Massachusetts Must Control It's Health Insurance Costs

While Massachusetts has succeeded in expanding health insurance coverage, it has not succeeded in slashing costs. As of June 2010, Massachusetts has the lowest uninsured rate in the United States at 4.8 percent, having slashed the uninsured rate by 60 percent. Compare that to the United States as a whole, where 15.4% of citizens are not covered.  Massachusetts’ efforts in expanding covered should be classified as successful.

However, the successes of broader coverage cannot hide the plan’s inability to cut costs.  The wide coverage, coupled with state subsidies and reduced rivalry between health providers, has caused costs to rise. The Massachusetts Department of Insurance has denied insurers’ demands for rate hikes in an attempt to keep expenses low for consumers. Meanwhile, insurers argue that reducing rates without slashing health provider costs places undue stress on them. Premiums have increased substantially for individuals and families, while the use of the emergency room for non-emergencies did not markedly decrease, perhaps indicating a deeper issue: the primary care physician shortage.

The similarities between the Massachusetts plan and the 2010 US Affordable Care Act make Massachusetts’ successes and failures ever more glaring on the national stage. According to a report from Fortune Magazine, both the Massachusetts and Obama plans increase health care demands without addressing health care shortages.  Prices have gone through the roof, and according to Fortune, will not decrease until the government stops targeting insurers.  Insurance pools also grow more expensive as younger, healthier members drop out while sicker members stay in.  Subsidizing middle-income plans may also prove expensive, while additional state-mandated benefits have also strained the system.  According to Fortune, Massachusetts residents have begun to manipulate the system to optimize their health insurance benefits and subsidies.

If Massachusetts can successfully manage the costs associated with its health care reform, perhaps this will bode well for the Affordable Health Care Act.  Four years into the Massachusetts plan, costs have continued to skyrocket as more residents are covered. In the current economy, controlling costs is ever more crucial to the health care industry and to the country’s economy as a whole.  Solving the primary care and health provider shortage may prove a good step in shaving down costs.

In the end, it will be the costs, not universal coverage, that determine success for both the Massachusetts and federal reform programs. I hope that both reforms can find a way to cut costs beyond placing limits on insurers, perhaps by streamlining health care overall and improving the pool of preventative

Supreme Court Nomination May Overturn on Roe v. Wade

If Roe v. Wade was overturned, the likelihood that we would see any variation in the amount of abortions in the US would be slim.  More problems may arise than would be solved in the event that Roe v. Wade was overturned.  If it was, there are about 20-25 states that would immediately enact laws against abortion.  This would make it more difficult for females to find a doctor offering abortion services.  However, it would not stop them from having abortions.  Females will either go to the states offering abortion services or find other means that are less safe and healthy than finding an available doctor.  Overturning Roe v. Wade would theoretically eliminate 170 doctors providing abortion services, which is less than 10% of all services available in the US.

Overturning Roe v. Wade will pose serious health and financial burdens.  As mentioned before, females will take more risky measures to have an abortion.  Those who decide to keep their baby are immediately faced with the high hospital costs and medical costs associated with having a baby.  Consequently, more women may consider taking contraceptives to prevent pregnancy in the first place.  However, this too can be expensive because many health insurance plans do not cover contraceptives.  If they do offer coverage, there is often a high out-of-pocket charge for the contraceptive prescription.  Also, there are very few health insurance companies that offer abortion coverage (most are private insurance companies).  It is likely that these health insurance companies will establish much higher costs in the states that would choose to allow abortion after overturning Roe v. Wade.

The replacement of Anthony Kennedy is not an immediate concern, but it is a possibility in the near future.  Kennedy’s retirement should not be in question because he is not likely to retire soon.  The only imminent threat to his position would be a Republican president, who may choose to replace Kennedy with a candidate who opposes abortion.  This decision, however, would have many repercussions and may not solve any abortion issues.

Connecticut’s strict Certificate of Need (CON) laws prevent new competition from entering the market. CON approval, regardless of cost, is required for anyone acquiring, purchasing, or accepting donation of a CT scanner, PET scanner, PET/CT scanner, or similar new technology equipment (see more about the Certificate of Need Process from the department of insurance). The CON board is controlled by the hospitals, making it even more impossible for new competition to enter the market.

This market power of the hospital oligopolies is one reason why the public option is so dangerous to private insurers. A public option would reduce unit costs below private insurers and quickly put them out of business, removing competition altogether.

Ingenix is a subsidiary of UnitedHealth Group which is also used by nearly 20 regional and national health insurers. Ingenix agreed last January to pay $350 million in order to settle allegation that it kept its rate low to underpay doctors.  Other health insurers include Aetna, CIGNA, and Wellpoint.

