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Open Enrollment 2017 Opens This Week Amid Rate Hikes and Fewer Plan Options

Posted by Susan Donegan on Mon, Oct 31, 2016

Federal regulators opened the federal exchange for consumers to browse for plans on Monday, as they announced that rates will be up 25% for the plans for which the tax subsidies are calculated. HHS also warned that more than one in five consumers using the site will only have one insurer from which to choose coverage. The second lowest cost silver plan on the exchanges is the benchmark plan that regulators base tax credits on. That's the rate that is up 25%, which is also the expected overall increase in 2017. (USA Today, 10/24/16)

Health insurance companies are still struggling with improving price transparency in order to gain greater trust from their consumer base. One survey has shown low customer service satisfaction and a need for payers to inform consumers about their financial responsibility. Commercial health payers may lose contracts with employers by lacking price transparency. Adam Russo, CEO of Phia Group, explained that the lack of price transparency led him to self-insure his employees. (HealthPayer Intelligence, 10/24/16)

The White House predicts 13.8 million people will enroll in a health plan on the Affordable Care Act’s exchanges by Jan. 31, the end of the open enrollment for 2017 coverage. That marks a 9 percent increase beyond the 12.7 million plan selections by the end of open enrollment in 2016. (The Business Journals, 10/20/16)

Hundreds of millions of dollars have been invested in dozens of fledgling health insurance companies. More than $1.3 billion was invested in these companies in the United States in 2015 alone, according to CB Insights. With all the funds and fanfare surrounding health insurance startups, how do they plan to change the insurance industry? (Healthcare Dive, 10/19/16)

When the health insurance marketplace opens, many consumers will have a new option for fourth open-enrollment period: standardized health plans that cover basic services without a deductible. With many health plans on the marketplace including deductibles in the thousands of dollars, consumers have complained that they were getting little benefit beyond coverage for catastrophic problems. (The New York Times, 10/17/16)

"Clearly, there are many individuals who are not getting federal premium subsidies who could face significant increases in their costs next year. These increases are likely to be bigger than those that occurred in 2015 and 2016. However, prior to the ACA, annual premium increases were around 10% per year. So, the 2017 rate hikes will be more in line with historical trends," says Caroline Pearson, senior VP at Avalere Health LLC. (AIS's Inside Health Insurance Exchanges.. From INSIDE HEALTH INSURANCE EXCHANGES"Subsidies Insulate Many From Rate Hikes; Millions Aren't Eligible", 9/29/16)

Tags: Healthcare, ACA, healthcare exchanges, HIX

CMS Efforts to Ensure Network Adequacy and Alter Risk-Adjustment Payments

Posted by Susan Donegan on Fri, Sep 30, 2016

CMS is aware that some states may struggle more than others in developing strategies that ensure network adequacy, especially those with large rural populations. So, CMS is teaming up with Medicaid directors to create a guidance that will read more like a best-practices document, James Golden, director of the agency's division of managed-care plans, said at the Medicaid Health Plans of America conference. (Modern Healthcare, 9/22/16)

HHS’s proposed Notice of Benefit and Payment Parameters for 2018 could alter the way risk adjustment and other tenets of ACA exchanges work, but the provisions, to keep carriers on the exchanges or bring back those that have left, failed to impress Wall Street or ease concerns of insurers. One major analyst said the sheer complexity of the formulas used by HHS is one of the reasons few health plans make money on public marketplaces. (Health Business Daily, 9/20/16)

Urban Institute researchers found that, in more than three-quarters of states and 80 percent of the large metropolitan areas they studied, total premiums were lower in an average marketplace plan than in employer-provided plans. "It's not that these markets are necessarily outrageously expensive -- in the vast majority of cases they're not," said Linda Blumberg, a senior fellow in the health policy center of the Urban Institute. However, most people who receive health insurance through their employers directly pay only a portion of the premium each month. The rest is paid by the employer, as part of workers' compensation. (Washington Post, 9/19/16)

President Barack Obama urged U.S. insurers offering coverage next year on the exchanges to step up their efforts to enroll those who remain uninsured, especially younger and healthier Americans. His administration will help find and enroll those who still lack coverage, with a particular focus on enrolling young adults. (Fortune, 9/13/16)

