Monthly Archives: May 2014

Obamacare Co-Ops

Obamacare Co-Ops Undercut Insurance Giants. Can They Survive? – Businessweek.

Aetna and UnitedHealth have decades of experience writing health-insurance policies and determining how much they need to collect in premiums to pay for medical claims. That would suggest they have a pretty good sense of how to set rates. And even though co-ops don’t have the same need to please Wall Street with profits, that alone doesn’t account for premiums that are sometimes 50 to 60 percent lower than traditional competitors, says Jonathan Wu, an economist with insurance comparison website ValuePenguin. “I don’t see how just by being nonprofit you could try and cut that much off,” he says.

In Colorado we have CoHealthOp, which is a health insurance cooperative. CoHealthOp and Kaiser had aggressive pricing for the first open enrollment period. Time will tell if they determined their premium correctly. I can tell you that low prices sell! No surprise there, just ask Walmart.

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Medicaid? Read this first…

Especially for the children – Zane Pollard: The Bureaucrat Sitting on Your Doctors Shoulder – WSJ.com.

Obamacare is designed to steer children of lower income families (< 250% of the Federal Poverty Level, $59,000 for a family of 4) onto Medicaid. Before you blindly allow the government to make that choice for you please read the above article.

Yes, it’s so very tempting. You can either put your children on Medicaid at basically zero cost, or you can put them on your plan and receive no subsidy for their portion of the total family premium.

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Narrow networks: “Enjoy”

More Insured, but the Choices Are Narrowing – NYTimes.com.

In the midst of all the turmoil in health care these days, one thing is becoming clear: No matter what kind of health plan consumers choose, they will find fewer doctors and hospitals in their network — or pay much more for the privilege of going to any provider they want.

These so-called narrow networks, featuring limited groups of providers, have made a big entrance on the newly created state insurance exchanges, where they are a common feature in many of the plans. While the sizes of the networks vary considerably, many plans now exclude at least some large hospitals or doctors’ groups. Smaller networks are also becoming more common in health care coverage offered by employers and in private Medicare Advantage plans.

In Colorado, all exchange plans except Rocky Mountain Health Plans PPO, have state based networks if not more restrictive. Off exchange, nationwide networks are available from Assurant Health, Humana and Rocky Mountain Health Plans.

Narrow networks are great until they’re not. In general, if you’re looking to go out of network, there are serious issues that require and access to a specialist. The insurance company won’t pay because the specialist is either out of state or out of network. The solution to the above problems is cash…. or access to cash. Believe me, the specialist and his facility will be glad to accept your cash, what do you think the insurance company pays them?

How do you get “cash”, through an insurance policy that will be triggered by some of these serious issues. Potential policies include:

  • Critical Illness
  • Cancer/Heart Attack/Stroke
  • Accident coverage
  • Hospital indemnity coverage

Critical Illness may not be a coverage you are familiar with. Basically it is expanded Cancer/Heart Attack/Stroke. Expanded coverage vary from provider to provider, but typical additional coverages include: major organ transplant, coma, end stage renal failure, paralysis, blindness and severe burns.

Critical Illness and Cancer/Heart Attack/Stroke pay out the selected benefit upon diagnosis. Supplemental accident coverage usually cover the cost of treatment up to the limit of the policy (some accident plans work differently), Hospital indemnity pay specified amounts, such as $2000/day in the hospital.

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Rate relief for resort areas…

New Obamacare map could cut insurance costs | AspenTimes.com.

Redrawing the maps will still leave resort county residents with some of the country’s highest Obamacare premiums.

Salazar said the new lineup of insurance regions could bring cost down between 4 to 8 percent in resort areas. That’s about $20 a month. Other rural areas in Colorado would see their costs go up 4 to 6 percent, also about $20 a month to about $366 a month.

The current premium for a 40-year-old non-smoker in the resort counties is $483 a month.

Ouch! It appears to me the whole Westerm portion of Colorado, Mesa County excepted (think Rocky Mountain Health Plans), will now have some of the highest rates in the nation.

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Obamacare drug coverage: Do your homework

Report: Health Exchanges Drug Coverage Confusing – Top News – InsuranceNewsNet.com.

“It was very difficult for consumers to get a more nuanced view of what their plans covered,” Pearson said. In some cases, a consumer would have to click six times to find drug coverage information. Even worse, no links to lists of covered drugs existed for some health plans.

That forced consumers to search insurance company websites, and, even if they found the covered drug lists, it could be tough to determine which lists went with the exchange plans they were comparing, Pearson said.

“Many chronic conditions rely on medications for management and to keep people out of the hospital,” Pearson said. “If your drug is not covered, then you’re responsible for the full cost or you have to switch to a different drug. The impact on the patient could be several thousands of dollars a year.”

Make sure you do your homework on drug coverage. The big issue of course, is you may not know you’re about to be diagnosed with a chronic condition, so how do you evaluate drug coverage in general?

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