Health insurers submit information to Ingenix to determine the costs for care received out of network. Health insurance companies often skew data to underestimate the costs of medical services so that patients would have to pay more in out of pocket costs.

“The result of this practice is that American consumers have paid billions of dollars for health care services that their insurance companies should have paid,” states the Senate Commerce Committee’s investigative staff.

“Insurers know that policyholders are so baffled by those notices they usually just ignore them or throw them away,” said Wendell Potter, a former insurance executive at CIGNA. “And that’s exactly the point. If they were more understandable, more consumers might realize that they are being ripped off.”

To see the full report, go to http://www.google.com/hostednews/ap/article/ALeqM5g4s2x4w7hv-cWoKaCbdWmE1sQecAD991BJOO0.

These changes affect the CIGNA HMO and CIGNA HMO Point-of-Service Plans which are currently used by employers with more than 50 eligible employees as well as the stand alone HMO only network use by New Hampshire Small Group employers with 50 or less than 50 employees. In order to help ease the transaction clients can replace their HMO/POS Plans upon renewal with one of the other plans that CIGNA will continue to offer.

Clients and their employees will be notified of this termination in writing starting with mailings scheduled for the week of June 15th.

A recent study done by J.D. Power and Associates ranked the nations best health insurance plans by areas of the United States. The study measured health plans based on seven key factors that drive the members’ overall health plan experience: Provider Choice; Information and Communication; Coverage and Benefits; Claims Processing; Statements; Customer Service; and Approval Processes. Included in the study are 131 health plans in 17 regions in the United States and the results of more that 33,000 health plan member surveys conducted between December of 2008 and January of 2009.

Headlining the results of the study is Health Alliance Plan (HAP), which was rated “Highest in Member Satisfaction among Commercial Health Plans in Michigan.” This is the second year in a row where HAP ranked highest in member satisfaction among Michigan commercial health plans. HAP earned a five star Power Circle Rating which signifies “Among the Best” in four areas: Customer Service, Overall Experience, Coverage and Benefit, and Information and Communication.

Other award recipients include: BlueCross BlueShield of AZ, AL, FL, NE, and IL, HIP Health Plan in New York/New Jersey, Harvard Pilgrim Health Care in New England, and Humana in the South Atlantic and Texas.

Approximately 15% of his patients have registered for Muney’s $79 a month flat rate health plan, or 500 people. The $79 fee includes unlimited preventive visits, minor surgeries, on site medical services, lab work, and gynecological care.

“Our healthcare system lends itself to abuse, fraud and waste,” he said. “With this model, we’re bypassing all that.”

Muney has receive several complains from New York state insurance authorities stating that he must charge for over head costs and a per visit fee of $33. He knows this fee may deter people from signing up for the program.

The goal of Intracorp and CIGNA’s workers compensation nurseline is to assist callers in evaluating symptoms and accessing appropriate care. This enable enhanced return to work outcomes and reduces workers compensation costs.

“When an injury happens at work, it’s not always clear what kind of medical attention an individual needs,” said Betsy Robinson, Vice President and Intracorp. “Out of caution, managers might send employees straight to an emergency room for evaluation. But depending on the circumstances, that may not be best option, and it’s among the most costly choices. Having access to the nurseline will allow the nurse to ask the caller a few questions about the individual’s symptoms and situation, then help the caller to decide upon the appropriate type of care or other available informational resources to access. It also helps to facilitate prompt and accurate reporting of workplace injuries (BusinessWire).”

Intracorp, a subsidiary of CIGNA Corporation, has specialized in workers’ compensation for more than 39 years. They help provider workers’ compensation and disability programs to enhance the productivity of their workforce. Together with CIGNA, a leader in the health insurance industry, Intracorp hopes to succeed in helping reduce costs while improving the work environment.

-          Graduating college students

-          People in between jobs

-          Part time, temporary, or seasonal employees who are not offered employer-sponsored health plans

-          Retirees not yet eligible for Medicare

-          Unemployed individuals

-          And new employees waiting for their benefits to begin

HumanaOne’s Short Term Medical health insurance plans are available in Alabama, Arizona, Colorado, Louisiana, Michigan, Nebraska, Ohio, and Wisconsin. The plan is flexible offering different options depending on the individuals needs. Deductibles range from $500 to $5,000 for individuals and $1,000 to $10,000 for families. The plans have a $2 million maximum benefit and include prescription drug coverage for time periods between 30 days up to 6 months or a year.