Blues Plans Updates:

Blue Cross Blue Shield of Tennessee, the state’s largest health insurer, announced plans to exit the federal health exchanges in Nashville, Memphis and Knoxville next year. The insurer cited considerable losses and the ongoing uncertainties on the individual health marketplaces created under the Affordable Care Act (ACA) as reasons for the withdrawal. (Insurance Business America, 9/27/16)

Blue Cross Blue Shield of Nebraska (BCBSNE) plans to discontinue its ACA products due to poor financial performance threatening the payer’s responsibility “to remain stable and secure.” (Fierce Healthcare, 9/26/16)

Blue Cross Blue Shield of North Carolina (BCBSNC), has announced that it will continue offering ACA exchange plans. (Fierce Healthcare, 9/26/16)

Tags: Healthcare, health reform, ACA, healthcare exchanges, HIX

Operational Adjustments in the Health Care Marketplaces as Plans Leave the Exchanges

Posted by Susan Donegan on Mon, Sep 12, 2016

CMS said it plans to roll out a pilot program to assess the effect of more stringent requirements for people signing up for insurance through the ACA's public exchanges outside of the open enrollment period. "Our intent in conducting such a pilot would be to evaluate the impact of pre-enrollment verification of special enrollment period eligibility on compliance, enrollment, continuity of coverage, the risk pool, and other outcomes. The scope of the pilot is still being determined." (Business Insider, 9/6/16)

To help make it easier for consumers to choose health insurance plans, the federal government, is encouraging insurers to offer “simple choice plans” as an option this fall. The goal is to make comparing plans easier for consumers, according to a report from KHN. Acing the consumer shopping experience is crucial for the success of offering standardized plans. “Otherwise you might as well not bother,” Sabrina Corlette of the Georgetown Center for Health Insurance Reform told KHN. (Fierce Healthcare, 9/2/16)

Aetna, UnitedHealthcare and Humana–the company Aetna recently tried to merge with–are all leaving exchanges. On top of these departures are smaller providers, including several government-funded carriers. The biggest problem cited is demographics. Namely, the people signing up for the program are older and sicker than expected. Some may also be taking advantage of insurers by waiting until they are sick or need medical help to sign up. (Law Street, 9/1/16)

Federal officials continue to make operational adjustments in the health care marketplaces and meet with some insurers to encourage them to offer more plans in areas of the country that are forecast to be low on competition following the withdrawal of some major insurers for 2017, said Department of Health and Human Services Secretary, Sylvia Burwell. (Kaiser Health News, 9/1/16)

A new McKinsey & Co. analysis of regulatory filings for 18 states and the District of Columbia found that 75% of the offerings on their exchanges in 2017 will likely be health-maintenance organizations or a similar plan design known as an exclusive provider organization, or EPO. Only a quarter of the exchange plans next year would still be preferred-provider organizations, or PPOs, with a larger selection of doctors and hospitals and include out-of-network coverage. (Wall Street Journal, 8/31/16)

The Obama administration will roll out a big push later this year encouraging the 28.6 million folks who remain uninsured to sign up when open enrollment begins in November. An enrollment boost would likely signal that healthier people are entering the market. Providing coverage on the individual exchanges remains a struggle. Insurer downsizings mean that 19% of all enrollees will only have a single company to choose from, up from 2% this year, according to a new Kaiser analysis. And 38% of enrollees may only have two insurers in their exchanges. (CNN Money, 8/29/16)

Tags: healthcare reform, ACA, healthcare exchanges, HIX

Rising Health Plan Rates, Health Plan Consolidation and Competition on the Exchanges

Posted by Susan Donegan on Thu, Aug 25, 2016

We’re reading about health plan changes for 2017 Open Enrollment and the impact of competition on the exchanges. Here’s a summary of interesting news, perspectives and datapoints.

