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Despite Obamacare, gap health insurance market explodes

Despite Obamacare, gap health insurance market explodes | Healthcare and Technology news | Scoop.it

Despite the promise of coverage through the U.S. Affordable Care Act (ACA), the number of people applying for non-compliant, short-term health insurance policies was up more than 100 percent in 2014, according to new data available from companies who broker these policies.


This type of health insurance is exactly the kind that the ACA, known commonly as Obamacare, was supposed to upgrade. Short-term plans provide low-cost coverage for major medical events like hospital stays, with high deductibles and out-of-pocket costs, and are subject to denial if applicants have pre-existing conditions. They do not offer the protections of Obamacare for preventive care or maternity coverage, for example.


The government does not count these gap plans as qualifying health insurance, so people who have them are subject to penalties for being uninsured.


Sign-ups at eHealth Inc to the short-term plans it offers through its website were up to 140,000 in 2014 from 60,000 in 2013, an increase of 134 percent, according to the company.


At another short-term carrier, Agile Health Insurance, a subsidiary of Health Insurance Innovations Inc, new policies were up 100 percent last year over the previous year, and are up again so far in 2015, according to Scott Lingle, the company's senior vice president of business development.


Accounting for much of the jump are individuals who somehow missed the open enrollment period for an Obamacare plan. More than 11.7 million consumers signed up for Obamacare coverage through Feb. 22, according to the government.


People missed out mostly because of poor communication between consumers, the government and insurance companies, says Nate Purpura, eHealth's director of PR and Content. Those who missed the opportunity to sign up and did not have a qualifying event now have to wait until the next open enrollment period to try again, so they need an insurance plan to bridge the gap.


Both eHealth and Agile are also seeing new signups from retirees who are looking for a low-cost plan to tide them over until Medicare kicks in at 65. At eHealth, the 55 to 64 age group is now 9 percent of the market.


"If you shop for a 50-year-old on healthcare.gov, it is very expensive," says Agile's Lingle. "There are people who have looked at the prices and it makes more sense to buy short term."


The largest constituency is young, healthy people seeking low-cost catastrophic coverage. Those aged 18 to 34 account for 57 percent of eHealth's buyers. A typical policy could cost around $100 a month, depending on the state of residency and the features of the plan.


These customers include 19-year-old college student Kelly Thomas-Cutshaw, who had no insurance through family and her school did not offer group coverage. Thomas-Cutshaw did not qualify for a subsidy under the ACA because she did not have enough income, yet she could not get Medicaid in Oklahoma, where she goes to school, because she made too much and was not a permanent resident there.


Over the winter, Thomas-Cutshaw became ill, and now has a medical bill she says will take her four years to pay off. She decided she needed some plan in place in case she fell ill again.


When her short-term plan runs out in the fall, she is prepared to sign up for an ACA-compliant major medical plan.


"I can mostly afford to live, so that's nice," Thomas-Cutshaw said, thanks to a summer job she just landed. "It been a ridiculous and frustrating experience. I don't wish this on other people."

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What Do Women Know About Obamacare That Men Don’t?

What Do Women Know About Obamacare That Men Don’t? | Healthcare and Technology news | Scoop.it

For the second year running, more women than men have signed up for coverage in health insurance marketplaces during open enrollment under the Affordable Care Act. According to the Department of Health and Human Services, enrollment ran 56 percent female, 44 percent male, during last year’s open enrollment season; preliminary data from this year shows enrollment at 55 percent female, 45 percent male – a 10 percentage point difference.

What gives? An HHS spokeswoman says the department can’t explain most of the differential. Females make up about 51 percent of the U.S. population, but there is no real evidence that, prior to ACA implementation, they were disproportionately more likely to be uninsured than men – and in fact, some evidence indicates that they were less likely to be uninsured than males .

What is clear that many women were highly motivated to obtain coverage under the health reform law – most likely because they want it, and need it.

It’s widely accepted that women tend to be highly concerned about health and health care; they use more of it than men, in part due to reproductive services, and make 80 percent of health care decisions for their families . The early evidence also suggests that women who obtained coverage during open enrollment season last year actively used it.  According to Inovalon, a company that tracks and analyzes data for health plans and providers, people who used the coverage they bought through the marketplaces last year tended to be older, sicker, and more female than the general commercially insured population. As of June 2014, 41 percent of females who purchased coverage through exchanges had face-to-face visits with health care professionals, versus 32 percent of males.

Those numbers are consistent with the notion that many women who signed up for coverage under the ACA had preexisting conditions or other health issues that led them to seek treatment.  In some cases, their pre-ACA insurance may have excluded those conditions, or the preexisting conditions may have prevented them from obtaining coverage at all.

