United Health may stop offering ACA Exchange plans

[travelover]

............As far as reigning in cost's , healthcare is one of those areas that hit a brick wall years ago. Most medical supplies, equipment , etc are already from the lowest cost producers around the world., and the working conditions for many medical occupations are just nuts . Not much left to automate or offshore, so you are seeing the real rate of inflation. If some medical sector is getting rich, I'd like to know , my pharma stocks make money, but not out of line with other large cap co's.

If other countries were not doing it, I might agree with you. Coming from an industry that lived in denial for decades, I see the medical care industry just dripping with low hanging fruit to reduce costs. But currently they are putting their money on inertia, politics and an army of lobbyists to maintain the status quo.

 

[MBSC]

Aetna and Anthem already accounted for the exchange business in their earnings forecasts.

Aetna and Anthem sought to reassure investors that their Obamacare businesses had not worsened after UnitedHealth Group warned of mounting losses in that sector. Aetna and Anthem said their individual insurance businesses had performed in line with projections through October. Both backed their earnings forecasts for 2015. The announcements came after UnitedHealth cut its earnings forecast.

Leerink Partners analyst Ana Gupte said Aetna's statement showed the company had already factored in the individual business' challenges to its forecasts. Aetna has about 815,000 members in plans on the exchanges.

Anthem remains committed to the exchanges, Chief Executive Officer Joseph Swedish said in a statement. Anthem said last month that 2016 would be a challenging year on the exchanges, where it has about 824,000 customers, and that the business would drag on profit.

The earnings affirmations echo that of Centene Corp and Molina Healthcare. The small health insurers, which focus on Medicaid, also said its exchange business was performing in line with its expectations. Molina CEO J. Mario Molina said that Molina was targeting low-income people, similar to its Medicaid patients, and that it was not having the same problems as UnitedHealth.

Kaiser Permanente, a hospital and insurer system, also said that it was "strongly committed" to the exchanges.

Aetna, Anthem reassure investors on Obamacare business | Reuters
CMS proposes changes for 2017 exchange plans.

CMS issued the proposed annual Notice of Benefit and Payment Parameters for 2017, governing participation in the Health Insurance Marketplaces. The proposed rule seeks comment on proposals that will provide continued choice and competition for consumers. The proposed rule seeks to improve the consumer experience, both when individuals shop for health insurance and when they use it.

The proposed 2017 maximum annual limitation on cost sharing would be $7,150 for individual coverage and $14,300 cumulative for family coverage.

In an effort to reduce surprises consumers may face after buying a policy, CMS is seeking comment on a requirement that health plans in the federal Marketplace count certain out-of-pocket expenses on unexpected out-of-network services towards a policy holder’s annual out-of-pocket maximum, if the service was performed at an in-network facility and advance notice was not provided. For instance, if a patient who had surgery at an in-network facility finds out later that their anesthesiologist was not part of the health plan’s network, cost-sharing charges for that anesthesiologist’s services would count toward the out-of-pocket maximum, protecting the patient against additional financial liability. Currently, these types of out-of-network cost-sharing charges are generally not counted towards the out-of-pocket maximum.

https://www.cms.gov/Newsroom/MediaR...ses/2015-Press-releases-items/2015-11-20.html

 

[winger]

Thing is, even on this forum of above average intelligent, savvy people there remains a ton of confusion. I've been following it for over a year now and still don't have my arms completely around how this is supposed to work.

This isn't startup problems. I spent my whole career in "new product rollouts".
This is a program that wasn't fully thought out, poorly executed and even more poorly explained. I've yet to meet an average Joe who has any clue on how this works.

It's as if everybody said: "Ok, we got it into law" and then just walked away as if the passing was the goal and not the starting point.

The bad news is the next time someone want to pass some good sweeping legislation, the implementation of this mess will be pointed to as a reason not to.

It requires money to implement and explain a sweeping change to existing law. Much of the ACA was inadequately funded at the federal level, by congress. I recall HHS asked for nearly 10 times the funds they ultimately received.

There are plenty of folks who don't want the ACA. Political sabotage is one of the tactics.

 

[marko]

It requires money to implement and explain a sweeping change to existing law. Much of the ACA was inadequately funded at the federal level, by congress. I recall HHS asked for nearly 10 times the funds they ultimately received.

There are plenty of folks who don't want the ACA. Political sabotage is one of the tactics.

In the world I came from, there was something called a "critical product readiness review".
The idea was to insure that a product was ready to go for market rather than just thrown out there; an entire team from various disciplines had a voice (engineering, marketing, accounting, service, order entry, manufacturing etc).

One of the top ten questions always was: "what is the roll-out budget and it is adequate for this to be a success?"

If the answer was "no", well, then..."Then you're not ready to go to market with this, are you? Let's put it on hold until we figure that out and can fund it for success".

In this case, it was launched, ready or not and, as you point out, doomed to fail from the beginning. Who does that?

