Archive for the ‘Aetna health insurance’ Category

If Aetna Leaves the Exchanges, Others Likely to Follow

Thursday, January 23rd, 2014

With all of the ruckus over the Affordable Care Act, there is one aspect that we haven’t considered yet in this blog.  Health insurance companies might start backing out of the exchanges if things don’t go as planned with enrollment.  So far, not enough young and healthy people have purchased insurance through the exchanges.  This puts the entire plan out of balance because young people help to keep the costs down for everyone involved, including the insurance companies.  According to CNBC’s Matthew Belvedere, “Aetna could be forced out of Obamacare: CEO.”  Aetna’s CEO, Mark Bertolini, worries that the age of enrollment and Medicare changes could force his company out of the health insurance exchanges.  They have to publish their health insurance rates in the exchange for 2015 by May of this year.  As of now, they don’t have enough information to decide whether they will have double digit gains, smaller gains, or have to leave the program altogether.

According to Aetna’s CEO, the majority of people who have bought health insurance in an exchange already had individual health insurance.  They just switched to an exchange to save money because of the available federal subsidies.  Right now, 11% of the people buying in exchanges were fully uninsured before the Affordable Care Act.  That statistic isn’t promising to support the claims that this act would help insure nearly all Americans in an affordable way.  Mr. Bertolini says that the exchanges need more choices in them.  More insurance companies need to offer plans in the exchanges in order for them to actually function like the marketplace they were supposed to.  This will bring more Americans into the exchanges to search for health insurance.  This could also bring more younger, healthier people into the exchanges.  These young Americans help keep rates down for everyone.  Plans from the Afforable Care Act only make up 3% of Aetna’s revenue, so they aren’t concerned about it making or breaking them.  It seems to me that the process is more of a headache to Aetna as it stands now.  Aetna’s CEO forecasts a large number of people using exchanges over the next 6 years, but says the majority of those will be in private exchanges rather than public.


Highmark Blue Cross Blue Shield Sole Insurer in WV Exchange

Saturday, September 14th, 2013

Competition breeds lower costs when it comes to insurance plans and most other things.  So will the fact that there will only be one health insurance company in West Virginia’s exchange mean that premium costs will be less competitive?  We don’t know yet, but we will know more about pricing when the exchanges across America start offering plans October 1.  According to the Cumberland Times-News out of West Virginia in the article, “Insurance market in W.Va. will have one company,” two insurers applied and were accepted into the state’s health insurance exchange, but only one is following through with their plans.  Carelink/Coventry withdrew from the individual health insurance exchange marketplace in West Virginia.  Their parent company, Aetna, reevaluated their overall strategy and determined that they would wait to see what happened with the exchanges in 2014 before offering plans in this state.  They decided to focus on markets where they feel they can be the most competitive and offer the most value to consumers.

Highmark Blue Cross Blue Shield will be the only insurer participating in West Virginia’s exchange when it starts offering plans next month.  They will be offering eleven different individual plans and four small business plans in that particular marketplace.  Each plan will offer different coverage levels with differing costs.  Plan enrollment will start at the beginning of next month, while coverage will start at the beginning of next year.  West Virginians for Affordable Health Care’s executive director believes that premium prices would be better with more competition in the marketplace.  But Highmark Blue Cross Blue Shield might offer great pricing, it’s just not yet available for viewing.  He is hopeful that more health insurance companies will join the exchange in the future, making pricing more competitive.  There is always the possibility that Caremark/Coventry will start offering plans in the future, according to a spokesman for Aetna.

Blue Cross Blue Shield Will Offer Exchange Plans in All Florida Counties

Friday, August 16th, 2013

Florida’s health insurance exchange will open for business on October 1 of this year, with plans taking effect next January 1.  The health insurance exchanges will offer more coverage options to Americans who couldn’t afford health insurance before.  That is the idea at least.  Florida Blue’s Joe Gregor does believe that consumers will have more affordable options and less difficulty finding health insurance when the Affordable Care Act takes full effect.  According to the Orlando Sentinel’s “More details emerge on Florida health insurance exchange,” Marni Jameson said that we now know how many insurers will offer plans in each Florida county.  It’s actually not as many as you might expect, with some counties only having one insurer offering plans.  Blue Cross Blue Shield will be the lone insurer in some of the more rural counties, but they assure Floridians that their prices reflect expected competition and not the fact that they are the sole option in some places.