What’s more, as HHS points out in a recent report, there are plenty of benefits in the ACA’s qualified health plans that are especially attractive to women. These include coverage at no out of pocket cost for many preventive measures, such as mammograms or screening for gestational diabetes.  An estimated 48.5 million are benefitting from that provision of the law alone.

Other data support the notion that many U.S. women are in disproportionately higher medical need, relative to men – even adjusting for the fact that they typically live longer.  According to an analysis of Medical Expenditure Panel Survey data from the Agency for Healthcare Research and Quality, women constitute nearly 60 percent of people in the top tenth of medical expenditures in 2011 and 2012.  Most of those in the top tenth of spending are either ages 45 to 64, or 65 and older.

One obvious conclusion is that many, and perhaps most, of those who’ve benefited from coverage under the Affordable Care Act are female – and especially women in middle age and beyond. Another is that, if the Supreme Court rules in King v. Burwell that subsidized coverage can’t be obtained through the federal marketplace, women will be disproportionately harmed.

A case in point: Rosemary Forrest, 63, who lives in Augusta, Georgia.  Laid off from her job at a university science lab at age 55, she spent five years unemployed and without health insurance.   She now works as a contractor to a small nonprofit agency; battling painful osteoporosis, she sometimes earns less than $400 a month.  Last year, when the federal health insurance marketplace went live, she signed up for coverage.  This year, she re-enrolled, and after federal tax credits, pays $86 per month in premiums.


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Don’t look back to how medicine used to be

Don’t look back to how medicine used to be | Healthcare and Technology news | Scoop.it

Is it just me, or is the world of medicine getting way more complicated?

Sometimes I long for the good old days of practicing medicine.

First, the hospital switched over to electronic medical records, which required us to to attend Saturday morning classes to learn how to tell the nurses our patients could go home after surgery.


Next, our office got an insurance memo that said we must now add extra codes on our billing forms. The codes indicate that we’ve told our patients to quit smoking, warned them about the risks of our treatment, and offered them a follow-up appointment.

As if doctoring wasn’t time-intensive enough, now we must enter and re-enter data that has very little meaning to anyone except the pencil-pushers in insurance land.

It’s enough to make a doctor weary. Burned out. Aggravated.

It reminds me of a call I made 10 years ago to one of my mentors.

Here’s how it went down …

First, let me say that I’m just like you. I rarely reach out to call my mentor in the middle of a workday. He knows this about me. So, when he heard me on the other end of the phone, his first question was, “Are you calling from the operating room?”

We both laughed, relieved that my answer was no. Then we got on to the topic at hand. It went something like this.

I asked him why medicine had gone to hell in a hand basket, and how could I turn back the clock to the days when he was first in practice.

Here’s what he then asked me:

  1. When you go to a restaurant, do you feel like you can order pretty much whatever you want?
  2. Do you like where you live? Is the neighborhood safe?
  3. Does your car run OK, without you being fearful of it breaking down on your way to work every day?

Of course, my answers were yes, yes, and yes.

His response was, “Then quit your complaining.” (I believe he actually used a stronger word that rhymed with “itching.”)

He went on to remind me of all the things we all take for granted on a daily basis. That we are more fortunate than at least 90 percent of the world. And how we have the ability to help people, to know people more intimately and more authentically than in any other profession, and that we make a reasonable living doing it.

His take home message was: Don’t look back.

Don’t look back to how medicine used to be. Or how it looked when Marcus Welby, MD, was a not-so-unrealistic TV doctor. Or even how it was when we started medical school.

Instead, look forward at the innovations that have come to medicine that are helpful. Be grateful for the improvements in treatment for many diseases that used to have no hope. Appreciate the technology that, despite the overkill, allows us to Google medications we don’t know (even as it lets our patients Google symptoms that lead to their anxiety).

So, whenever I’m having the kind of day I had yesterday, where I have to pull myself up short and give myself a talking to … I remember my dear mentor’s words.

I remind myself to search for joy.

I remind myself to be grateful.

And I think about other words of wisdom that tell similar tales. Words from teachers such as Deepak Chopra, who said, “Each of us is like a millionaire with amnesia. We go through life feeling poor, having forgotten that in reality we are very rich. In other words, by being so convinced we are limited in mind and body, we have forgotten the truth that our soul knows no boundaries.”

Deepak wasn’t talking to doctors and health care providers.

But he could’ve been.



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Giving Out Private Data for Discount in Insurance

Giving Out Private Data for Discount in Insurance | Healthcare and Technology news | Scoop.it

Andrew Thomas’s life insurer knows exactly when he arrives at his local gym. The company is notified when he swipes his membership card, and 30 minutes later, it checks that he is still there, tracking his location through his smartphone.