 

[travelover]

............One of the top ten questions always was: "what is the roll-out budget and it is adequate for this to be a success?"

If the answer was "no", well, then..."Then you're not ready to go to market with this, are you? Let's put it on hold until we figure that out and can fund it for success".

In this case, it was launched, ready or not and, as you point out, doomed to fail from the beginning. Who does that?

Doubtless this is at least partly true, but health care reform has been put on hold for decades. Like any big social change, there are always those who say we are not ready, to wait a little longer, pointing out that some people are against it. It is not over, because costs are still out of control.

 

[mpeirce]

In the world I came from, there was something called a "critical product readiness review".

I'm guess not the government sector?

 

[Alan]

I was not actually thinking of becoming a citizen of another country, maybe just a temporary or permanent resident if the cost of healthcare & health insurance are not reigned in within the US. I don't want to sound like Debbie Downer, but will Medicare even exist or be considered decent coverage for my generation and beyond? (Gen X & Y).

I never mentioned becoming a citizen, but to get permanent resident or long term visa status is still very difficult in many countries.

 

[MBSC]

Why wouldn't a "healthy" person not go off exchange and get an underwritten policy?

That's basically what DW & I do. We save thousands of dollars each year over an exchange policy.

"Sick" people have no choice, so they end up on the exchanges.

I thought about your post above when I read the following on another forum.

I'm dropping my preACA BCBS $1500 ded $2500 MOOP plan and the wife's Bronze HSA $6500 MOOP plan and taking underwritten short term health for the year. $12,000/year in premiums is too much.

We'll save $8000 in premiums and pay $3000 in penalty, net savings $5000.

 

[travelover]

I thought about your post above when I read the following on another forum.

I don't understand how this works. Does it pay your hospital bills if you get sick?

 

[Mulligan]

I thought about your post above when I read the following on another forum.

I first read that and thought, that is not very smart trying to use short term health for long term insurance. But I read a few articles and see plenty of merit to it. Sign on for a 12 month term, during ACA window, then if you develop a health issue or cant get re underwritten, you slide back into ACA. An article said short term buying has increased a lot since ACA went into effect. I could get underwritten, but am not at a point where I would consider it. But if I did I would buy the short term policy, but not pay the penalty.


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[NW-Bound]

... I could get underwritten, but am not at a point where I would consider it. But if I did I would buy the short term policy, but not pay the penalty.

"Hell no, I won't pay", to borrow from a political protest in the past?

Back on United Health dropping PPO, there are fewer PPO plans offered this year where I am. PPO is what we always have, and it costs more. I have not signed up for 2016, and been thinking what I would miss if I switch to HMO. All of my doctors are on an HMO plan that I pick for comparison. I need to look at this more.

 

[Mulligan]

"Hell no, I won't pay", to borrow from a political protest in the past?



Back on United Health dropping PPO, there are fewer PPO plans offered this year where I am. PPO is what we always have, and it costs more. I have not signed up for 2016, and been thinking what I would miss if I switch to HMO. All of my doctors are on an HMO plan that I pick for comparison. I need to look at this more.

Speaking of United.... At Thanksgiving I was trying to explain the policy options for my brother since his plan is being dropped at end of year. While looking at his options United Health was $100 less a month than the other carriers. Lowest price bronze options were around $400 for him except United Health which was $300. If they don't want people signing up with them to avoid losses, charging a $100 less for same plan isn't a good strategy.


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[photoguy]

I'm dropping my preACA BCBS $1500 ded $2500 MOOP plan and the wife's Bronze HSA $6500 MOOP plan and taking underwritten short term health for the year. $12,000/year in premiums is too much.

We'll save $8000 in premiums and pay $3000 in penalty, net savings $5000.

It's still possible to get underwritten health insurance I thought ACA did away with that for both on and off exchange plans.

 

[Mulligan]

It's still possible to get underwritten health insurance I thought ACA did away with that for both on and off exchange plans.

I believe short term insurance is not under ACA guidelines... In theory you would never use it as a replacement as come renewal time they would just non-renew you and then you would be in a world of hurt. But accidentally I imagine, used in proper conjunction with ACA renewal periods, you could go cheap until you had an issue.
Pre ACA this would never work as if you were dropped from short term, long term sure wouldn't sign you up at that point. So historically speaking it was only used as say a bridge for a time period in between employment gigs. I had to use it once for a 3 month period myself a dozen years ago or so.


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[ziggy29]

It's still possible to get underwritten health insurance I thought ACA did away with that for both on and off exchange plans.

Short term, meaning that if you have it for more than 2 months out of the year, you may owe penalties for not having ACA-compliant coverage. For some people, though, they may run the numbers and decide the penalty is worth eating. Which, to me, is a large part of the reason why the "individual mandate" is failing -- the penalties, IMO, aren't steep enough to discourage going without a compliant policy.

