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.
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 firstname.lastname@example.org.
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.
Insurance mergers aka Mergersurance Mania continues at a steady pace with April 2016 Florida’s approval of Anthem Blue Cross and CIGNA merger. This is one month after Florida approved the Aetna and Humana merger. Investors have given their blessings to be sure while 10 States have also given approval. The Anthem Cigna $54 billion merger leaves only three national major providers of health care. Worries remain about the potential effect on consumers and the rising cost of health care.
Health Insurers consolidation argument are that they need to be able to merge in order to absorb added costs and blunted profit margins under the Affordable Care Act. Additionally, medical groups and hospitals groups have merged themselves rapidly giving them negotiation cost controls. This has traditionally been trending in smaller regional markets but are now also felt in major US Cities.
Evidence indeed is pointing to expected large insurance increases due to overwhelming market domination by hospitals. While Doctors and AMA are rightfully concerned about Insurer mergers the vast majority are now working for a Hospital System or Medical IPA.
Without public outcry there seems to be lax Regulator oversight and the arms race should not come as a surprise. On the local level we have yet to see a recent example of hospital merger that was curtailed.
This goes well beyond political partisanship. In a tight Presidential race it is important to understand that whether or not one supports a Single Payer we all suffer. This is bad for consumers, providers and tax payer all around. In an Oligopoly health care system with lack of competition the U.S. tax payers are also stuck with inflated costs.
Breaking: All Health Republic plans (Group and Individual) ending on 11/30. according to early reports the healthcare Co-Op Health Republic NY will be shutting down Nov 30, 2015. New York State Department of Financial Services (NYDFS), the New York State of Health Marketplace (NYSOH), and the Centers for Medicare and Medicaid Services (CMS) announced additional actions regarding Health Republic Insurance of New York (“Health Republic”) and a transition plan for Health Republic customers.
Oct 28th – Utah Healthcare Co-Op shutting down end of 2015. This sis the 5th Co-Op to shut down
June 2015 – With a spike in rate increase of 15-20% for 2016 to reflect unexpected high costs of new 200,000 membership the most affordable health plan was experiencing difficulties. The insurer reported $130 million in losses during its first 18 months of operations, according to financial filings, even as it enrolled more customers than any other insurer. DFS did allow for a 13 percent increase in the second year and a 14 percent increase heading into 2016. Both were lower than what Health Republic requested, though, and were not enough to save the struggling insurer.
May 2015- Health Republic was dealt its death blow when it became clear that the Affordable Care Act’s risk corridor program would not be fully funded, said one source familiar with the company’s finances. A report from Standard & Poor’s in May said the program had only 10 percent of the funds needed to make payments.
Summer 2013 -Health Republic had borrowed $265 million to begin operations.
New Insurance Risk Corridors paid for by a combination of both consumer insurance premium surcharge tax of 2-3% and Health Insurers is suppose to reclaim capital to those that are less profitable. Health Republic was owed approximately $147 million but was told by the Centers for Medicare and Medicaid Services to expect less than half that according to sources.
Regrettably, we all suffer when an Insurer exits the market. Furthermore, it will be a while again when Federal funds earmarked to start a low cost affordable health plans will materialize again. We are pulling for neighboring co-op Health Republic of NJ and hope this trend discontinues.
Our agency will be working closely with our clients to mitigate this exposure and transition smoothly for Dec 1, 2015. Individuals on the Marketplace can contact the New York State Department of Financial Services Consumer Hot Line with questions regarding Health Republic by calling 1-800-342-3736. The Hot Line hours are weekdays (Monday through Friday) from 8:00 a.m. to 8:00 p.m., and Saturday from 9:00 a.m. to 1:00 p.m.
Please Click here to read the full Press Release from NYDFS.
Stay posted, more news to follow. Our Agency as in the past will be out and early in front positioning our clients for best options. For more information on this or to schedule a call please contact us email@example.com today.
Breaking News President Announces Cancelled Policies Fix
Yesterday, the President announced that people with health care coverage that is not Affordable Care Act (ACA)-compliant may be able to keep their plans in 2014. Effectively “Grandfathering” of plans purchased after the original law has passed in 2010 There has been a great deal of concern being reported in the national media around the prospect of millions of people losing their health insurance coverage effective January 1, 2014 because of the Patient Protection and Affordable Care Act (“PPACA” aka “ObamaCare”).
We are awaiting how specifically your State’s Insurance Commissioner will react to this. Questions remain about how this new policy will work, including how insurance commissioners will react, whether insurance companies will choose to continue these policies, what the rates for the policies will be, and whether this grandfathering will extend past 2014.