Oxford USA is available to New Jersey, New York, Connecticut, and Lehigh Valley employers through the United Choice Plus Network. All of the Oxford USA health plans are of high quality, flexible, and streamlined. The Choice Plus plans provide one of the largest directly contracted physician and hospital networks in the United States. No referrals are necessary to see a specialist with an Oxford USA plan.

Oxford USA plans include service associates that stand ready to assist members by providing timely and accurate information and services. Their health promotion includes Healthy Mind Health Body magazine, Healthy Mother, Health Baby program, and access to their Self-Help Library, in order to help members be healthy and stay healthy.  Healthy Bonus^SM recognizes the beneficial impact of health and fitness therefore members are offered discounts on gym and exercise facility memberships.

For in-area members, access to over 70,000 physicians and 200 hospitals make it easy to find health care when needed. Out of area employees have access to the United Choice Plus Network which includes over 400,000 providers and 4,000 hospitals.

UnitedHealthcare Choice Plus plans give employees the opportunity to access non-network physicians. Benefits of the plan include access to a network of physicians, hospitals, and specialists without designating a primary physician or obtaining a referral. Emergencies are covered anywhere in the world. Prenatal care, routine checkups, immunizations, and vision and hearing screenings are all covered as well.

All New Jersey Oxford HMO members will have in-network access to the national UnitedHealthcare Choice Plus network and health benefits, effective January 1, 2009.

Best Commercial Health Plans: North

1.       Harvard Pilgrim Health Care:  Offers HMO and POS plans to members in Maine and Massachusetts. Earned 5 stars for Consumer assessment, prevention, and treatment and an overall score of 91.2

2.       Tufts Associated HMO: Offers HMO and POS plans to members in Massachusetts, New Hampshire, and Rhode Island. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and overall score of 91.2

3. Harvard Pilgrim Health Care of New England: Offers HMO and POS plans to members in New Hampshire. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 90.6

4. Geisinger Health Plan: Offers HMO and POS plans to members in Pennsylvania. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 88.2

5. Health New England: Offers HMO and POS plans to members in Connecticut and Massachusetts. Earned 5 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 88.1

Best Commercial Plans: South

1. Capital Health Plan: Offers HMO plans to members in Florida. Earned 4 stars in Consumer Assessment, 5 in Prevention, and 4 in Treatment and an overall score of 86.8

2. Kaiser Foundation Health Plan of Georgia: Offers HMO plans to members in Georgia. Earned 2 stars in Consumer Assessment, 5 in Prevention and Treatment and an overall score of 86.7

3. CIGNA HealthCare Mid-Atlantic: Offers HMO and POS plans to members in DC, Maryland, and Virginia. Earned 3 stars in Consumer Assessment, 4 stars in Prevention and Treatment and an overall score of 84.9

4. Optima Health Plan: Offers HMO and POS plans to members in Virginia. Earned 4 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 84.9

5. Health First Health Plans: Offers HMO plans to members in Florida. Earned 4 stars in Consumer Assessment, Prevention, and Treatment and an overall score of 84.5

Best Commercial Plans: Midwest

1. Grand Valley Health Plan: Offers HMO plans to members in Michigan. Earned 4 stars in Consumer Assessment and Prevention, 5 in Treatment and an overall score of 89.1

2. Group Health Cooperative of South Central Wisconsin: Offers HMO plans to members in Wisconsin. Earned 3 stars in Consumer Assessment, 5 in Prevention and Treatment and an overall score of 87.8

3. Priority Health: Offers HMO plans to members in Michigan. Earned 5 stars in Consumer Assessment, 4 in Prevention and Treatment and an overall score of 87.2

4. Security Health Plan of Wisconsin: Offers HMO plans to members in Wisconsin. Earned 4 stars in Consumer Assessment and Prevention, 5 in Treatment and an overall score of 86.9

5. Unity Health Plans Insurance: Offers HMO and POS plans to members in Wisconsin. Earned 4 stars in Consumer Assessment and Prevention, 5 in Treatment and an overall score of 86.8

Best Health Plans: West

1. Kaiser Foundation Health Plan of Colorado: Offers HMO plans to members in Colorado. Earned 2 stars in Consumer Assessment, 4 in Prevention, 5 in Treatment and an overall score of 85.7

2. Kaiser Foundation Health Plan of Northern California: Offers HMO plans to members in California. Earned 2 stars in Consumer Assessment, 4 in Prevention, 5 in Treatment and an overall score of 85.3

3. Kaiser Foundation Health Plan of the Northwest: Offers HMO plans to members in Oregon and Washington. Earned 2 stars in Consumer Assessment, 3 in Prevention, 5 in Treatment and an overall score of 85.3