 

[Mulligan]

Short term, meaning that if you have it for more than 2 months out of the year, you may owe penalties for not having ACA-compliant coverage. For some people, though, they may run the numbers and decide the penalty is worth eating. Which, to me, is a large part of the reason why the "individual mandate" is failing -- the penalties, IMO, aren't steep enough to discourage going without a compliant policy.

The ironic part is the administration which pushed for the individual mandate to make it succeed then later kept releasing exemptions from the list which now just about includes everyone if they do not want to pay the penalty.


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[NW-Bound]

Speaking of United.... At Thanksgiving I was trying to explain the policy options for my brother since his plan is being dropped at end of year. While looking at his options United Health was $100 less a month than the other carriers. Lowest price bronze options were around $400 for him except United Health which was $300. If they don't want people signing up with them to avoid losses, charging a $100 less for same plan isn't a good strategy.

So, I have been spending a few hours looking at several alternatives, including that HMO plan that is $220/month less than the UHC PPO that I have had. Yes, my general practitioner plus my two specialists in case I need them are in their network. Everything looks good until I happened to look at the hospitals in their network. I never knew these existed. Oh boy! Do I need surgery in the next 12 months? I don't think so.

Still, you kind of get what you pay for I guess. Perhaps I should just cough up the extra $2640/yr to feel "safe".

 

[Mulligan]

So, I have been spending a few hours looking at several alternatives, including that HMO plan that is $220/month less than the UHC PPO that I have had. Yes, my general practitioner plus my two specialists in case I need them are in their network. Everything looks good until I happened to look at the hospitals in their network. I never knew these existed. Oh boy! Do I need surgery in the next 12 months? I don't think so.



Still, you kind of get what you pay for I guess. Perhaps I should just cough up the extra $2640/yr to feel "safe".

My "low cost" plan excludes the premier area medical center also. But I am 50 miles from it anyways. If an emergency arises I would be taken to the nearest hospital which is in network. Like you the second medical center in my network I had never heard of either. But I do know where its at now after looking online.


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[NW-Bound]

A problem with far-away hospitals is that my doctors may not go there. I do not see myself needing in-patient service for anything next year, but what is the point of buying "cheap" insurance if you cannot use it, if and when you need it?

I think I will just pay up. Ka ching!

 

[Mulligan]

A problem with far-away hospitals is that my doctors may not go there. I do not see myself needing in-patient service for anything next year, but what is the point of buying "cheap" insurance if you cannot use it, if and when you need it?

I think I will just pay up. Ka ching!

Thats true. I guess my situation is the inverse. The cheaper plan is the local care provider for me. And anyways, I am going with the sports phrase assumption "on any given day" applies here too. Who is to say the "A team" doctor is having an off day, that day while the "B team" doctor is bring it home hard that day!


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[travelover]

The ironic part is the administration which pushed for the individual mandate to make it succeed then later kept releasing exemptions from the list which now just about includes everyone if they do not want to pay the penalty.

Making a social change this big was/is a heavy lift. It needs carrots and sticks to work, but while people love the carrots (insurance coverage regardless of pre-existing conditions), they hate the stick (mandatory to buy insurance). So, politics being what they are, compromises were made to make it palatable. I guess this is why sausage making plants don't have windows onto the street.

 

[audreyh1]

I didn't realize that someone could just buy short-term health insurance to cover up to 12 months as long as they were able to pass the medical underwriting, and pay the penalty for non-compliant insurance. And then hope that nothing comes up during the year so they can renew again 12 months later.

 

[NW-Bound]

I just looked, and saw that we could still buy non-ACA insurance for $220/month for 2, deductible of $5000. Caveat: pre-existing conditions not covered, lifetime limit of $1M.

That is not bad at all, darn cheap in fact! I used to pay 3x that for pre-ACA insurance with a $10K deductible, and the caveat was the same, I thought. What happened?

 

[ziggy29]

I didn't realize that someone could just buy short-term health insurance to cover up to 12 months as long as they were able to pass the medical underwriting, and pay the penalty for non-compliant insurance. And then hope that nothing comes up during the year so they can renew again 12 months later.

Yeah, that's how it works. If you can pass the underwriting you can get a short-term plan for up to 12 months, and if your health stays good enough you can renew it again (paying the penalty) and re-up for another year of it. And if something happens that would disqualify you or exclude a preexisting condition, then you can go on an ACA-compliant plan.

IMO, the ease with which the system can be gamed is part of the problem.

 

[Texas Proud]

I didn't realize that someone could just buy short-term health insurance to cover up to 12 months as long as they were able to pass the medical underwriting, and pay the penalty for non-compliant insurance. And then hope that nothing comes up during the year so they can renew again 12 months later.

You have to remember that the policy does not automatically renew... you have to renew it yourself... and you can go with a different insurer if you want.

Not sure how they would do if you had a major problem such as a heart attack or stroke... one of the tricks for insurance is to just deny a claim....