Ten insurance companies were federally approved to offer plans in Florida, some in one county and some in many of Florida’s 67 counties.  Aetna Life Insurance Company, Blue Cross Blue Shield of Florida, Cigna Health & Life Insurance Company, Coventry Health Care of Florida Inc., Florida Health Care Plan Inc., Health First Health Plans, Health First Insurance Company, Health Options Inc., Humana Medical Plan Inc., and Molina Health Care of Florida Inc. are the ten approved companies.  Blue Cross Blue Shield of Florida will be the only insurance company offering affordable coverage in all 67 counties.  The big counties in South Florida like Miami-Dade and Broward will have nine different choices, but which insurers are operating in which counties has yet to be released.  Palm Beach county residents will have eight insurance choices and most Central Florida counties have five or six different options from which to choose.

Each insurance company will offer different tiers of plans that will range from bronze to platinum.  The lower plans will obviously offer less coverage than the highest plans, but you can choose what you need for the price you will be able to afford.  The government is offering credits to Americans with certain income levels to help pay for the cost of their mandated health insurance.  In order to receive any government help with health insurance though, you have to choose from the federally approved plans.  In 21 counties in Florida, Blue Cross Blue Shield or Florida Blue as they operate in the state, will be the only insurance exchange option.  Other counties will have more choices.  But each county will have at least one insurance company operating in it, something that some state have not yet been able to accomplish.  If you live in Florida and are looking to purchase health insurance through the new exchange soon, you should have some affordable options for coverage.

California Insurance Exchange Gets Even More Options

Wednesday, August 7th, 2013

There have been health insurance exchanges in California for decades, something that much of the country is just starting to understand now.  Since 1996, CaliforniaChoice has been operating a private health insurance exchange in California.  They are the most successful small group private insurance exchange, serving 150,000 individuals and more than 10,000 employers in the state.  This information comes from CaliforniaChoice’s press release “CaliforniaChoice Welcomes Covered California Into the Health Insurance Exchanges Market.”  In addition to their other members, Covered California has now joined this private health insurance exchange.  This is good news for California residents looking for health insurance because more competition, be it in private or public health insurance exchanges, benefits the general public.

CaliforniaChoice has many things to offer in addition to health insurance.  They provide dental, vision, life insurance, and chiropractic care options.  For no cost, they also give added value in the form of employee discounts and online human resources support.  Some of the providers in CaliforniaChoice’s exchange include Health Net, Aetna, Kaiser Permanante, Anthem Blue Cross, Sharp Health Plan, and Western Health Advantage.  Covered California includes options from some of these insurers as well as others.  They also just announced last week the carriers that are going to be part of their new Small Business Health Options Program (SHOP) marketplace.

The success of both public and private health insurance exchanges lies in a combination of great choices for consumers and excellent customer service availability.  In addition to that, qualified brokers are the cornerstone of CaliforniaChoice for their expertise and unbiased information.  Their plans are only sold through brokers.  Small businesses aren’t currently penalized for not offering health insurance or forced to join Covered California’s SHOP program, but rules are changing for some employers when the full Affordable Care Act takes effect.  But as attention to health insurance and exchanges in particular increases across the United States, CaliforniaChoice hopes that more employers will realize that they can offer affordable health insurance to their employees and increase quality of life.

Access Health CT to Open Six Storefronts in Connecticut

Monday, June 17th, 2013

Connecticut is the latest state opening brick and mortar health insurance exchange locations to help match the uninsured with health plans.  In The Bristol Press, Scott Whipple detailed the new locations in his article “Health insurance exchange coming soon to match uninsured with health care plan.”  Originally, Access Health CT, the state insurance exchange, thought that they would be opening seven locations.  After working on their plans for two years, it looks like they will open six locations.  New Britain’s storefront will be in addition to the other five locations in Bridgeport, Hartford, New Haven, Stamford, and Waterbury.  They have yet to finalize the New Britain location, but stress that it will both have plenty of parking and be located very near a CTfastrak terminal.

New Britain’s location was chosen to help match some of the 334,000 uninsured Connecticut residents with affordable health insurance plans for a few reasons.  It is a poorer city, very densely populated, and has a high number of residents who don’t currently have health insurance.  The location should be open on or before October 1 of this year.  Each Access Health location will have brokers on site as well as people there with specific knowledge of the Affordable Care Act and how it will affect uninsured individuals.  They are structuring their storefronts in the way of Apple in order to mimic their way of making it easy to buy a more sophisticated product in a clean, well lit and high-functioning space.

