HHS sees a sunny forecast ahead for the remaining states and the federal exchanges. We'll see.

report:
http://aspe.hhs.gov/health/reports/2013/MarketCompetitionPremiums/rb_premiums.pdf
web page:
ASPE

A goal of the Affordable Care Act is to increase competition and transparency in the markets for individual and small group insurance, leading to higher quality, more affordable products. Information on proposed premiums in the individual and small group markets has recently been made available by selected states, and it is now possible to move from theoretical arguments to data-driven analysis. This research brief analyzes proposed rates in the individual market for 2014 in the eleven states that have made information available, and compares these rates to those estimated by the Congressional Budget Office. Further, for six states, we compare the rates that will be charged to small employers with the average amount that small employers would have been expected to pay in 2014 for comparable coverage and a comparable population. Overall, silver premiums in the 2014 individual and small group markets are nearly 20% lower than expected....

...Although there are many hypotheses that might account for the finding that actual premiums appear to be substantially below ASPE-derived CBO estimates, a likely explanation is that greater competition and greater transparency are driving down prices in the Marketplace.

Figure 2: Comparison of ASPE-Derived CBO 2014 Premium Estimate to Individual Market Second Lowest Cost Issuer’s Silver Premium, Weighted by Expected 2014 Individual Market Age Distribution

Note: Ohio and Virginia have not yet posted premiums for all issuers; the numbers presented here may be higher than the lowest cost 2014 silver premiums when all filings are posted.
Sources: Congressional Budget Office estimate derived as described in footnote 19. State data from publicly available sources, weighted by RAND COMPARE estimate of enrollment by age in the individual market in 2014. US average constructed by weighting each state according to its proportion of individual market enrollees per the 2011 Medical Loss Ratio filings.

 

[MichaelB]

Looks like e-Health will have some competition. Kaiser health news reports Univision Obamacare Deal Could Put WellPoint, Blues Ahead Of Competitors - Kaiser Health News

WellPoint and other Blues insurers in six states including Florida have signed deals with Univision for undisclosed sums to be the exclusive health insurance sponsor of the network’s Peabody-award winning health initiative, "Salud Es Vida," which means Health Is Life.

The deals include a special plan-sponsored Univision website that will be able to connect Latinos with coverage on the online markets, or exchanges, that will serve individuals beginning in October.

This is sure to increase the reach of the program, especially younger people.

Wonkier types and insomniacs will find the rules in this Federal Register http://www.gpo.gov/fdsys/pkg/FR-2013-06-19/pdf/2013-14540.pdf