Tag: health plans

Many Americans can’t afford health costs even with insurance

Posted on by Judith E. Ashton

By Michael Ollove | Stateline.org (TNS)

BALTIMORE — The number of Americans with health insurance has climbed to historic highs during the COVID-19 pandemic, but within that silver lining is a darker hue.

Many Americans have policies that only provide limited financial protection, to the point that many patients report forgoing needed medical care or prescriptions to avoid being hit with punishing out-of-pocket costs.

Those are some of the findings from a new health insurance survey conducted by the Commonwealth Fund, a private research foundation that promotes high-quality, equitable health care.

The survey comes on the heels of other health insurance data, including some released by the US Census Bureau from its annual American Community Survey, attesting that certain pandemic measures, particularly those Congress passed, have ushered more people into health insurance than ever before.

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In 2021, nearly 299 million Americans had health insurance, the most ever, and the number of Americans without health insurance — just over 28 million in 2021 — had dropped by 1.4 million people from 2019, according to the American Community Survey.

During the pandemic, Congress has prevented states from disenrolling anyone from Medicaid, the health plan for lower-income Americans. It also increased subsidies to help pay for individual health plans bought on the Affordable Care Act markets.

Yet the increased insurance hasn’t necessarily provided sufficient financial protection and by extension, necessary medical care.

The Affordable Care Act requires insurance plans to provide specified benefits, but it doesn’t eliminate the copays and deductibles that patients must pay.

“The big ‘but’ is that while it’s great that more people have insurance coverage, it’s also half the battle,” said Gideon Lukens, director of research and data analysis for health policy at the left-leaning research institute, the Center on Budget

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Bright Health Pulling Insurance Plans Including Obamacare From Nine States

Posted on by Judith E. Ashton

Bright Health Group is pulling individual Obamacare and family health insurance plans from nine states, which will force hundreds of thousands of Americans to choose new healthcare coverage for next year.

Thehealth insurance company Tuesday”health insurance company Tuesday said it will “no longer offer Individual and Family Plan products through Bright HealthCare in 2023, or Medicare Advantage products outside of California and Florida.” The announcement came on a day Bright Health said raised $175 million “that is expected to close in the coming weeks and take the business through profitability.”

It’s unclear exactly how many enrollees will be impacted by the decision and faced with choosing new health plans for 2023. Bright Health, which became a publicly traded company just last year, had about 1 million total health plan enrollees projected for 2022, the company has said.

Bright Health couldn’t be reached this morning for comment on how many health plan subscribers would be impacted, but the move impacts customers in at least nine states, according to its press release on the exits.

“With this announcement, in addition to the previously announced market exits, Bright HealthCare will not offer Individual and Family health plans in Alabama, Arizona, Colorado, Florida, Georgia, Nebraska, North Carolina, Texas, and Tennessee after 2022,” the company said.

By scaling back to its largest healthcare markets, Bright Health said the company will be “profitable on an Adjusted EBITDA basis in 2023 and will serve underserved populations through its risk-bearing care delivery business, Medicare Advantage products, and the ACO REACH Program in states that covers 26% of the aging US population.”

“We have demonstrated the power of the Fully Aligned Care Model in serving aging

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Just Six Health Plans Earn Top Scores In NCQA 2022 Health Insurance Ratings

Posted on by Judith E. Ashton

In the landscape of American healthcare, no sector is less trusted than health insurance. According to a 2021 American Board of Internal Medicine Foundation surveyjust 33% of people said they trust health insurance companies, compared with 85% who said they trust doctors.

New data from the National Committee for Quality Assurance (NCQA) suggests this figure may not be improving.

In NCQA’s 2022 Health Plan Ratings, released today, satisfaction with care got worse among members on commercial and Medicaid health plans. Commercial member satisfaction dropped 4 points, from 55.9% last year to 51.8% this year, and Medicaid member satisfaction dropped 2 points, from 58.7% last year to 56.5% this year. Though these changes may look small, they are statistically significant.

The annual ratings evaluate health plans across the commercial, Medicare, and Medicaid segments. Plans are rated on a scale of 0 to 5 stars based on nearly 50 assessments of patients’ access to care, outcomes, experience, and satisfaction. These assessments capture things like how easy or hard it is for members to get the care they need and how satisfied members are with their health plan’s customer service.

The 2022 ratings include health plans serving more than 200 million people, more than 60% of the United States population, according to NCQA.