The insurance company has a vested interest in keeping Mr. Thomas alive and well. In return for sharing his exercise habits, his cholesterol level and other medical information, Mr. Thomas, a 51-year-old medical publisher who lives in Johannesburg, earns points, which translate into premium savings and other perks. By staying in good shape, it is less likely that Discovery, his insurer, will have to pay out his life and disability policies.

“Every Saturday morning, just for playing golf, I get points,” said Mr. Thomas, who said he received about 9 percent back on his life insurance premiums for each of the last five years. “It is trying to make people live a health y lifestyle.”

Now John Hancock will become the first life insurance company to introduce a similar program for American consumers. The program, being announced Wednesday, will apply to both term and universal life insurance policies and is being operated through a partnership with Vitality, a global wellness company that already works with employers and health insurers in the United States.

The concept — which has been used in South Africa, where Vitality is based, Europe, Singapore and Australia — has the potential to transform the way life insurance is priced, at least for consumers who are willing to continually share their health data. But it also raises questions about how that information will be protected — and whether it could be used in ways that ultimately work against a consumer’s best interests.

People who sign up will receive a free Fitbit monitor, which can be set to automatically upload activity levels to the insurer. The most active customers may earn a discount of up to 15 percent on their premiums, in addition to Amazon gift cards, half-price stays at Hyatt hotels and other perks.

John Hancock, a division of Canadian insurer Manulife Financial, says it hopes the program will help reinvigorate life insurance sales, which have stagnated industrywide for decades. Just 44 percent of households in the United States own individual policies, according to Limra, a trade group, a 50-year low. Any product that reminds consumers of their mortality is hard to get excited about, but industry analysts said that financially strained households, changing demographics and increasingly complex and expensive products have led to the decline in sales.

“It has been a slow to no-growth industry for a long time,” said Michael Doughty, president of John Hancock Insurance, based in Boston. “It is crying out for innovation and for someone to try to reinvent the product to make it more relevant.”

The new program also upends the traditional approach to life insurance underwriting, which typically bases its pricing on a detailed but static snapshot of a person’s medical status. Now, John Hancock’s term and universal policies will be priced continuously, at least for consumers who choose the Vitality program.
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John Hancock and Vitality, which is owned by Discovery, said the information would not be sold and would be shared only with entities that help with the program’s administration, though the aggregate data could be used to inform the development of new insurance products.

Nonetheless, some specialists expressed privacy concerns.

“All of a sudden, everything you do and everything you eat, depending on which bits of the information they collect, is sitting in someone’s database,” said Anna Slomovic, lead research scientist at the Cyber Security Policy and Research Institute at George Washington University and a former chief privacy officer at Equifax and Revolution Health.

Of course, buying any life insurance policy requires customers to share detailed medical histories upfront. But consumers participating in the Vitality program must be comfortable providing enough information continuously to meet certain thresholds that will convert into worthwhile savings. That might include the frequency of workouts, reporting a physical exam or answering sensitive personal questions: During the last 30 days, how often did you feel so nervous that nothing could calm you down? Hopeless? Depressed?

“You do not have to send us any data you are not comfortable with,” Mr. Doughty said. “The trade-off is you won’t get points for that.”

Participants need to amass 3,500 points to achieve silver status, 7,000 to reach gold and 10,000 for platinum. Nonsmokers automatically earn 1,000 points, and people with in-range cholesterol, glucose and blood pressure will receive 1,000 points for each. A “verified” standard workout three times a week, or an advanced workout twice a week, provides another 3,120 points over the course of a year. Flu shots, 400 points. The clock is reset each year, though 10 percent of points may carry over.

All customers participating in the program will start by paying a premium priced at the gold level. That is a discount of about 9 percent for a 45-year-old man who bought a $500,000 term insurance policy that covered a 20-year period: He would pay $750 annually, compared with the $825 it would cost outside of the Vitality program.

So what if he does everything right, but breaks his leg? Or worse, gets a serious disease like cancer? While those conditions would not directly affect his rate, if he could not maintain gold status for any reason, he could see premium increases of 1.1 to 1.6 percent each year. But if he reached platinum status, his premiums would fall by about 0.30 percent each year.

The program may attract healthier people who have already engaged in these activities on their own. The strategy also tries to tap into the way humans are naturally wired: There is generally no immediate tangible benefit to life insurance, but this program is structured to try to change that.

“People respond far more to immediate gratification than delayed gratification,” said Dr. Kevin Volpp, director of the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute. (He has performed research sponsored by Vitality.)

The number of points assigned to a particular activity is determined by how it will influence a person’s longevity, based on Vitality’s internal findings — and its level of difficulty. “Stopping smoking is more valuable than one session of activity,” explained Alan Pollard, chief executive of Vitality. “If something is a complex behavioral change, it will attract more points.”

Vitality’s research has found that Americans are generally five years older than their actual age, after taking into account various health and wellness factors. All participating policyholders will be given a “Vitality age,” which will help the program set personal guideposts.