Access Health CT’s chief marketing officer said that the most difficult part of this planning has been that the uninsured have no knowledge of the insurance plans available to them.  One local Connecticut health insurance broker doesn’t think that the state is doing anything different and points out that there are already insurance storefronts where the uninsured could have gone to look for options.  But I do think it will be different for the government run program because of the changes with the Affordable Care Act.  Access Health’s CMO made a career change after the passage of this act to see what will come of the sweeping changes, after working for big insurance names like Aetna and Wellpoint.  While he admits that he doesn’t know it will all work out, he is hopeful that the hundreds of thousands of uninsured residents in Connecticut will be able to find affordable health insurance.

Here’s to Hoping Health Care Costs Don’t Soar

Wednesday, March 27th, 2013

There were many purposes for the Affordable Care Act, not the least of which was to lower health care costs for Americans.  By creating insurance pools to increase competition among health insurers, the idea was that the cost of health care services and premiums would decrease.  While that is still President Obama’s hope, The Society of Actuaries just released a report saying that many consumers may see just the opposite effect.  The Motley Fool’s Sean Williams asks “Is Obamacare About to Skyrocket Your Health Care Costs?”

Some of the other changes being made in addition to creating insurance pools are banning insurers from denying people coverage for pre-existing conditions, mandating individuals to carry health insurance, and  requiring insurance companies to spend 80% or more of the premiums they collect on actual care.  The law also qualifies more patients for Medicaid and creates a medical device excise tax of 2.3% from medical device makers’ revenue.  That last change will help to pay for the expansion of the government sponsored Medicaid program.

So, all of these changes sound great right?  The problem that The Society of Actuaries found is an estimated 32% increase in the cost of underlying claims by the year 2017.  This is an estimated cost for non-group members, or those who don’t have insurance through their employer.  These prices can and should go down with the competition from the created pools, but some states may still see increases.  Ohio and Wisconsin are forecasted to see the cost of their claims go up by 80%.

32 million people who were uninsured will now be able to afford and carry health insurance because of the Affordable Care Act.  In addition to that, many consumers who had very basic health coverage will be able to get better insurance.  But there are some companies and individuals negatively affected by this and making changes because of it.  Stryker, a medical device manufacturer, cut its workforce by 5% because of the new tax imposed upon them.  Aetna increased some premiums by 21% in anticipation of the impending caps on pricing from the law.  Many other companies, including Papa John’s pizza, have complained to lawmakers about the increase in costs to them because of the law.  Is there really any sweeping change that could positively effect everyone involved?

Aetna Insurance Paying for Obesity Pills

Wednesday, November 21st, 2012

One decision made by one health insurance company can really change the ways of the whole industry.  Aetna has made the decision to cover the cost of weight loss drugs for some of its patients.  This not only helps these patients, but the drug makers have seen an increase in stock prices because of this decision by Aetna.  They will be selling more weight loss drugs because of Aetna’s patients, but it also is likely that other health insurers will follow Aetna’s lead and cover the drugs for their patients as well.  This information comes from The Associated Press article “Weight loss drugmakers rise on Aetna Policy Update.”

Vivus Inc.’s Qsymia and Arena Pharmaceuticals Inc.’s Bleviq will now be covered by Aetna for patients who have a medical necessity.  Aetna already covers Pfizer Inc.’s Didrex, GlaxoSmithKline plc’s Alli, and Roche’s Xenical.  Aetna has the third largest enrollment of all health insurance companies in the United States.  With 35% of the population being obese, Aetna has deemed this medical problem serious enough to cover drugs to help take care of it.  Untreated, obesity leads to a host of other medical conditions that may cost insurers much more than these pills.

It’s not yet clear how many more people will be able to receive these drugs with Aetna’s policy update.  Compare other health plans and it’s likely that the largest insurers will follow Aetna’s lead in covering these weight loss drugs.  The FDA has been more willing to approve new weight loss drugs in the last year.  A new drug is expected to be sent for approval next year.  With the news of Aetna’s policy change, Vivus’ shares increased 13% and Arena Pharmaceuticals’ went up by 3.4%.  Orexigen Therapeuticals Inc., who is developing obesity drug Contrave, saw a 6.9% increase in their share price.  Maybe these obesity drugs can help stop the increasing rate of obesity in the United States.

Aetna Health Insurance Covers Prostate Cancer Drug

Saturday, September 29th, 2012

More prostate cancer patients will be receiving treatment with a newer cancer drug.  Previously, metastatic prostate cancer patients whose disease had spread to the brain or lungs were not able to receive Provenge.  Aetna health insurance did not pay for this course of treatment for patients whose cancer had spread to the brain, lungs, or liver.  They still don’t cover Provenge when patients’ cancer has spread to the liver, but have removed the exclusion for brain and lungs.  Toni Clarke’s Reuters story, “Aetna expands coverage of Dendreon drug; stock jumps,” says that the company who makes the drug has seen increasing stock prices because of this announcement.  Dendreon Corp.’s shares have increased ten percent.