Overall, just six out of 1,048 health plans in the 2022 ratings earned 5 stars, the best possible score. Of the six top-rated plans, four are Kaiser Foundation Health Plans, including Kaiser Foundation Health Plan of the Mid-Atlantic States, which earned 5 stars in all three insurance categories. Kaiser Foundation Health Plan of Colorado also earned the top score in Medicare.

Kaiser Foundation Health Plans may do particularly well on these ratings because they use an integrated approach, connecting health

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New insurer in Maine’s ACA marketplace to offer hybrid health insurance

Posted on by Judith E. Ashton

Starting this fall, Cumberland County residents will have the option of purchasing a new type of health insurance on the Affordable Care Act marketplace that blends traditional insurance and direct primary care.

Taro Health – a new insurer based in Maine – is offering a potentially first-in-the-nation insurance model that is being teed up for next year. The company’s rates are approved, but plan filings have yet to be finalized by the Maine Bureau of Insurance, so the plans are not yet approved to sell insurance for 2023.

The insurer is targeting about 5,000 people who choose to pay their doctors directly and forgo traditional insurance, a model called direct primary care. Under direct primary care, patients pay out of pocket for routine doctor visits and the type of care that can be done in a doctor’s office, such as diagnosing and treating mild illnesses, some screenings, blood tests and annual physicals.

People who want to switch to a direct primary care doctor would also be eligible for Taro Health plans.

By eliminating insurance paperwork for routine care, direct primary care advocates say, doctors can focus more time on patients and pass on cost savings from not having to process insurance claims.

But that model flounders when patients need specialized care, such as for broken bones, cancer or rare diseases. If they hadn’t purchased insurance in addition to paying direct primary care fees, they would be on the hook for the cost of expensive hospital visits and specialty care. The Taro Health plan is a hybrid of conventional insurance and direct primary care. Members pay a monthly premium for traditional health insurance options and a network of 12 physicians who participate as direct primary care providers.

A COMBINING OF CONCEPTS

“There’s a combining of concepts,” Jeff Yuan, a co-founder of

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Health insurance rates are going up for WNY small businesses and individuals | Business Local

Posted on by Judith E. Ashton

Premiums are going up for small group and individual health insurance across the state and in Western New York – but not by nearly as much as insurers had requested.

The state Department of Financial Services on Wednesday announced it had approved health insurers’ premium rate increases for 2023, with some tweaks. The state reduced insurers’ requested rates by 48% in the individual market and by 52% for small groups, collectively saving the more than 1.1 million New Yorkers enrolled in those plans a total of almost $800 million, the department estimated.

Here’s how that shakes out in Western New York:

  • The entity that includes Highmark Blue Cross Blue Shield of Western New York had sought a 20.5% increase for individuals – 6,457 people enrolled in those plans – but the state accepted an increase of 12.8% instead. For small group plans, which cover employers with up to 100 workers, Highmark had requested a 15.3% increase, with the state approving an increase of 10.7%. Highmark has 74,726 members in its small group plan.
  • Meanwhile, Independent Health requested a 10.2% increase for individuals – 7,641 enrolled – and the state accepted an increase of 6.1%. On the small groups, of which Independent Health lists 26,217 members, the insurer requested a 15.9% increase, but the state approved a 12.9% jump.
  • Excellus Health Plan, which includes Univera Healthcare, had sought 14% increase for individuals – 26,562 enrolled – and the state accepted an increase of 10%. For small group plans, for which Excellus listed 154,316 members, the insurer wanted a 12.9% increase, but the state approved a 9.4% boost.

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The rate adjustments affect people who buy individual commercial health insurance and small employers with 100 or fewer full-time workers, together comprising a small slice of members for the

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Health insurance provider directories often have errors; what to do, a health consumer guide

Posted on by Judith E. Ashton

If you have medical insurance, chances are you’ve become exasperated at some point trying to find an available doctor or mental health practitioner in your health plan’s network.

You find multiple providers in your plan’s directory, and you call them. All of them. But the number is wrong. Or the doctor has moved or retired or isn’t accepting new patients. Or the next available appointment is three months away. Or the provider isn’t actually in your network.

Despite state and federal regulations that require more accurate health plan directories, they still can contain errors and often are outdated.

Flawed directories not only impede our ability to get care. They also signal that health insurers aren‘t meeting requirements to provide timely care — even if they tell regulators they are.

