by Admin. | Aug 8, 2016 | group health insurance, Health Exchanges, Individual Exchanges, individual health insurance, NY News, United Healthcare
NYS 2017 FINAL Rates Approved
NYS has approved 2017 Final Rates. Small group rates will increase 8.3%, a reduction from the 12.3% average originally requested. In the individual market, the average increase will be 16.6%, a reduction from the originally requested 19.3%.
As per NY State Law carriers are required to send out early notices of rate request filings to groups and subscribers see original –NYS 2017 Rate Requests. With only 3 months of mature claims experience for 2016 health insurers’ requests are historically above average. Ultimately the State reduces this request substantially. This year, however, NYS acknowledged that medical costs increased, citing a 7-percent average increase on the individual market and an 8.5-percent increase on the small group market. The administration also acknowledged drug prices have impacted insurers, pointing specifically to blockbuster drugs for Hepatitis C.
OTHER STATES
The national rate trend, however, has been much higher than in past years due to higher health care costs Like other states throughout the nation, the 2017 rate of increase for individuals in New York is higher than in past years partly due to the termination of the federal reinsurance program. The lost of the program’s aka federal risk reinsurance corridor funds accounts for 5.5 percent of the rate increase.
How are neighboring States doing? In NJ, not that bad. According to a review of filings made public last week the expected rate increase will be likley ve half. Example: Horizon Blue Cross Blue Shield requested a 4.8% increase on their OMINA Plans. For CT market, on the other hand, things are much worse at least for individual marketplace with average 25% rate increases.
SMALL GROUP MARKET VS. INDIVIDUAL MARKET
The new premium hikes ranged from as little as 5.6 percent for Oxford Small group to a whopping 58.5% percent increase for Crystal Run Health Insurance Company, an insurer that covers parts of the Hudson Valley and Catskills. Importantly, small group market are still more advantageous than individual markets unless one gets a sizable low income tax credit.
Overall, about 350,000 individual plan consumers will be affected by the price hike, while more than a million users will be hit by higher small group fees. Earlier this year, Blue Cross Blue Shield released a study showing Obamacare user costs were 22 percent higher than people with employer-sponsored health plans, while UnitedHealth plans to exit most Exchanges see – Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017.
The correct approach for a small business in keeping with simplicity is a Private Exchange. This is a true defined contribution empowering employees with choice of leading insurers offering paperless technologies integrating HRIS/Benefits/Payroll. Both employee and employers still gain tax advantage benefits under the business. Also, the benefits, rates and network size are superior under a group plan as the risk are lower for small group plans than individual markets.
* All amounts are rounded to the nearest 1/10.
**Indicates that the company makes products available on the “New York State of Health” marketplace.
***After rate applications were filed on 5/9/2016, additional information, including the final results of the federal risk adjustment program, prompted several insurers to update their initially filed rates.
For more information on how a Private Exchange can help your group please contact us at (855)667-4621.
by Admin. | Jun 28, 2016 | individual health insurance, latest health insurance news, NY News, United Healthcare
Breaking: Oxford Exits Metro Indiv & Oxford Liberty HMO 2017
A neat quote mentioned in yesterday’s Crains Health Pulse. I only wish it were for better news.
1. Oxford will be leaving NY Individual health plans. The popular Oxford Metro plan offered off-exchange marketplace will no longer be offered next year. Notably, this is the only plan that contained par excellence cancer hospitals such as Memorial Sloan Kettering.
Oxford Metro will still be available for NY Small groups.
2. Oxford Liberty HMO plans will be leaving ALL segments – Individuals to commercial large groups. For restaurants and retail shops, as an example, this is a very popular platform as this allowed flexibility of NO minimum participation. If only 1 person wanted to enroll on plan out 20 that was OK.
Oxford will be sending these letters out to Employers starting with Jan 2017 renewals.
Oxford Health Plans (NY), Inc. (OHP) License Withdrawal, Effective January 1, 2017, Upon Renewal
Please note the following:
- This change does not affect their regular Oxford Health Insurance, Inc. (OHI) plans. Their OHI portfolio in New York offers a wide range of coverage options for employers of all sizes.