As rates for health plans sold on public exchanges continue to rise higher than expected, causing large insurers to cut and run from this marketplace, brokers and advisers are gathering useful information. Plans in the employer market are borrowing lessons learned from the exchanges in terms of ways to evolve their product designs to be more efficient,” explains Caroline Pearson, senior VP of Avalere. (Employer Benefit Adviser, 8/22/16)

The health insurance market seems to be heading toward more and more consolidation as the major payers Humana and Aetna along with Cigna and Anthem seem to be bent on merging, even though the Department of Justice filed suit to block the deals. More payers are moving outside of the exchanges, the tensions are pointing at some of the faults within the ACA, which may have brought difficulties that stand in the way of keeping revenue stable among top insurers. (Health Payer Intelligence, 8/19/16)

Competition on some exchanges will be diminished next year when three of the nation's largest health insurers — Aetna, UnitedHealthcare and Humana — will sell individual plans in many fewer markets. The departure of several Blue Cross and Blue Shield plans in various states will also hurt. These pullbacks also come on top of the closure of 16 nonprofit co-ops. What's ahead for consumers depends very much on where they live. (NPR, 8/18/16)

Roughly 20 million more Americans have health insurance now than when President Obama’s health care law was passed in 2010. There are still about 24 million adults with no coverage, according to a survey by the Commonwealth Fund, a health research group. That translates to an uninsured rate of about 13 percent, down from 20 percent in 2013. (New York Times, 8/18/16)

Projected Losses on the Exchanges

Tags: ACA, healthcare exchanges, Health plan, HIX

New Plans Being Added While Existing Plans Are Coming Off the Exchanges

Posted by Laura McMullen on Fri, Jul 29, 2016

We’re reading about exchange plan comings and goings and the impact of the ACA on the federal budget. Here’s a roundup of interesting datapoints, perspectives, and news.

Aetna and Gateway Health are forming an accountable care organization and releasing a new individual insurance plan to sell on in time for the 2017 open enrollment period. The new plan Aetna Leap offers lower overall out-of-pocket costs for members who see providers within the new Aetna Whole Health–Gateway Health network. (Healthcare Finance, 7/15/16)

7 ... of the 23 original Consumer Operated and Oriented Plans (CO-OPs) under the ACA will sell coverage on the exchanges this fall, with the remainder on the financial ropes. (AIS Health Business Daily, 7/26/16, Click here to read the INSIDE HEALTH INSURANCE EXCHANGES article in which this datapoint appeared — "With 16 CO-OPs Out, MCOs May See Smaller Risk-Adjustment Payouts" Free for HEX subscribers; $17 for non-subscribers.) For a refresher on CO-OPs, take a look at our blog postfrom 10/15.

Humana Inc. plans to greatly reduce the plans it offers through public health insurance exchanges and stop offering coverage in “substantially” all other individual markets next year. The health insurer said “individual business remains very challenging.” With the change, Humana said its 2017 “presence for its individual offerings is expected to cover no more than 156 counties across 11 states, down from 1,351 counties across 19 states in 2016.” (Business Insurance, 7/21/16)

The federal government's deficit for this year is expected to be $600 billion, or about $16 billion lower than what was predicted this past February, according to amid-year analysis released Friday by the White House. Lower-than-expected enrollment in the Affordable Care Act's public health insurance exchanges shaved $6 billion off federal spending. (Modern Healthcare, 7/15/16)

Questions about access and consumer preferences continue to be in the news as the debate about the future of the Affordable Care Act continues. House Ways and Means hearings on July 12 resulted in lawmakers agreeing that the ACA isn’t working as intended and that enrollment is lower than anticipated. (AIS Health Business Daily, 7/25/16)

Access to healthcare remains a challenge through the Affordable Care Act and commercial health plans, according to a study in the July issue of Health Affairs. The study investigated two questions: first, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? (Managed Healthcare Executive, 7/22/16)

43% ... of young adults (age 18 to 34) are willing to consider a network without their current provider for a lower premium, according to a recent survey by the Deloitte Center for Health Solutions. (AIS Health Business Daily 7/27/16, Click here to read the HEALTH PLAN WEEK article in which this datapoint appeared — "Insurers Are Learning the Do's And Don'ts for Selling to Millennials" Free for HPW subscribers; $17 for non-subscribers.)

Tags: Affordable Care Act, ACA, healthcare exchanges, HIX

Carrier Offerings on the Exchanges and Employer Preferences in the Commercial Group Market

Posted by Laura McMullen on Fri, Jul 08, 2016

We’re reading about carrier offerings and costs on public exchanges and employer preferences in the commercial group market. Here’s a roundup of interesting datapoints, perspectives, and news.