4. CIGNA HealthCare of Colorado: Offers HMO and POS plans to members in Colorado. Earned 3 stars in Consumer Assessment, 4 in Prevention and Treatment and an overall score of 83.9

5. Group Health Cooperative: Offers HMO plans to members in Idaho and Washington. Earned 3 stars in Consumer Assessment and Prevention, 4 in Treatment and an overall score of 83.1

America’s Best Commercial Health Plans Honor Roll

1.       Harvard Pilgrim Health Care: 91.2

2.       Tufts Associated HMO: 91.2

3.       Harvard Pilgrim Health Care of NE: 90.6

4.       Grand Valley Health Plan: 89.1

5.       Geisinger Health Plan: 88.2

6.       Health New England: 88.1

7.       Anthem BC/BS of CT: 87.8

8.       Group Health Cooperative of South Central WI: 87.8

9.       BC/BS of MA: 87.8

10.   CIGNA HealthCare of NH: 87.6

For the complete list, refer to the U.S. News & World Report website. The site also ranks best Medicare health plans as well as best Medicaid plans.

So why were they ranked among America’s top 20 health plans? For 13 consecutive years, HealthAmerica’s HMO product and HealthAssurance’s POS product were both awarded “Excellent” accreditation from the NCQA. They’re HMO and POS are number 1 in 8 of 15 key measures. They have received the highest scores in:

• Well-child visits for members 3 to 6 years old
• Well-child visits for members over 6 years old
• Beta blocker after a heart attack
• Prenatal care in the 1^st trimester
• Cervical cancer screening
• Screening and testing of adults with diabetes
• Controlling hypertension (high blood pressure)
• Cholesterol screening for patients with cardiovascular conditions

HealthAmerica provides its members with a greater combination of health benefits and services for their money suitable to their needs and wants. They offer more health benefits, like coverage for most preventive health services, including periodic checkups, coverage for hospital and surgical care, emergency care worldwide, and chiropractic services. They offer access to over 35,000 providers in Pennsylvania and Ohio and more than 350 hospitals.  As a member, you are also entitled to the WellBeing program. This program offers free wellness programs and discounts on a wide range of products and services such as:

• QualSight LASIK Discount Program
• Weight Watchers
• GlobalFit fitness network
• Healthy Living and Wellness
• Health Education Reimbursement
• Wellbeing fitness clubs, acupuncture, and massage discounts
• Personalized Health Improvement
• EyeMed Vision Care Vision One EyeCare Discount Program and LASIK Vision Correction

With your health plan you also get 24 hour assistance. You can call and talk to a Member Service Representative and get answers about any question you may have with convenient hours during the week and on the weekends. The website is always available for health information. My Online Services is a feature that allows you to manage your personal health care transactions anytime it’s convenient for you.

They have a wide variety of other products, employee health benefit plans, and value-added services. With the ability to customize benefit programs that meet your needs, you can choose from HealthAssurance Coordinated Care PPO (POS), HealthPass/HealthAssurance PPO, HealthAssurance FlexChoice, and HealthAmericaOne Individual plans.

HealthAmerica’s health insurance plans can help you get the coverage you need. They are known nationwide for their service and quality and in result they have achieved the recognition of top rank in health plans. HealthAmerica’s commercial plans were rated higher than the national average in all 15 key measures of medical services and member satisfaction. The plans were also ranked higher than the Pennsylvania state average in 12 of the 15 key measures.

In September, Blue Cross Blue Shield of Arizona launched 5 new individual plans to provide more options to meet the needs and budgets of Arizona residents. Richard L. Boals, BCBSAZ president and CEO says “By matching our individual product line to fit the evolving health coverage needs of today’s customer, we are providing competitively priced products delivered with the quality and service customers have come to expect from Blue Cross Blue Shield of Arizona.”

Their new plans are:

