Weekly Health Insurance Industry Highlights
Catch up on healthcare news and gain insights from our own industry gurus.
Shifts in How Individuals Obtain Coverage Expected
Health Enrollment Shifts Predicted
As provisions from the Affordable Care Act (ACA) cover more Americans, the result will be significant changes to how people are concentrated by coverage type within segments. Many people are expected to switch from employment-based coverage to off-exchange individual plans while others will qualify and enroll in public exchanges. Uninsured and underinsured people being targeted for expanded Medicaid programs will add to a surge in Medicaid enrollment which has already begun.
- Six million people are projected to have coverage through the public exchanges in 2014.
- In 2014, an estimated 7 million will obtain Medicaid and CHIP coverage above and beyond those who would have had Medicaid coverage in the absence of the ACA.
- By 2015, the net impact of ACA changes is expected to result in the reduction of employment-based coverage by 2 million. This reduction is expected to increase to 8 million by the year 2018.
- The number enrolled in nongroup (off exchange individual plans) and other coverage outside the exchanges is projected to decline by 3 million in 2015.
- CBO projects that 12 million more nonelderly people will have health insurance in 2014 than would have had it in the absence of the ACA, thus reducing the number of uninsured by 12 million in 2014.
More Companies Considering Private Exchange
Many companies are open to making major changes to healthcare benefits, including possibly eliminating them altogether, according to a survey of mid-sized and large companies commissioned by Prudential Financial.
More than half of the companies surveyed indicated that they are considering sending their employees to private insurance exchanges to purchase subsidized coverage. That includes 28% that reported they are very likely to move to a private exchange model or have already done so, and 25% that are somewhat likely to embrace such a change.
New York – Emergency Medical Services and Surprise Bills – 2014.07.08
The “Emergency Medical Services and Surprise Bills” law, new legislation passed in the 2014-15 New York State budget includes greater transparency of out-of-network (OON) charges and network participation, as well as broader availability of a patient’s right to go OON if the insurance plan’s existing network is insufficient and, most heralded, safeguards against “surprise bills” from OON physicians.
Key provisions in the new law:
Out of Network and Surprise Bills
Consumers who receive OON emergency services will not have to pay more than their usual in-network cost sharing and/or copayment amounts, regardless of the network status of the physician. Similarly, consumers who receive OON non-emergency services because there were no adequate in-network physicians available, or because they received a referral to an OON provider without the proper disclosures, will not have to pay more than their usual in-network co-pay/cost-sharing. The disputed bill must be negotiated directly between the physician and the health plan.
Healthcare providers, including group practices and diagnostic and treatment centers on their behalf, must provide patients with their plan and hospital affiliations prior to the provision of non-emergency services and verbally at the time of the appointment. If a provider is not in the patient’s network, the provider must inform the patient prior to providing non-emergency services that the amount or estimated amount for the service is available upon request and if requested, must be disclosed with a warning that costs could go up if unanticipated complications occur.
Insurers are currently obligated to give consumers a provider directory that is updated annually and that includes the name, address, telephone number and specialty of all participating providers, facilities, and, in the case of physicians, board certification. Under the new law, insurers also will be obligated to have information in writing and on the internet that allows consumers to estimate anticipated out of pocket costs for OON services in a particular geographic area based on the difference between what the insurer will be reimbursed for the OON services and the usual and customary costs for the OON services.
Network Adequacy and OON Coverage
The new law requires all health insurers, not just HMOs, to have adequate networks to ensure greater choice and access to care. If a plan’s network does not have a geographically accessible provider with appropriate training and expertise to treat a patient’s condition, the patient can seek services from an OON provider without incurring additional out-of-pocket expenses.The law will take effect on April 1, 2015.
2015 HIX Participants
Individual State Updates
For more information about a specific state, click on the state name to be directed to the state’s 2015 HIX Competitors page. These state specific pages will be updated regularly as information becomes available about 2015 insurers and product offerings.
UnitedHealthcare has applied to sell health plans on the exchange in 2015, the state Department of Insurance and the company confirmed. The national company isn’t participating this year on the Affordable Care Act exchanges in Alabama but has about 250,000 customers in Alabama.
Last year Blue Cross offered health plans in all of Alabama’s 67 counties and has applied to do the same in 2015. It was the sole provider of insurance offerings on the exchange in 64 of those counties.
Humana offered plans in Jefferson, Shelby and Madison counties, and the company will do the same in 2015, said spokesman Mitch Lubitz. AL.COM | BLUE CROSS IN ALABAMA WILL FACE MORE COMPETITION ON OBAMACARE EXCHANGES IN NEXT ENROLLMENT
Arkansas Insurance Commissioner Jay Bradford announced that five companies have filed to sell individual health insurance plans on Arkansas’s Federally-facilitated Health Insurance Marketplace for the 2015 plan year. The issuers filing for qualified health plan certification are Arkansas Blue Cross Blue Shield, Celtic Insurance Company, National Blue Cross Blue Shield Multi-State, QCH Health Plan Inc., and QualChoice Life and Health Insurance Company, Inc. ARKANSAS INSURANCE DEPARTMENT | NEWS RELEASE | ARKANSAS INSURANCE COMMISSIONER ANNOUNCES COMPANIES FILING 2015 PLANS ON HEALTH INSURANCE MARKETPLACE
2015 health insurance exchange participants have filed rates. DEPARTMENT OF BUSINESS AND INDUSTRY – NEVADA DIVISION OF INSURANCE | HEALTH INSURANCE RATE REVIEW
Over all, including plans inside or outside the exchange, insurance companies asked for average rate increases of 13 percent in 2015, the state’s Financial Services Department said Wednesday. The requests cover individual and small-group plans, but not large-group plans like those offered by large companies and government employers.
State officials sought to play down the importance of the proposed rate increases, saying that they were only proposals and that they would probably be knocked down to some extent by state regulators, who have the final say. THE NEW YORK TIMES | INSURERS ON NEW YORK STATE’S HEALTH EXCHANGE SEEK SIGNIFICANT RATE INCREASES