- Impacted groups and members will receive a notice from us approximately 180-days prior to their 2017 coverage end date. The notice will outline the actions they need to take and other available coverage options.
Stay proactive and contact us today for a customized consult on how your organization can prepare ahead for ACA, Benefits, Payroll and HR @ (855) 667-4621 or info@medicalsolutionscorp.com.
by Admin. | Apr 20, 2016 | healthcare, Individual Exchanges, individual health insurance, latest health insurance news, Obamacare, State Exchanges, United Healthcare
UnitedHealthcare will drop ACA exchanges
UnitedHealthcare Individual by State
BREAKING:
So far, New York and Nevada have confirmed that UnitedHealth plans to remain on their ACA exchanges next year. The company has also filed plans to participate in Virginia for 2017. Wisconsin said it hasn’t received an exit notice from UnitedHealth, and that it doesn’t comment on insurers’ business plans. A representative of Covered California, the state’s Obamacare exchange, said plan participation is confidential until it’s announced later this year.
UnitedHealthcare will drop out of most ACA Exchanges by 2017 as reported in Modern Healthcare. Just how significant is this to the market? Realistically, United took a cautious wait and see approach. In NYS, for example, they have been the most expensive plan on the Obamacare Exchange Marketplace. They expect to lose over a billion dollars in this space for 2015 and 2016, so to them it makes no sense to stay in that market. The concern for the individual market is to expect large pricing increases in 2017 to reflect the higher risk than the safer Group Market.
UnitedHealth, which had about 795,000 ACA customers as of March 31, warned in November that it was posting losses on ACA policies. In December, the company said it should have stayed out of the individual exchange market longer. UnitedHealth also is withdrawing from some related state insurance markets for small businesses.
See United-healthcare Individual members enrolled by State:
UnitedHealthcare will drop ACA exchanges
MODERN HEALTHCARE
By Bob Herman
April 19, 2016
UnitedHealth Group CEO Stephen Hemsley said Tuesday the health insurance and services conglomerate will pull out of most of its Affordable Care Act marketplaces. But the company won’t bail on the exchanges completely and will sell individual plans in a “handful” of states.
“We cannot broadly serve it on an effective and sustained basis,” Hemsley told analysts and investors on a conference call. UnitedHealth has fully or partially exited five states so far—Arkansas, Georgia, Louisiana, Michigan and Oklahoma, according to various news reports.
The company sold plans in 34 states for this policy year and did not disclose which states it will stay in. Insurers that sell plans through the federal HealthCare.gov portal have until May 11 to file rates for 2017 plans.
A new analysis from the Kaiser Family Foundation, however, notes that UnitedHealth’s exits would only have a modest effect on competition and prices nationally since it has a small ACA footprint and charged higher premiums from the outset.
UnitedHealth recorded an additional $125 million loss on its individual ACA plans, meaning the company’s total ACA losses for 2015 and 2016 will exceed $1 billion. UnitedHealth signed up many sicker-than-expected members, ending the first quarter with 795,000 public exchange enrollees, which is only a fraction of the ACA’s individual market.
The insurer also overpriced its plans in 2015 after barely participating on the exchanges in 2014. UnitedHealth expects its exchange membership will decline to 650,000 by the end of the year.
But despite those heavy losses, which UnitedHealth previewed late last year, the company’s other lines of business like Medicare Advantage and Optum have been making money at a healthy clip. UnitedHealth’s profit climbed 14% year over year, totaling $1.6 billion in the first three months of this year. Adjusted earnings per share rose 17% to $1.81, beating estimates on Wall Street.
Revenue soared almost 25% to $44.5 billion in the first quarter, putting UnitedHealth on pace to hit $182 billion of revenue for the year. The Minnetonka, Minn.-based company recorded double-digit revenue growth across every major segment, including employer, Medicaid, Medicare Advantage and its Optum health services business. UnitedHealth now covers the medical care of nearly 47.7 million Americans.
