Monthly Archives: May 2015

Humana: Obamacare indigestion in Georgia

Obamacare Setback Has Humana Attempting a Georgia Turnaround – Bloomberg Business

Humana’s Georgia struggle shows the challenges health insurers face entering unfamiliar markets. President Barack Obama’s 2010 health-care law will provide an estimated $19 billion in subsidies and helped about 12 million people buy coverage for this year. As insurers have raced to capture those customers, some are doing well, and others have overreached.

Humana, which touts its skills at selling health insurance directly to individuals, ran into trouble in Georgia after charging too little for plans it sold on the state’s new marketplace. Customers came running.

Unfortunately, more of them were sicker than Humana expected. Flooded with patients, Humana let them see doctors who aren’t in its networks. That’s expensive — health insurers make deals with doctors and hospitals to add them to their networks, negotiating lower prices in return for business.

Unfortunately, more of them were sicker than Humana expected. Flooded with patients, Humana let them see doctors who aren’t in its networks. That’s expensive — health insurers make deals with doctors and hospitals to add them to their networks, negotiating lower prices in return for business.

Sounds like everyone is unhappy to me. When a company prices plans to low, price sensitive consumers take the bait.

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Colorado health insurance exchange / marketplace: Obamacare enrollment

Colorado health insurance exchange / marketplace: Obamacare enrollment

Connect for Health Colorado reported that 141,639 people signed up for qualified health plans, including about 47,000 consumers who were new to the marketplace in 2015.

The lack of Medicaid reimbursement is nothing short of a travesty…

The four other state-run exchanges with similar enrollment totals all receive at least a third of their funding – and as much as more than half of their funding – from Medicaid.  But Connect for Health Colorado doesn’t get any funding from Medicaid (and agents/brokers who enroll people in Medicaid through Connect for Health Colorado don’t receive any compensation, unlike other states).

The exchange can request reimbursement from CMS for expenses incurred to enroll people in Medicaid, and the 2016 revenue projection includes $2.5 million in recouped funds from CMS.  That still pales in comparison with the $15 million to $29 million that other similarly-sized exchanges are reimbursed annually by Medicaid.

There’s plenty of incompetence to go around, but Colorado Medicaid stands out as both arrogant and incompetent.

 

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