More Americans now have health insurance than ever before, but that doesn’t mean there are fewer gaps in the screening, monitoring, and management of healthcare and chronic disease. Most health plan members believe their plan’s communications are impersonal and centered around bills rather than healthcare guidance. The majority of members are either disconnected from or rarely visit their health plans on social media and member portals. Additionally, many members feel they are missing valuable support from their plans around digital health data and price transparency. The findings are based on a survey of 750 insured consumers who have sponsored health insurance. The results are now available in the 2017 HealthMine Health Intelligence Report: Communication and Digital Healthcare Tools. [Read more…]
Health Insurance Coverage News
Health insurance coverage determines what a patient pays, which doctors a patient can see, and whether a claim is paid or denied. This section of Health Plan News covers the plans themselves: individual and family coverage sold on the Affordable Care Act (ACA) marketplace, employer-sponsored health benefits, short-term plans, and the premium, deductible and out-of-pocket changes that arrive every plan year.
What We Cover
This section tracks rate filings and premium increases, open enrollment deadlines, changes to marketplace subsidies (the premium tax credits that lower monthly costs for qualifying households), and the rules that govern prior authorization and claim denials. We also report on employer benefit trends, including high-deductible health plans paired with a Health Savings Account (HSA), a tax-advantaged account for medical expenses.
Coverage news rarely stays in one lane. Federal and state rules shape every plan, so this section works alongside our Healthcare Policy and Law coverage. Carrier decisions drive what is available in each market, which is why we also follow the health insurance companies and the Blue Cross Blue Shield plans by name.
Guides to Health Insurance Plan Types
For readers comparing options, our reference guides explain how each type of plan works: choosing a health insurance plan, individual health insurance plans, family health insurance plans, high-deductible health plans, short-term health insurance, catastrophic coverage, health sharing plans and low-income health insurance. Readers aged 65 and older should start with our Medicare section, and lower-income families should review our Medicaid and CHIP coverage.
The latest health insurance coverage news appears below, newest first.
Minnesota Council of Health Plans report operating losses over $680 million
Minnesota health insurers reported $687 million in operating losses for 2016, according to information released today by the Minnesota Council of Health Plans. Medical reserves were tapped to pay for doctor visits, nursing, hospital stays, medications and other care.
Overall, revenue from premiums increased 4 percent over the prior year to nearly $25.9 billion, while expenses increased 6 percent to $26.6 billion. State public programs accounted for more than half of the overall red ink, followed by continued losses in the individual market. Insurance employers provide remained steady. On average, health insurers paid $763 per second for care. To pay those bills, insurers withdrew nearly $560 million from state-mandated medical reserves.
Related Coverage
- Most Health Insurers Are Waiving Costs for COVID-19 but Few Expect to Raise Premiums
- Governor Appoints WellCare of Nebraska’s Medical Director to Palliative Care and Quality of Life Advisory Council
For more reporting on this topic, see our Health Insurance Companies news hub.
Texas Legislators File Bills to Increase Health Insurance Transparency, Oversight
The Texas Association of Freestanding Emergency Centers (TAFEC) supports legislation introduced in the Texas Legislature aimed at increasing oversight of health insurance companies and protecting consumers from surprise medical costs. [Read more…]
Talix and Geisinger Health Plan to Present on Data Analytics for Risk Adjustment
Talix, Inc., a premier provider of risk analytics solutions for value-based care, today announced that Shahyan Currimbhoy, senior vice president of product management and engineering at Talix, and Karena Weikel, ASA, FAHM, CSFS, vice president of risk and revenue management at Geisinger Health Plan (GHP), will be presenting at the 2017 RISE Nashville Summit. The summit takes place March 6-8, 2017 at the Omni Nashville Hotel in Nashville, Tenn. [Read more…]
Actuaries Examine Implications of ACA Reform and Replacement Proposals
In three new issue briefs, the American Academy of Actuaries examines a number of key public policy considerations that policymakers should weigh when evaluating specific proposals for reforming or replacing the Affordable Care Act. Developed by the Academy’s Individual and Small Group Markets Committee, the papers address high-risk pools, selling health insurance across state lines, and association health plans. [Read more…]