To be clear, what’s being reported principally has to do with the individual health insurance market in the US which insures approximately 15 million people, or about 5% of the country’s population. Within that segment of the privately insured market, a large percentage, certainly more than half, of individual policies are not considered to be “grandfathered” under the law’s requirements for such status. As a result, to be in compliance with the law’s new mandates and coverage requirements, virtually all “non-grandfathered” policies are scheduled to be terminated January 1st, and it will be up to individuals to replace their existing coverage with new compliant policies after this date.
These recent developments have resulted in
1) President Obama issuing an apology to affected individuals on November 7th.
2) the President’s announcement earlier yesterday during a hastily called press conference at the White House that pursuant to an Executive Order, Americans may keep individual health insurance policies they were told will be canceled because these policies failed to meet requirements established by the new law.
President Obama has left it up to the states to independently determine how they will go about implementing this change which is being characterized as an “administrative fix”. However, since the insurance business is state-regulated, each state will need to determine whether or not they will implement this change, and if they choose to implement it, they will have control over defining some of the specific parameters. Insurance companies will also need to quickly make decisions on how to accommodate this new provision if the change is adapted in a state in which they operate.
In closing, if you should have any further questions or comments about the above or the attached, please let us know.We will continue to monitor this issue and all ACA implementation in an effort to keep you informed of new developments. In the meantime, please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
Breaking Westchester Health Care News: As reported in The Journal News earlier. A Stellaris Hospitals Break Up is planned; Phelps, Lawrence, Northern Westchester and White Plains may form new alliances. Stellaris had been in the news in recent years with down to the wite negotiations with Empire Blue Cross Empire & Stellaris Reach Pact effective 8/1/10.
A Stellaris Hospitals Break Up is not surprising. This is viewed as possible strategic move for acquisition form larger local hospitals or even national chains such as Cardinal Health or HCA. Insurers have also purchaszed recenlty medical groups,see UnitedHealthcare Buying Medical Groups? Will it our market allow an Insurer to purchase a Hospital?
4 hospitals seek to cut Stellaris ties
By Jane Lerner
Four hospitals in Westchester County want to cut ties with their parent organization — a move that could signal their interest in forming new consolidations and alliances with other health-care facilities.
Phelps Memorial Hospital Center in Sleepy Hollow, Lawrence Hospital Center in Bronxville, Northern Westchester Hospital in Mount Kisco and White Plains Hospital are seeking to leave the Stellaris Health Network.
“Stellaris and its member hospitals made this decision after a lengthy strategic review that evaluated a variety of alternatives to respond to a dynamic and ever more challenging health-care environment,” Stellaris said in a statement.
The state Department of Health has to approve any change in ownership of a hospital. Requests from the four hospitals to “dis-establish” Stellaris as “active parent and co-operator” were filed with the state last week.
Leaving Stellaris will enable each hospital to seek new partners.
“By becoming independent, each hospital can move forward in the direction that each feels is best for its community,” said Arthur Nizza, who is on his way out as president and chief executive officer of Stellaris.
All four hospitals declined to comment.
As the parent organization of the four hospitals, Armonk-based Stellaris handled their negotiations with commercial insurance companies, purchasing and information technologies.
Stellaris will continue to provide IT support and some other services to the hospitals. But once they leave the network, they will be able to seek new partners to increase their bargaining power and share services and expenses.
Numerous hospital consolidations and mergers are taking place nationwide.
“I think in time — not immediately — the idea of a freestanding community hospital is going to be passe,” said Kevin Dahill, president of the Northern Metropolitan Hospital Association, an industry group.
Sound Shore Medical Center in New Rochelle and its Mount Vernon Hospital are seeking to merge with Montefiore Medical Center in the Bronx once the Westchester County institutions emerge from Bankruptcy Court. In New York City, Mount Sinai Medical Center and Continuum Health Partners, a network that includes Beth Israel and two St. Luke’s-Roosevelt campuses, agreed last week to merge.
“Hospitals are doing what they have to do to position their organizations,” Dahill said.
Stellaris was formed in 1996 as an alliance between White Plains and Northern Westchester hospitals. In 1997, Phelps and Lawrence joined and, in 2000, the company formed an emergency medical service to provide paramedic service to part of Westchester.
Nizza will become CEO of St. Francis Hospital and Health Centers in Poughkeepsie next month. Sharon Lucian, who has been with Stellaris since 1999 and is vice president and chief financial officer, will replace him.