UnitedHealth’s medical-loss ratio, which shows how much of its premium dollars were spent on medical care or “quality improvement” programs, was 81.7% in the quarter. That was up slightly from the 81.4% posted in the same quarter last year, which UnitedHealth attributed to the leap day.
by Admin. | Aug 5, 2014 | Health Care Reform, United Healthcare
Oxford’s Garden State
OK so this may not be the catatonic movie of our favorite State starring Zach Braff and Natalie Portman but just the same Oxford couldn’t resist using the same logical name for the new network. Starting Sept 1, 2014 Oxford will be offering the Oxford Garden State Network on all size NJ group business. The 18,000 Doctor and 65 hospitals network will answer the call for a flexible lower cost plan option.
Judging by the #1 selling plan – Oxford Liberty HMO the market supports a smaller lower cost quality network. Taking the same playbook Oxford unveiled their plan last Friday. The plan will cover members outside NJ only on emergencies. Unlike the Liberty HMO some plans options are non-gated plans not needing referrals to for access to a Specialist Doctor.
The Garden State Network provides access to the 21 New Jersey counties only.The Garden State Network does not provide national access to the UnitedHealthcare Choice Plus network. For NJ 1-50, up to 4 plan options can be selected and the Garden State products can be paired with Liberty and Freedom network options. With this network, employers can select which of the 13, in-network only plan designs available will work best for their needs and for the needs of their employees.
Oxford/United has been purchasing Provider groups since 2011 , see our post UnitedHealthcare Buying Medical Groups? This strategy of late is by no means exclusive to this Insurer but it is worth pointing them out as they are a national leading health Provider and worth paying attention to.
Some highlights of the plan designs available with the Oxford Garden State Network are below:
∙ Routine, in-network preventive care covered at 100 percent
∙ In-network only coverage
∙ Choice between 11 non-gated and two gated plan designs (gated plan designs will require a referral)
∙ Plan designs with copayments, deductible and coinsurance, and Health Savings Accounts (HSA) are available.
Oxford Garden State FAQ
The_Oxford_Garden_State_Network
Sign up for latest news updates. Please contact us for immediate information on how to implement these initiatives for your group-specific needs at info@medicalsolutionscorp.com or Call (855) 667-4621.
by Admin. | May 14, 2012 | Hospitals, United Healthcare
Oxford /United Healthcare has announced last week their contract termination with the Valhalla teaching hospital, Westchester Medical Center effective May 1, 2012. The NYS “cooling off period” imposes both parties to renegotiate a contract until July 1st. The hospital will be considered in-network until that time.
This marks the second time a large health insurer has terminated their contracts with Westchester medical Center. Empire had terminated their contract on Nov 10, 2010 after a similar dispute and is still not under contract. While contractual posturing is all too common in the health industry with eleventh hour agreements, we are seeing this disturbing trend playing out in other instances now.
We will monitor the situation and keep members posted. Oxford member letters explaing this are going out. Please contact us with any questions.
by Admin. | Nov 2, 2009 | latest health insurance news, Uncategorized, United Healthcare
Health Care Reform!
Americans woke up earlier today to the new Health Care Reform House Bill, “Affordable Health Care for America Act. HR 392”, which completes an important 1st step of 3 stages of a final bill. While I didn’t quite make it through the 1990 page there are couple of items that stood out.
According to The Associated Press the Congressional Budget Office concludes that the public option might actually cost consumers more than private coverage. The bill is expected to fetch close to $1 trillion dollars over 10 years. However, the bill could lead to $104 billion net reduction in deficit by spending cuts, revenue raisers and other bill provisions.
- The bill would create a Health Insurance Exchange system that individuals could use to buy health insurance from private insurers and government-run plans.
- The bill also would provide incentives for the creation of nonprofit, state-based health insurance cooperatives.
- The public option plans would have to negotiate their own rates with providers, rather than using the ultra-low Medicare rates.
- Individual responsibility: A “shared responsibility” section that would take effect in 2013 and covers both individuals and employers. The max tax for individuals would be either 2.5% of persons AGI or cost of average health insurance premiums.