Best and Worst States for Group Health Insurance
Employer-sponsored health insurance is greatly affected by geographic region, industry, and employer size. While some cost trends have been fairly consistent since the Patient Protection and Affordable Care Act (ACA) was put in place, United Benefit Advisors (UBA) finds several surprises in their 2016 Health Plan Survey. [Read more…]
Secretary of Health Urges U.S. Legislators to Consider How Repealing ACA Could Eliminate Critical Health Funding for the Commonwealth
Secretary of Health Dr. Karen Murphy is urging the commonwealth’s U.S. Congressional delegation to consider the effect that repealing the Affordable Care Act (ACA) could have on all Pennsylvanians, especially children and seniors in need. [Read more…]
N.J. Hospitals Sustained $1.5 Billion in ACA Funding Cuts
Hospitals and health systems in New Jersey have already absorbed nearly $1.5 billion in funding cuts since the Affordable Care Act was enacted in 2010, with the promise of expanded healthcare coverage to mitigate these losses. As the 115th Congress advances legislation to repeal major provisions of the ACA, healthcare providers are concerned the cuts will remain despite the coverage of 796,291 state residents being jeopardized. [Read more…]
Insurance Commissioner Reminds Pennsylvanians of Upcoming Open Enrollment Deadline
Insurance Commissioner Teresa Miller today reminded Pennsylvania consumers that the open enrollment period for 2017 health insurance coverage available through the federal marketplace at www.Healthcare.gov closes at 11:59 p.m. on January 31. More than 413,000 Pennsylvanians are currently enrolled in plans for 2017. [Read more…]
Milliman Identifies 6 Questions Arising from the Trump ACA Executive Order
Milliman, Inc., the premier global consulting and actuarial firm, has published six questions for consideration by healthcare stakeholders about the Trump Administration’s recent executive order, which gives a sweeping command to the leaders of the new administration to unwind certain aspects of the Patient Protection and Affordable Care Act (ACA)—especially those components deemed “burdensome.” It remains unclear how the Trump Administration will implement this authority, especially due to the interconnected nature of the ACA, but given Milliman’s comprehension of the law, several key questions arise. [Read more…]
Harmony Health Plan Helps Kidz Korna Make the Holidays Special
Harmony Health Plan, Inc., a subsidiary of WellCare Health Plans, Inc. (NYSE: WCG), gave $10,000 to Kidz Korna to help make the holidays special for thousands of children living in Chicago’s low-income communities, such as Englewood, Bronzeville, Roseland and the Westside. [Read more…]
Goodman Institute Health Economist: No Replacement for Obamacare
Finding a replacement for Obamacare that their colleagues will support may prove to be an impossible task for Republicans on Capitol Hill, says a health economist familiar with the obstacles involved. [Read more…]
Emerge Launches New Online Tool
Emerge, an online platform that reimagines how consumers purchase emergency insurance, has announced that its site is live and ready to educate individuals and help them avoid the risk of medical debt. [Read more…]
Study shows 30% of Americans don’t know their health plan deductible
The U.S. business group of Sun Life Financial has released a study titled “Voluntary Benefits: An Unknown but Needed Option,” illustrating that due to health care costs continuing to rise, American workers need to adequately understand what voluntary benefits are. [Read more…]
Accolades Recognize Preeminence of FAIR Health Consumer Website
FAIR Health’s consumer website marked another year as the preeminent site for consumers to access accurate, actionable healthcare cost estimates and health insurance information. In a time of flux in healthcare policy at the federal and state levels, the site continues to serve as a lighthouse to consumers at sea among high-deductible health plans, narrow networks and other potentially confusing aspects of the healthcare marketplace. To that end, FAIR Health offers five tips for consumers below. [Read more…]
Class Settlement Over Health Insurance Benefits for Same-Sex Spouses of Walmart Associates
Former Walmart associate Jacqueline Cote and her lawyers filed a motion today asking the U.S. District Court for the District of Massachusetts to grant preliminary approval of a class action settlement in Cote’s action that challenged Walmart’s lack of health insurance benefits for same-sex spouses of Walmart associates prior to 2014. [Read more…]
UPMC Health Plan opens new Connect Service and Sales Center Store
UPMC Health Plan Service and Sales Associates are now available to answer individual’s health insurance questions and meet your health care coverage needs at a new Monroeville Mall store. The grand opening celebration was today, Saturday, Nov. 5, 2016 from 10 a.m. to 3 p.m. [Read more…]