Health insurers are announcing their intentions for the 2016-17 open enrollment period:

And requesting rate increases:

  • Credit Suisse reports that 20.7% is the average increase in the price of plans that will be sold in 2017 through public exchanges. (AIS Health Business Daily, 6/22/16, From INSIDE HEALTH INSURANCE EXCHANGES)
  • Arizona Blue has requested a rate increase of 65.9% and will be the only exchange option in every county in the state. Phoenix Health Plans requested a rate increase of 60.4%. (Arizona Republic, 6/13/16)
  • Louisiana Blue Cross Blue Shield requested rate increases ranging from 20.5% to 28.3% on average for the various plans offered on the exchanges. Their plans cover about 70% of the people in the individual market in that state. It’s (New Orleans Times-Picayune, 6/6/16)

Employers are still offering health insurance to their employees: "Everyone thought [the Affordable Care Act] was the curtain call for small businesses...that they would just drop off coverage and send their folks to the exchanges. We haven't seen that happen. In fact, we've seen a bit of resurgence in small group in the last several months and are growing slightly in terms of overall membership." — Brian Cheney, divisional vice president of small business at Health Care Service Corp., which operates Blues plans in five states, told The AIS Report on Blue Cross and Blue Shield Plans*.*. (AIS Health Business Daily, 7/6/16, Click here to read the THE AIS REPORT ON BLUE CROSS AND BLUE SHIELD PLANS* article in which this quote appeared — "Death of the Small-Group Market Has Been Greatly Exaggerated, Blues Plans Say" Free for THE AIS REPORT subscribers; $17 for non-subscribers.) * Not affiliated with the Blue Cross and Blue Shield Association or its member companies. (AIS Health Business Daily, 7/6/16)

And they see opportunities to make improvements for their employees:

  • “Employers are doubling down on opportunities to impact health care quality and costs at the source — by working more closely with high-performing providers through select networks and providing better information to help employees make higher-value health care choices,” stated a report by the Pacific Business Group on Health (PBGH) for the American Health Policy Institute (AHPI). (AIS Health Business Daily, 6/16/16)
  • 85% ... of employers that evaluated private health insurance exchanges opted to not move forward, with the main reason being unproven cost savings. About half were also concerned about employee disruption, according to employer surveys by Chicago-based Pacific Resources Benefits Advisers, LLC. (AIS Health Business Daily, 6/23/16, From INSIDE HEALTH INSURANCE EXCHANGES "Private Exchanges Are Evolving, But Firms May Lack Motive to Adapt”)

How are these trends playing out in your market? Are these rate increases an opportunity for you? What about the employer interest in high-performing networks?

Tags: ACA. healthcare exchanges, ACA, HIX

Voluntary Ancillary Growth is a By-Product of ACA

Posted by Laura McMullen on Fri, Jun 24, 2016

Business is booming for insurance companies specializing in ancillary benefits for employer groups – and the mandated benefit requirements of the Affordable Care Act are driving the growth. A 2016 study of Form 5500 Schedule A data by analytics firm, miEdge, valued the market at more than $1 billion in 2015, a gain of 3.32% over the previous year.

Employee Benefit Advisor interviewed four ancillary companies with double-digit growth to learn more about their strategies to capitalize on this trend. Click here to read the article. Here are some highlights:

  1. Medical premiums are still growing in part due to mandated benefit provisions in the Affordable Care Act. Brokers and employers are looking for ways to offer comprehensive benefits without raising overall cost and voluntary ancillary options fit right in.
  2. Private exchanges make it easier to offer a mix of voluntary and employer-paid benefits from multiple carriers. Employees are comfortable with e-commerce so online enrollment is business-as-usual.
  3. Pediatric dental care is required by the ACA creating a new market for dental benefits. More interest and education about dental has opened the door to other ancillaries, such as vision (often sold with dental) and even legal plans.

Employee Benefit Advisor reported “the top five grossers in voluntary benefits, according to miEdge, were Delta Dental of Rhode Island (up 105.59% and over $40 million), Delta Dental of Illinois (up 99.34% and over $46 million), Combined Insurance Company of America (up 82.03% and over $81 million), Hyatt Legal Plans (up 21.12% and over $15 million), and Principal Financial Group (up 20.83% and over $14 million).”

