2019 Preliminary Rate Increase are Here!

The Division of Insurance just released the average rate increases for the individual health insurance market in 2019. You can view the release here. For 2019 individual plans, the average premium increase request is 5.94 percent across all companies and metal levels. The rate increases are not uniform across plan categories… Looking closer, the requested average premium increase for individual gold plans is 6.85 percent, and is 12.30 percent for silver plans. For bronze plans, the requested average premium increase is 0.9 percent. And the highest priced provider in the state, Anthem, is requesting rate decrease!! In addition, for the first time in years, an insurance company is requesting a rate decrease for individual market plans for 2019. In fact, both companies under the Anthem umbrella, HMO Colorado and Rocky Mountain Hospital and Medical Service, requested average decreases:  -0.44 percent for HMO Colorado, and -2.64 percent for Rocky Mountain Hospital and Medical Service. Aside from the fact that insurance premiums are simply too high for households that don’t qualify for tax credits, this is good news!

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Bright Health, from ex-UnitedHealthcare CEO Bob Sheehy, financials

A young innovative company – Start-up health insurer led by former UnitedHealthcare CEO is off to a good start, filings show | CNBC Bright Health competes with Oscar Health and other start-up insurance plans. It has raised more than $240 million from technology and health investors. New filings show how it fared in its first year: 2017. The company sells its plan on the individual market in Colorado, including via the state exchange created through the Affordable Care Act. Its Minneapolis-based team is also planning to expand into other states and into the burgeoning market for Medicare Advantage in the coming months. Sheehy told CNBC he saw an opportunity to sell individual health insurance under Obamacare, as his former company pulled out of multiple states, reportedly to stem losses. In Colorado, both UnitedHealth Group and Humana announced plans to stop selling individual plans in 2016. “I started the company with a vision to catalyze the individual marketplace,” he said. “My vision was to improve health affordability, and the health care experience.” Bright’s secret sauce involves working in tight partnership with a single health system within a region, in this case Centura Health, which gives it better window into physician cost and quality. As a broker, they are a breath of fresh air when it comes to their service, lack of bureaucracy, and their support as expressed by reasonable commissions.  

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Direct Primary Care Inteview

Direct primary care interview – Exploring Direct Primary Health Care with Dr. Shelby Smith | KSMU Radio This week on Making Democracy Work, host Chrystal Brigman Mahaney talks with one of the founding physicians with Equality Health Care, Dr. Shelby Smith. I’ve been using a Direct Primary Care practice for at least 3 years. Dr. Smith mentions physician burnout, dealing insurance bureaucracy and corporate medicine (significant loss of autonomy).

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Is Medicare.gov Plan Finder Tool Confusing?

Hmmm: New Report Blasts ‘Confusing’ Medicare Search Tool The issues mentioned as problems are: Out-of-pocket cost information is difficult to understand Provider and pharmacy directories are hard to navigate Plan comparisons do not permit inclusion of Medigap policies, the private plans that consumers can buy to supplement Medicare The layout and display of the website are confusing The language is not accessible Navigation and usability of the site are complex and inconsistent Human support is not available Information on quality Star Ratings of the health plans is confusing Plan information is not customized well Information is not always accurate I actually thought the tool was pretty good but the above claims are valid. I’ll will say that compared to the plan comparison tools available on Connect for Health Colorado, the Medicare tool is vastly superior. That said, there are certainly sections that have confused me. For example, with Part D drug plans it took a while for me to understand the “total cost” per month includes the expected medication costs PLUS the monthly premium. I’m sure this could confuse the casual user. Another example is when look at Medicare Advantage plans that include Part D drug coverage, there appears to be a maximum out of pocket, which is good. However, what is not clear, although it is logical, is that the Part D drug plan operates separately and is not capped by the MA plan maximum out of pocket. Instead it operates under regular Part D rules where even if you enter the catastrophic drug coverage phase, you are paying 5% of the cost of medication.

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What will be the Coverage Periods for Short Term Plans?

They’re talking about Short Term major medical plans – Should Health Plans Comply With Obamacare? States Are Deciding | Bloomberg Law Starting in April (or so) of 2017 the duration of Short Term plans was limited to 3 months by the Federal Government. Prior to that time, in many states they could last 11 months and this varied state by state. The Trump administration has proposed that short term plans be allowed to last as long as a year. It is believed that states will have the authority to limit enrollment to shorter periods of time. Prior to regulation, Colorado limited plans to 6 months and you couldn’t have more than 2 consecutive plans. I expect Colorado will go back to 6 months but wouldn’t be at all surprised if they limited plans to 3 months in length. This should play out over the next few months.

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Medicare Clients – Beware of “Observation Status”

NPR correspondent Alison Kodjak’s mom was admitted to the hospital for four nights after a fall. Because the hospital said she was an outpatient, Medicare wouldn’t pay for her rehabilitative care. Medicare isn’t perfect, be aware and ideally be prepared – How Medicare’s Conflicting Hospitalization Rules Cost Me Thousands Of Dollars This problem occurs when you are placed in “observation status” at the hospital instead of officially admitted. Is there anything that can be done to combat this issue? The real solution is for Congress to fix the problem. Until that happens the following coverage can be helpful: Hospital Stay – Hospital Indemnity policy Rehabilitation stay – Short Term Recovery Care plan Hospital Indemnity plans pay a fixed amount (i.e. $200, $300 per day) while you are in the hospital. While Medicare will cover your stay, even when in observation status, these funds can be applied towards the costs of a rehabilitation stay as described in the article. Also, if you are on a Medicare Advantage plan you can pay your in-patient hospital copay with the benefits. Short Term Recovery plans cover actual medical costs up to the selected maximum benefit amount, for example $200 per day. These plans have a elimination period (i.e. 0, 15 or 30 days until benefits kick in) and a maximum benefit period (such as 120, 240 or 360 days). If there is a recovery there can be a one time restoration of benefits. If you would like additional information, please contact us at 303.495.3045 or 303.859.1709.

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‘White Coat Syndrome?’

Be careful out there. ‘White coat hypertension’ may be sign of a real problem, study finds But the risk of death was nearly twice as high for patients with white coat hypertension, compared to patients whose blood pressure is normal when taken at the doctor’s office and at home, the report published in the New England Journal of Medicine on Wednesday shows.

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