Oklahomans Brace for Skyrocketing Increases on ACA Marketplace
Health insurance premiums will likely increase by an average of 76 percent for Oklahomans who buy individual coverage through the Affordable Care Act’s marketplace. The increases for individual market plans range from 58 percent to 96 percent. [Read more…]
Karen Brach Named President of Illinois Office by Meridian Health Plan
Karen Brach has been named the new President of Meridian Health Plan of Illinois and is scheduled to step into that role on April 5. Brach is a managed care executive with more than 15 years of Medicaid and Medicare managed care senior leadership experience. [Read more…]
43% Expect to Pay More for Healthcare in 2016
According to the latest survey conducted by leading personal finance website GOBankingRates.com, 43 percent of Americans expect to pay more for health insurance in 2016, with 23 percent expecting to pay “a little more than the last year” and 20 percent expecting to pay “a lot more than the last year.” [Read more…]
10 Days Left to Sign Up for Health Insurance
“In just ten days, January 31, 2016, most residents of Atlanta must have health insurance or face new tax penalties,” said Dr. Jane L. Delgado, President and CEO of the National Alliance for Hispanic Health, the nation’s leading Hispanic health advocacy group. She added, “making a decision on health insurance is not easy and many are looking for help they can trust. Our bilingual Navigators are ready to help!.” [Read more…]
Highest Health Insurance Costs Are in New York and South Carolina
As monthly premiums for the most popular plans offered under the Affordable Care Act are seeing a 10.1 percent spike up from 2015*, GOBankingRates conducted a study to see which states’ residents are paying more (or less) for health insurance in 2016 – and what they’re getting for their money.
New York residents pay the most for basic health insurance, whereas residents of New Mexico pay the least, according to a new study released today by leading personal finance website GOBankingRates.com.
The study compared silver plans ? the most popular plan according to the Department of Health and Human Services ? offered through the national or state-level insurance exchanges administered through the Affordable Care Act.1
The lowest-cost silver plans for each state were ranked based on the favorability of the following cost factors:
The plan’s monthly premium
The deductible
The emergency care copay
The copay for care from a primary physician
To see full details on the methodology, visit:
http://www.gobankingrates.com/personal-finance/10-best-worst-states-health-insurance-costs/
Related Coverage
- 43% Expect to Pay More for Healthcare in 2016
- Americans Will Spend An Average of $5,952/Year for Health Insurance in 2021
- Inland Empire Health Plan Offers Lowest-Cost Silver Plan in San Bernardino and Riverside Counties – See What’s New for 2025
For more reporting on this topic, see our Health Insurance Coverage news hub.
Equifax Achieves Milestone in Helping Employers Manage the Affordable Care Act
Equifax Workforce Solutions, a leader in human resource, analytics and verification services, and a business unit of Equifax Inc. (NYSE: EFX), has achieved a major milestone in Affordable Care Act (ACA) management for employers. The company’s ACA Management Platform, a software application that automates ACA administrative tasks and helps employers reduce their potential for penalties, is now used to manage compliance for over 10 million employees.
The Equifax ACA Management Platform, which has been recognized as a leading technology by Human Resource Executive® Magazine, Ventana Research, and the Brandon Hall Group, has seen the adoption rate for ACA-related services grow exponentially since the final versions of Internal Revenue Service (IRS) reporting forms 1094 and 1095 were released. These forms, which require detailed monthly information regarding the coverage offered and provided to employees and their dependents, will be used by the IRS to assess fines under both the individual and the employer mandate.
In addition to releasing the IRS Reporting module to automate the preparation and fulfillment of forms 1095 and 1094, the company recently released additional features, including the Appeals Management module that streamlines the process of storing and responding to subsidy notifications from the exchanges.
Following the Supreme Court’s ruling on King v. Burwell, in favor of Burwell, the government has taken another step in the longevity of the ACA and its impact on employers. The much anticipated decision upheld the legality of Premium Tax Credits, or subsidies, for health insurance provided under the federal Marketplace. Because subsidies trigger penalties for employers, this decision had the potential to significantly impact the Pay or Play mandate. To help employers understand the impact of the Court’s ruling and the next steps they should take in the ACA compliance journey, Equifax is hosting a webinar on July 7, 2015.
