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 UnitedHealthplans 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.
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 info@medicalsolutionscorp.com.
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.
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.
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.
United Healthcare Dropping Medicare Docs. United Healthcare has notified 10-15% of its Medicare Advantage Providers that they will be dropped from their network this February.
Providers are calling the move by the insurer to increase their star rating in order to increase Medicare (CMS) reimbursements. Quality-incentive payments to insurers under CMS’ five-star rating system for health plans will get stricter in 2014, eliminating payments to any plan earning fewer than four stars. Over the past two years, plans with 3 or 3.5 stars received payments.
According to today’s WSJ article UnitedHealth Culls Doctors From Medicare Advantage Plans – The company said it is managing its network, in part, to provide more value for members, particularly given Medicare’s new five-star rating system that ties bonus payments for insurers to certain measures of cost and quality.”That’s what’s driving our actions,” said Austin Pittman, president of UnitedHealth’s networks. He also said, “It’s no secret that we are under substantial funding pressure from the federal government.”
According to a study by the Kaiser family Foundation, United received $540 million in bonus payments in 2012 — the largest share for any single carrier. United had a CMS rating of 3.17 stars that year, according to the study.
This is important as AARP endorses the popular AARP Medicare Advantage Insurance Plans, insured by UnitedHealthcare Insurance Company. According to WSJ article AARP issued a
statement saying it “has heard from a small number of our members regarding this decision” and was encouraging anyone with concerns to contact UnitedHealth directly.
The article points out “Medicare Advantage, an alternative to traditional Medicare, combines hospital and doctor coverage and often includes prescription drugs and perks like gym memberships. Enrollment has more than doubled since 2004 to 13 million in 2012, which represents about 27% of Americans on Medicare.” Also worth noting, “providers have the right to an appeal within 30 days.”
2014 Medicare Open Enrollment is here. Medicare Open Enrollment for 2014 ends Dec 7th. We, at Millennium Medical Solutions Inc, are working closely with affected members to help them find new providers and that patients enrolled in its commercial, Medicaid and Medicare supplement plans are not affected by the changes. Some members may turn back to original Medicare as a result of possibly losing their Doctors.
Download a Copy Of The Medicare and You 2014 Handbook Here.
Is your Doctor still in the network? Is Medicare Advantage still right for you? Please contact us for immediate review at (855) 667-4621. Please visit our https://360peo.com/about-us/blog to view past blogs and Legislative Alerts.
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.