• BlueOptimum is a preferred provider organization (PPO) with co-pays covering in-network services such as office visits and urgent care. Deductibles range from $250 to $10,000 for individuals in-network, and $500 to $20,000 for families in-network. Coinsurance is 80/20 meaning BCBSAZ pays for 80% of most covered services after you meet the deductible and you only pay 20%. BlueOptimum is ideal for people who want set co-pays and first dollar coverage for in-network preventive care visits.
• BlueValue is a PPO plan with a mix of co-pay and coinsurance cost sharing, and the flexibility of fixed generic prescription co-pays. Deductibles range from $250 to $10,000 for individuals and $750 to $30,000 for families in-network. Coinsurance is 70/30 after the deductible is met. BlueValue is ideal for people who want to pay for services with a blend of co-pays and coinsurance that result in a lower monthly premium and who also want no deductible for preventive care visits.
• BlueEssential is a low cost PPO plan with basic coverage, a $1,000 cap on preventive care to help make the policy more affordable, and co-pays for three primary care physician (PCP) office visits per year. Deductibles range from $250 to $10,000 for individuals and $750 to $30,000 for families in-network. BlueEssential is ideal for people who want a plan with low monthly payments designed for low utilization of services and $15 co-pays for generic prescriptions.
• BluePortfolio is a qualified high deductible PPO plan for use with a health savings account (HSA). HSAs are tax-exempt trust or custodial account to be used for paying qualified medical expenses. Deductibles range from $1,750 to $5,500 for individuals and $3,500 to $11,000 for families in-network. BluePortfolio plans are ideal for people who want co-pays for in-network services such as physician office visits, urgent care, and prescription medications.
• BlueSecure and BlueSecure Plus are two options for a Health Maintenance Organization (HMO). PCP referrals are not required to visit specialists and co-pays apply to many covered services. The deductible for BlueSecure is $1,000 for individuals and $2,000 for families in-network. There is no deductible for BlueSecure Plus. BlueSecure or BlueSecure Plus is ideal for people who want an HMO plan that covered routine maternity after a 12-month waiting period or who want co-pays that cover most services.

WellPoint’s SmartSense product line makes up more than 50% of individual health insurance sales in California and is also available to Georgia residents. Since November, their SmartSense line of individual health insurance plans has been in the process of being launched in Colorado. SmartSense is tailored to fit your needs and is priced very low with premiums ranging from $33 to $178 a month for a health 25 year old male. The plan offers a wide range of annual deductibles and monthly rate combinations. It also has lower rates on services from in-network providers. They offer simple co-pays for your first three in-network doctor visits without having to meet your plan’s deductible first. SmartSense also offers out-of-state coverage which protects you from the high cost of unexpected emergencies when you travel.

Horizon BCBS of New Jersey has been making adjustments to their individual health plan prices. A new law in New Jersey allows them to use an applicant’s age in their rate calculations which should make plans more affordable for younger individuals.

Blue Cross Blue Shield isn’t the only health insurance company trying to launch new plans for individuals. Health Insurance is vital and many health insurance carriers are trying to make health plans for individuals more affordable.

The reason for the foundation of this type of insurance was to ensure that retirees, sole proprietors, and individuals not eligible for Medicare are insured. Since fewer employees are offering benefits to retirees there is the need for this option of health insurance.

A study done by Aetna, received from a U.S. Census report, shows that 14% of people ages 45-64 are uninsured. These unique products help target the many people who have difficulty getting health insurance. The biggest problem has been found in Georgia, where 17% of the population is uninsured.

You can select from a variety of plans including their quality Premier plans or Preventive and Hospital care plans. High deductible plans are compatible with tax advantaged HSAs (Health Savings Accounts). There are a total of 7 plan options to choose from within the three above plans. The Premier plans combine affordable medical coverage with prescription drug and hospitalization coverage. Members may choose in or out of network doctors and can choose from annual deductibles of $1,500, $2,500, and $5,000. The Preventive and Hospital plans include a physical exam, an annual ob-gyn exam and well child care. The plans also provide inpatient hospital coverage. Coverage for the above plans is nationwide so consumers do not have to worry when they are travelling.

AARP Essential Premier Health Insurance plans have special programs in addition to the standard health insurance coverage offered. Members can receive the Aetna Rx Home Delivery which allows them to order their medications through a mail order pharmacy. Other features include weight management programs, an informed health line with 24/7 access to health care answers, and the Aetna Natural products and services programs which allows eligible members to access complementary health care products at reduced rates. These products and services include massage therapy, dietetic counseling, acupuncture and chiropractic care. Some of the insurance plans also provide AARP Vision Discounts at no additional cost as well as pharmacy savings.

The AARP Essential Premier Health Insurance products are currently available in 31 states and Washington, D.C. They are sold in Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Louisiana, Maryland, Michigan, Mississippi, Missouri, Nebraska, Nevada, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Utah, Virginia, West Virginia, Wyoming and Washington, D.C

This is a great insurance option for AARP members. In this state of the economy, many “baby boomers” are being laid off because of the younger, college graduates who aren’t requesting as much money. It is getting harder and harder for retirees to maintain the health coverage they received when they were working so I’m sure the AARP Essential Premier Health Insurance is going to be a huge hit with the baby boomers.