Related Coverage
- Milliman Identifies 6 Questions Arising from the Trump ACA Executive Order
- Highest Health Insurance Costs Are in New York and South Carolina
- HealthPartners Improves Member Shopping Experiences on the ACA Marketplace
For more reporting on this topic, see our Health Insurance Coverage news hub.
Aon Hewitt Shows Continued Cost Savings for Companies and Individuals Participating in the Aon Active Health Exchange
Aon Hewitt, the global talent, retirement and health solutions business of Aon plc (NYSE: AON), has announced that employers and individuals participating in the Aon Active Health Exchange are seeing notable reductions in health care spend for the third straight year.
More than 600,000 employees and their dependents enrolled in health benefits through the Aon Active Health Exchange for the 2014 calendar year. All of the 18 companies that participated in 2014 are returning to the Aon Active Health Exchange in 2015. Across those companies, rates for medical coverage increased an average of 5.3 percent. This is lower than the industry average and includes costs associated with the Affordable Care Act. According to Aon Hewitt’s estimates and several other organizations,1 average health care cost increases in 2015 for large U.S. employers with self-insured arrangements are projected to be between 6.52 percent to 8.0 percent3 before employers make changes in deductibles and copays. Based on employer and employee feedback, plan designs in the Aon Active Health Exchange for 2015 will once again remain unchanged.
Companies participating in the Aon Active Health Exchange also reduced their overall health care cost for medical coverage by more than $750 per employee compared to their expected 2014 spending. These numbers factored in the savings delivered through the exchange model, the impact of employee choices to buy less rich coverage and the impact of employees who chose to purchase richer—and often more expensive—medical plans. Average health care costs were $8,342 per employee, down from $9,098 per employee. These savings were shared with employees through reduced payroll contributions, as well as through offering a range of more affordable health care coverage options.
Related Coverage
- Aon Active Health Exchange Expands Coverage Options
- Oklahomans Brace for Skyrocketing Increases on ACA Marketplace
- Centivo Launches New Health Plan Solution
For more reporting on this topic, see our Health Insurance Coverage news hub.
COB Smart Expands Nationwide to Identify Overlap in Health Insurance Benefits
CAQH® today announced that COB Smart™ has launched in all 50 states and the District of Columbia, enabling health plans and providers to identify overlapping insurance coverage nationwide. A CAQH Solution™, COB Smart determines when an individual is covered by more than one insurer and also indicates which insurer should pay first. The solution streamlines coordination of benefits (COB) activities so that healthcare claims can be processed correctly the first time.
Knowing accurate and timely COB information helps eliminate administrative inefficiencies that cost providers and health plans more than $800 million annually, according to CAQH research. COB Smart helps ensure that providers receive accurate payments, health plans reduce claim rework, and patients spend less time on registration forms and questionnaires.
Real-world use of the solution among health plans shows COB Smart to be highly successful in helping process claims accurately the first time by discovering unknown instances of overlapping insurance coverage. One national insurer and early participant of COB Smart concluded that approximately four out of five records identified by COB Smart had not been previously detected as having other insurance in its eligibility system.
CAQH has continued to enhance COB Smart since announcing its initial launch in February. Participating health plans may now access a new COB Smart payer portal to search and immediately identify instances where overlapping coverage exists for their members. This latest feature returns complete information that enables the participating health plan to contact the other insurer also covering the member.
Related Coverage
- Ambetter from Arkansas Health & Wellness Offers Health Insurance Across Arkansas
- Chubb Expands Insurance Solution in Canada to Address Exposures Faced by Today’s Private Equity Firms
- Aon Hewitt Shows Continued Cost Savings for Companies and Individuals Participating in the Aon Active Health Exchange
For more reporting on this topic, see our Health Insurance Coverage news hub.
One in Four Americans Have More Medical Debt than Emergency Savings
Twenty Five percent of Americans say they currently have more medical debt than emergency savings, according to a new Bankrate.com (NYSE: RATE) report. This number nearly doubles (44%) among those earning less than $30,000 per year.
Furthermore, people who do not currently have medical debt are concerned about it. Over half of Americans (55%) are worried they will find themselves overwhelmed by medical debt (27% are very worried and 28% are somewhat worried).
The report found that worry levels were the highest among people in their prime earning years, between the ages of 30 and 64.