Provenge was the first vaccine of its kind on the market when it was approved in April of 2010.  It is a personalized, therapeutic vaccine for cancer patients who have not responded to hormone therapy.  Unfortunately, the price tag of $93,000 per treatment coupled with physicians having trouble and confusion with reimbursement, hasn’t made it as popular as Dendreon thought it would be.  The company projected sales to be around $440 million in 2011, but they only saw around half of that.  Despite the controversy that Provenge has illicited, prostate cancer patients are hopeful that it will extend their life and improve the quality.  Initial clinical trials showed an increase of life expectancy of 4.1 months.  That increased survival time from 21.7 to 25.8 months.  With Aetna health insurance increasing the number of patients allowed to use Provenge, other insurers may follow suit to help cancer patients.

Republican States Hide Health Insurance Exchange Work

Monday, September 17th, 2012

It’s a tough time to be a Republican insurance commissioner right now, especially in a conservative state like Mississippi.  On one hand, the law is mandating that individual states show they will be able to run their own health insurance exchanges by November 16.  But with the Presidential election coming on November 6, some Republican party leaders are hopeful that the mandatory health insurance exchanges will go away if Mitt Romney defeats President Obama in the election.  By waiting to prepare a state health insurance exchange, insurance commissioners run the risk of Republicans losing the Presidential election and them running out of time to set up their exchanges.  If that happens, the federal government will run their exchange for them, which Mississippi’s commissioner does not think is in the best interest of his state.

Reuters’ Anna Yukhananov talked about the tough spot some commissioners are in in the article “U.S. state officials in stealth mode on health exchanges.”  Insurance commissioners in Republican run states have almost been forced to hide the work they are doing to prepare state health insurance exchanges because of pressure from Republican governors and other officials.  Some say that doing any work to follow the law of the Affordable Care Act somehow makes it more legitimate and they urge commissioners to force the federal government to run the exchanges themselves in hopes that they won’t be able to maintain the stipulations of the Act.  Mississippi’s Insurance Commissioner is under pressure from many organizations and political leaders not to organize an exchange, but he thinks it is better run by him than by the federal government in the case that the mandate is not repealed.

January of 2014 is the deadline for states to start running their health insurance exchanges, a mandate which hopes to help insure 16 million Americans that previously had no health insurance policies.  Thirteen states have committed to running their own exchange and seven states have said no way.  The remaining thirty states range from a loose commitment to establishing an exchange to the majority of Republican run states who have people working behind the scenes on their programs just in case they need them.  Insurance companies like Wellpoint, UnitedHealth, and Aetna health insurance would much rather see states run the program than the federal government because they know more of what is important locally.  While those in Republican states are under immense pressure not to conform to rules from the Affordable Care Act, many people don’t actually think Mitt Romney would get rid of the health insurance exchanges if elected.  It seems like it’s in the best interest of every state to at least have a plan, just in case.

Health Insurance Rates Only Part of Customer Satisfaction

Friday, April 29th, 2011

map PAPennsylvania health plans ranked higher in customer satisfaction than the national average in J.D. Power & Associates’ U.S. Member Health Insurance Plan Study.  According to “UPMC, Geisinger, Highmark lead Pa. customer satisfaction rankings” by Bob Graham of Insurance & Financial Advisor, UPMC Health Plan ranked the highest in Pennsylvania.  While health insurance rates are important to consumers, this study also looked at the coverage and benefits, customer service, communications, information, provider choice, claims processing, statements given, and the approval process.  UPMC scored 744 out of 1,000, well above the national average of 696 and significantly higher than Pennsylvania’s average of 714.

Geisinger Health Plan and Highmark BlueCross BlueShield followed UPMC in Pennsylvania’s rankings with scores of 737 and 735, respectively.  Capital Blue Cross and Independence BlueCross also scored higher than the state’s average.  Although Pennsylvania’s scores went down slightly in 2011, compared to 2010, four of the seventeen other regions surveyed saw much more significant declines.  Some of the insurance companies that scored lower than average in Pennsylvania were Highmark Blue Shield, CIGNA, HealthAmerica/HealthAssurance, Blue Cross of Northeastern Pennsylvania, Aetna, and UnitedHealthcare.  Of the 34,000 insurance plan members surveyed, 2,684 were in Pennsylvania.