How is your company capitalizing on this trend?

Tags: Affordable Care Act, Ancillary benefits, ACA, insurance companies, employee benefits, HIX

ACA Impact on Employer Plans, Challenges Facing Public Exchanges, and Premium Increases in 2017.

Posted by Susan Donegan on Fri, Jun 03, 2016

ACA is beginning to have an impact on employer plans. Both employers and employees have changed their behavior in response to the ACA, research shows these changes are directly related to cost. (Employee Benefit Adviser, 5/31/16)

25% ... of Medicare Advantage enrollment would reside in the combined firm formed by Aetna Inc.'s planned purchase of Humana Inc., if no divestitures are required, according to a new report from the Kaiser Family Foundation. (AIS Health Business Daily, 5/30/16, From MEDICARE ADVANTAGE NEWS)

One of the biggest challenges facing the public exchange system according to Dr. Jonathan Gruber, Ford Professor of Economics at Massachusetts Institute of Technology, is “adverse selection,” a phenomenon that occurs when healthy people switch to more affordable insurance plans when their premiums rise, while those with more serious or persistent health issues remain on the richer plans. As a result, the members who remain on the richer plan experience exorbitant premium hikes in order to offset the unhealthier group’s rising medical costs. (Northwestern Kellogg MacEachern Symposium. 5/27/16)

Employers are searching for solutions to meet their health plan needs, reduce costs and provide the optimal benefits to their employees. Healthcare regulations are making quite an impact on employers when it comes to picking the right health plan solutions, especially when it comes to the employer mandate and the Cadillac Tax. Employers are searching for options that would reduce their overall spend. (HealthPayer Intelligence, 5/27/16)

Losses during the first few years of the ACA are driving some health plans to seek substantial premium increases in 2017 for individual plans sold through the exchanges of more than a dozen states, according to The Wall Street Journal. The proposed increases made public so far illustrate how insurers are responding to the ways the ACA has changed how healthcare coverage is priced and sold in the U.S., according to the report. (Becker’s Hospital Review, 5/26/16)

Nearly 25% ... of the people who purchased 2015 health coverage through a public exchange stopped paying their premiums at some point during the year, yet most repurchased an exchange plan for 2016, according to a McKinsey & Co. report. (AIS Health Business Daily, 5/24/16, Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this datapoint appeared. Free for HEX subscribers; $17 for non-subscriber)

Tags: healthcare benefits, ACA, healthcare exchanges, HIX, Employer Plans

CMS Targets Special Enrollments, Quality Star Ratings, and Provider Network Inaccuracies

Posted by Susan Donegan on Fri, May 13, 2016

Aetna Inc. expects to continue selling Affordable Care Act exchange plans in 15 states, and the insurer said it may expand into new areas. Aetna Chief Executive Mark T. Bertolini told analysts that Aetna still saw its position in the ACA marketplaces as a “good investment.” But he also made pointed comments about the need for changes to the law to ensure a sustainable business. (Wall Street Journal, 5/11/16)

CMS tightened the use of special enrollments, specifically making the rules around moving to a new home more restrictive to avoid any gaming of the system. Co-ops also can seek outside funding from investors to build up their capital, something that was outlawed previously. CMS Acting Administrator Andy Slavitt told the Senate earlier this year that he thought allowing private investors to inject money into the co-ops would give them a better chance to be successful. (Modern Healthcare, 5/6/16)

Data from the first three years of Affordable Care Act marketplace plans will provide insurers a clearer picture of healthcare costs, allowing for more accurate premium pricing for 2017 that could offer sustainability within the marketplace, according to a report from the Kaiser Family Foundation (KFF). Policy experts say additional data collected over the past three years will offer more certainty as insurers attempt to align premiums with healthcare costs. (FierceHealthPayer, 5/6/16)

Anthem, Inc. "is well-positioned to continue growth through the exchanges if the market stabilizes. The insurer would like to roll out] more creative and innovative products on exchanges." — Anthem Chairman, President and CEO Joseph Swedish said in a recent conference call with investors to discuss first-quarter 2016 earnings (AIS Health Business Daily, 5/5/16 Click here to read the INSIDE HEALTH INSURANCE EXCHANGES E-ALERT in which this quote appeared. Free for HEX subscribers; $17 for non-subscribers).