Worse, patients who rely on erroneous directory information can face inflated bills from doctors or hospitals that turn out to be outside their network.

In 2016, California implemented a law to regulate the accuracy of provider directories. The state was trying to address long-standing problems, illustrated by anhealth-exchange-removes-its-physician-directories-because-of-errors.html” data-cms-ai=”0″embarrassing debacle in 2014, when Covered California, the insurance marketplace the state formed after the passage of the Affordable Care Act, was forced to pull its error-riddled directory within its first year.

Also in 2016, the federal Centers for Medicare & Medicaid Services demanded more accurate directories for Medicare Advantage health plans and policies sold through the federal ACA marketplace. The federal No Surprises Actwhich took effect this year, extends similar rules to employer-based and individual health plans.

The No Surprises Act stipulates that patients who rely on information in their provider directories and end up unwittingly seeing doctors outside their networks cannot be required to pay more than they would have paid for an in-network provider.

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Business Health Insurance Company Evry Health Expands Texas Coverage to Austin, San Antonio and Houston

Posted on by Judith E. Ashton

Evry Health’s expansion furthered by company’s accreditation from the National Committee for Quality Assurance

DALLAS, July 18, 2022–(BUSINESS WIRE)–Evry Health, a tech-savvy employer health insurance company, announced today it has expanded its reliable, value-based health care to Austin, Houston and San Antonio. Launched earlier this year with a focus on the Dallas-Fort Worth (DFW) business-to-business market, Evry Health is transforming the healthcare industry with its software automation yielding lowered healthcare costs for businesses, in addition to its model of no deductibles or copays for in-network care and its expansive, tailor-made benefit plans and rewards programs that encourage preventative health and access to care.

“Our expansion within the ‘Texas triangle’ underscores our mission of providing more employers and their employees with increased access to quality, affordable care which is especially important in today’s market afflicted by inflation,” said Chris Gay, Evry Health’s CEO. “Expanding our services outside of DFW will help thousands more people have access to great benefits without having to pay exorbitant prices. Our team has worked hard to provide an innovative group health insurance plan that is within reach for Austin, San Antonio and Houston residents. “

Evry Health is extending its Texas presence beyond Dallas-Fort Worth to these three key cities with in-demand employer health insurance benefits, targeting companies with 100 – 2,000 employees. The company has continued to experience momentum since its launch. It has built and expanded its extensive local medical network, focusing on the highest quality physicians and health systems, in addition to receiving accreditation from the National Committee for Quality Assurance (NCQA).

Accreditation demonstrates Evry’s commitment to quality healthcare – this ranking is based on NCQA’s evaluation of the quality of care patients receive, how happy patients are with their care and health plans‘ efforts to

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Good health insurance retains employees. Modern plan won’t break their banks. |Opinion

Posted on by Judith E. Ashton

Ross Klosterman is CEO and co-founder of Poppins Health of Columbus, a new health plan for small businesses.

When asked the question “Why do health insurance companies exist?” A reasonable person would likely respond that the role of health insurance companies is to use their influence to negotiate and keep healthcare costs low for members.

This same person might then be infuriated to find out that as a single person with effectively no negotiating power, oftentimes, they could potentially end up paying less out of pocket for medical services than what insurance companies negotiate on their behalf.

Which leads us to the following questionable, yet common scenario: A family of four pays an average of $22,000 a year for insurance, in addition to an approximate deductible of $5,000 before insurance even kicks in. How has this gotten to be the norm in the US?

More: Ohio hospitals’ prices differ widely for the same procedures

The answer could lie in how broken healthcare prices are. The vast majority of knee and hip replacements are done with “in-network” providers (meaning insurance has negotiated with them). As a result, the total price – and ultimately what members pay out of pocket – can vary drastically, even within the same facility.

Ross Klosterman is CEO and co-founder of Poppins Health of Columbus, a new health plan for small businesses.

Ross Klosterman is CEO and co-founder of Poppins Health of Columbus, a new health plan for small businesses.

More: How to submit guest opinion columns to the Columbus Dispatch

According to recent data, the cost for the same procedure at a San Francisco hospital has a staggering range of $22,865 to $101,571. Since every hospital and insurance company has a different process in place to determine procedure costsone patient might end up paying thousands of dollars more than someone else at the same location.

Under the traditional health care model, costs

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