These results comprise Bankrate.com’s Health Insurance Pulse, a monthly survey that tracks how Americans are feeling about health care and their personal finances. The survey was conducted by Princeton Survey Research Associates International (PSRAI) and can be seen in its entirety here:
http://www.bankrate.com/finance/insurance/health-insurance-poll-0814.aspx
Related Coverage
- 43% Expect to Pay More for Healthcare in 2016
- Survey: 45% of Insured Americans are Considering Health Insurance Changes During Open Enrollment
- Highest Health Insurance Costs Are in New York and South Carolina
For more reporting on this topic, see our Health Insurance Coverage news hub.
Buckeye Health Plan Has New Name, New Look
Buckeye Health Plan (Buckeye), formerly known as Buckeye Community Health Plan, today announced a new name and look designed to project the innovative, customer-centered mission and goals of the company.
During the past few years, Buckeye has experienced growth in its member base and has expanded across the State of Ohio. The name change and new brand identity will be phased into marketing materials beginning in September, 2014.
Related Coverage
For more reporting on this topic, see our Health Insurance Coverage news hub.
Aon Active Health Exchange Expands Coverage Options
To meet increasing employer demand to have additional benefits delivered via an exchange platform, Aon Hewitt, the global talent, retirement and health solutions business of Aon plc (NYSE: AON) today announced it is expanding the coverage options offered under the Aon Active Health Exchange for 2015.
Participating employers will have the option of offering their employees a wide range of elective benefit plans during this fall’s annual enrollment season. The elective benefits that can be offered on the Aon Active Health Exchange for coverage beginning January 1, 2015, include:
Critical Illness
Accident
Hospital Indemnity
Life
Long-term Disability
Identity Theft
Legal
Home/Auto
Pet Insurance
Related Coverage
- Aon Hewitt Shows Continued Cost Savings for Companies and Individuals Participating in the Aon Active Health Exchange
- Small Business Health Insurance
- TruHearing® Moves to Make Hearing Benefits as Prevalent as Vision and Dental Coverage
For more reporting on this topic, see our Health Insurance Coverage news hub.
2015 Platinum Plans Are Best Buy for Consumers Using Expensive Specialty Drugs
According to HealthPocket, HealthPocket found that among 2015 Obamacare metal plans whose rate filings have been made public, platinum plans incurred the lowest average out-of-pocket costs for the five common specialty drugs used in the study.
Using publicly released 2015 rate filings in 9 states, HealthPocket analyzed health plan costs for five common specialty drugs. Specialty drugs have been a growing concern for consumers given their high costs and shortage of generic alternatives. They treat complex medical conditions, can cost thousands per prescription, and are used for a broad variety of conditions like arthritis, diabetes, and multiple sclerosis.
HealthPocket found that among 2015 Obamacare metal plans whose rate filings have been made public, platinum plans incurred the lowest average out-of-pocket costs for the five common specialty drugs used in the study. The average out-of-pocket specialty drug costs for platinum plans were 64% lower than gold plans, 74% lower than silver plans, and 78% lower than bronze plans. Even though platinum plans have the highest premiums among the four categories of Obamacare health plans, their reduced co-payments and lower caps on annual out-of-pocket costs can translate into lower overall costs for people taking specialty drugs. 2015 Platinum Plans Are Best Buy for Consumers Using Expensive Specialty Drugs
Related Coverage
- Inland Empire Health Plan Offers Lowest-Cost Silver Plan in San Bernardino and Riverside Counties – See What’s New for 2025
- Americans Will Spend An Average of $5,952/Year for Health Insurance in 2021
- Short-Term Health Plans Leave Patients Vulnerable to Major Medical Bills
For more reporting on this topic, see our Health Insurance Coverage news hub.
How to Get Health Insurance Coverage
Buying health insurance coverage is a big decision. It’s complex, it’s costly, and it could have big monetary implications. Similar to a lot of other things, it’s simpler if you break up the job into lesser tasks and find your way out through them.
a) Create a list of solutions you and your household may need.
Take into consideration your gender, age, and family medical record. Are there any ongoing medical conditions? Is There anyone regular medical prescription?
At the lowest, plan to purchase ‘a high insurance deductible health plan’, which is usually termed as ‘catastrophic coverage’. Simply speaking, this coverage provides a reduced premium, and you make payment for most routine costs out of your pocket. If you’ve a critical accident or become severely ill, your insurance plan will activate when you attain your deductible. [Read more…]