CMS is delaying the quality star ratings of health plans on the federal and state-based marketplaces that use the federal platform, from 2017 to the open enrollment period for 2018. The delay will give CMS additional time to conduct focused consumer testing of how the star ratings are displayed on The star ratings provide consumers with comparable information about the quality of healthcare services through survey data on enrollee experiences. (Healthcare Finance, 5/5/15)

CMS intends to fine and impose enrollment sanctions on Medicare Advantage plans with substantial errors in their reported provider networks. In its final year, the Obama administration will use waning resources to go after managed care plans for a decades-old problem—provider network inaccuracies. Medicare Advantage oversight is one more step in a building reaction to “narrow network” health plans that spans regulators and markets. This reaction is remaking how regulators oversee health plan provider networks, and will check the drive to narrow networks just as the business case for doing so grows more compelling. (Managed Healthcare Executive, 5/2/16)

Tags: healthcare reform, ACA, HIX

Private Exchanges: High Interest and Slow Adoption

Posted by Laura McMullen on Fri, Apr 29, 2016

Accenture.jpgEnrollment growth in private exchanges grew 35% in the first quarter of 2016 to 8 million people, according to Accenture, or about 5% of the employer sponsored insurance market. While not the exponential growth some experts predicted, it’s enough growth to attract new entrants like Fidelity, ADP, and Zenefits to the employee benefits market. Many people are still expecting a steep growth curve as employers look for ways to reduce costs and streamline administration.

A recent survey by Employee Benefit News/Employee Benefit Advisor and SourceMedia Research found that 20% of the 273 firms surveyed were using an exchange, in the process of moving to an exchange, or considering the option. A further breakdown of these responses shows 17.2% are “considering, but not planning” to switch to a private exchange platform while the remainder are either “planning, but not implemented” or using an exchange. No employer in the survey with fewer than 100 employees has moved to an exchange yet.

What’s holding employer groups back?

The “Cadillac tax” is widely thought to be suppressing growth in private exchanges. “The Cadillac tax itself was a driver for people to drop the more expensive health plans, and therefore … it was considered to be a driver to a private exchange, but frankly, given that it's delayed now, I would say if anything the growth that you were expecting from that is not probably going to be there,” Jay Godla, Chicago-based partner with PricewaterhouseCoopers L.L.C., which doesn't operate an exchange, told Business Insurance.

Other reasons frequently cited in the EBN/EBA study for not moving to a private exchange are:

  • Private market is not mature enough (37.7%)
  • Unsure about the employee experience (28.1%)
  • Not enough information (23.1%)
  • Unsure of costs (23.1%)
    (Respondents could choose multiple answers)

But they’re still interested…

"Growth [for private exchanges in 2016] will continue to be slow. Employers seem to like the concepts that private exchanges offer — such as online enrollment, broader choice, decision support, defined contribution, voluntary integration — better than they like the private exchanges themselves, " Mike Smith, Lockton Benefit Group's director of exchange solutions, told AIS's Inside Health Insurance Exchanges.

And the big payoff will be in employee engagement. Employees who use private exchange decision support tools and have high-deductibles and other cost-sharing plan features are more engaged than those who have to accept a plan that their employer selected. Some of the exchanges sponsored by benefits consultants go one step further and offer care management options. In Employee Benefit Advisor, Barbara Gniewek, a principal in the healthcare practice of PricewaterhouseCoopers who oversees the Private Exchange Evaluation Cooperative, says “the two consultancies that offer care management overlays typically state savings of between 1.5% and 3% over carrier-only models.”

And a lot of companies are betting that the combination of lower costs, streamlined administration, and higher engagement will be worth buying by investing in platform-vendor exchanges like Liazon (purchased by Towers Watson in 2013) and bswift (purchased by Aetna in 2014), or building their own capabilities like Aon Active Health Exchange and Mercer MarketplaceSM.

When do you expect to see more employers entering the private exchange market?

Tags: ACA, healthcare exchanges, employee benefits, HIX, Private Exchanges





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