- Employer responsibility: would impose a tax equal to 8% of employee wages on employers over a minimum size that failed to provide health coverage. The payroll tax would be lower for employers with $500,000 to $750,000 in payroll, and 0% for employers with less than $500,000 in payroll costs.
- Forbid plans from basing premiums or denials of care on factors such as pre-existing conditions, race, or gender.
- Close the Medicare Part D prescription drug program “doughnut hole”.
- Provide “affordability credits” to help individuals and families who meet income requirements pay their health insurance premiums, and provide health insurance subsidies for small businesses.
- Require the secretary of Health and Human Services to negotiate drug prices on behalf of Medicare beneficiaries.
- Expand Medicaid.
How will this be paid for? The new costs would be paid for according House Democrats by “making Medicare and Medicaid more efficient, imposing 5.4% tax surcharge on individuals with adjusted gross incomes over $500,000 and married couples with adjusted gross incomes over $1 million; and adopting other tax measures.”
Our reaction is that without a greater focus on health care costs, families and employers will not be able to afford coverage. Health care has tripled in a span of 15 years since 1984 to over $2 trillion and is expected to increase to $3.1 trillion by 2012. Most uninsured have programs available that were absent when I was growing up. You can still be middle class and qualify for state subsidies. Example for NYS is Healthy NY for small businesses and sole prop. as well as Family Health Plus and Child Health Plus.
In the absence of tort reform, however, and an expected 21% reduction in Medicare reimbursement this will negatively affect providers. In speaking with our client physician groups and national polls this could lead unintended consequences such 25% retirement and reduction of new physicians. Could this lead to more prescribing privileges and responsibilities for Physician Assistants, Nurses and Pharmacists?
Malpractice costs account for only 1% of spending but this leads to another estimated 9% is for “defensive medicine”. According to JAMA– “Defen
sive spending is described such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents’ lack of confidence in their liability insurance and perceived burden of insurance premiums.”
The issue of private competition is a big factor. According to Kelly Loussedes, of National Association of Health Underwriters, “By injecting more competition into the insurance market, this might seem like an intelligent way to lower overall health care costs. A “public option” would simply shift health care costs onto private payers — and undermine the private insurance system”. We question how real the private sector can compete with a public plan
however, well intentioned it may be.
In addition, most uninsured in progressive states such as NY are young people who elect not to pay now, illegal residents and people who earn over $50,000 but decide to opt out. The issue how strong is the requirement for individuals to participate? If its like Massachusetts with only a $1500 penalty or not enforced then this creates actually much more costs.
According to Mark Wagar President of Empire Blue Cross, “fewer businesses and individuals purchase private coverage and enrollment shifts to high cost Medicaid coverage, further increasing State funding burdens. In turn, too many people delay needed services, resulting in increased costs for urgent care for hospitals and physicians when care becomes critical.” He goes on to say that in NYS where the non group individual market is unaffordable now “The presence of an effective mandate – alone – would reduce the cost of individual coverage in New York by
over 60 percent and enroll 8 times as many New Yorkers in coverage than today because of improved affordability.”
Progressive countries such as Denmark and France have actually moved to private sector. According to our client Lisa Halpern of Euro Center USA , which works with a Danish travel insurance company for expatriates, “Denmark’s public single payer system had to include the private sector starting more than 20 years ago. This has become increasingly popular in recent years because the public had trouble accessing physicians without longer waiting times, diagnostics and private hospitals. The Private Insurance has also benefitted as a tax deduction for private companies offering additional health insurance.”
We support taking steps to lower costs as mentioned in prior newsletter
such as negotiating with drug manufacturers and implementation of healthcare cooperatives. On the other hand, we are wary of moving
too quickly on this road of reform and leading to unintended consequences. As debate and legislation is clarifying that a public option is a probability we are concerned if this will lead to big government, wasteful spending, higher taxes and the specter of no private sector.
As the saying goes the madness is in the details. As a fellow business owner we ask that you join us in staying active with your local chamber, legislative rep., editorials and social media forums on this road to reform. We have included some helpful links below.
Get Health Care Right!
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