“The people who have the time to devote to jumping through all the hoops are likely to be better off than average, and those healthy enough to do wellness activities may be unrepresentative of the chronically ill,” said Frank Pasquale, a professor at University of Maryland Carey School of Law. “I believe that is one reason why there is empirical research severely questioning the value of wellness programs.”

John Hancock, which operates in all 50 states, said the universal life program had been approved by insurance regulators in 30 states, while the term program is available in 20 states; more states are expected to be announced throughout the year. It said no regulators had declined to approve it yet.

“It changes the paradigm of life insurance,” Dr. Volpp said. “In some sense, it tries to change your insurance into less of a passive vehicle that pays the bills if something happens, into a more active vehicle to get people to lower their risk.”


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CMS enrollment proposals spark criticism on range of issues - Modern Healthcare

CMS enrollment proposals spark criticism on range of issues - Modern Healthcare | Healthcare and Technology news | Scoop.it

Insurers are at odds with providers and consumer advocacy groups over the Obama administration's guidance on network adequacy. In the proposed rule, the CMS indicated that it will hold off on issuing additional regulations dealing with provider networks until after the National Association of Insurance Commissioners completes drafting a model state law.

Narrow networks have been a major source of contention since the exchanges launched. Insurers have insisted that limiting networks is a crucial means of holding down premiums, and exchange customers have flocked to low-cost plans. But consumer advocates and providers worry that unsophisticated customers are choosing plans that may not include their doctors or otherwise meet their coverage needs.

That division played out in comments to the CMS about a proposed rule for 2016 enrollment. Insurers praised the agency for deferring to the NAIC process before drafting additional network adequacy regulations, while hospitals and consumer groups called for more aggressive action.

“CMS should not delay further the development of more robust network adequacy requirements and more effective oversight and enforcement mechanisms,” wrote Chip Kahn, CEO of the Federation of American Hospitals. “Rather, CMS should instead adopt and adapt the Medicare Advantage network adequacy standards for the marketplaces.”

Insurers also are raising objections to the CMS' proposal to require that drug formularies and provider directories be made available in “machine-readable” files. That would allow third parties to create tools to help consumers to make more informed choices about which plans would best meet their needs.

But health plans suggested that it could put them at a competitive disadvantage and confuse customers. “If issuers were required to post machine-readable files for general consumption by third parties, issuers would have no ability to ensure that their benefit information was correctly represented by those third parties,” wrote Anthony Mader, Anthem's vice president for public policy. “Inaccurate information not only would increase the burden on issuers; it also would create consumer confusion and potential dissatisfaction.”

The CMS also proposed that insurers be required to use pharmacy and therapeutics committees to advise them on drug formularies. Some patient advocacy groups have complained that crucial drugs are only available at top-tier pricing and are therefore unaffordable for many consumers. There's also been concerns raised about a lack of transparency with regards to drug formularies.

"We have heard from members that many patients have had difficulty determining how/if exchange plans will cover their prescription drugs," the American Pharmacists Association said. "Plan beneficiaries will benefit significantly from clear, up-to-date information regarding prescription drug coverage."

Immigration advocacy groups are urging the CMS to establish a “language access coordinator” to help ensure the needs of exchange customers with limited English proficiency are being addressed. They noted the Federal Emergency Management Agency already has such a position to help non-native speakers gain access to information and services.

Immigration advocates also praised the CMS for proposing that exchanges and health plans be required to provide telephone interpretive services in at least 150 languages. But they questioned why there should be any limitation on language assistance. Instead, they'd like to see the agency require interpretive services in any language requested.

However, some insurers raised objections to the 150-language standard being proposed by the CMS, arguing it would result in unnecessary expenses and higher premiums. “While we acknowledge the need for translation services and currently provide this to our members, we believe that any requirement should instead be tied to an issuer's respective member demographics in order to avoid needless administrative expense and burden,” wrote Cathy Mahaffey, CEO of Common Ground Healthcare Cooperative, a not-for-profit health plan operating in Wisconsin.

The National Immigration Law Center is also calling on the CMS to adopt more stringent guidelines for when exchanges and health plans must provide written materials in a foreign language. There were widespread complaints during the first year of enrollment that many non-English speakers couldn't understand letters alerting them to problems with their immigration documents and therefore risked losing coverage.

The CMS has suggested requiring that anytime a health plan or web broker has at least 10,000 customers who share a primary language other than English, they must provide written materials in that language. The NILC wants that provision strengthened to require that translated versions of materials be provided anytime a language group makes up 5% or 500 customers, whichever threshold is lower.

But insurers objected to even the 10,000-customer standard floated by the CMS. Blue Shield of California noted it would require the health plan to provide materials in 48 languages.



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