I can't speak for any special interest groups but I have several clients who take Humira ($2500 a dose) and enrolled them in plans where the first dose of the year (which is paid by Humira under the Patient Assistance Program with a $5 copay) goes towards the plan deductible and makes the rest of the year virtually $0 cost for the client-this means the insurance company is absorbing the cost of Humira for 11 of the 12 months and spending far more than the premium on claims.
Aetna Leaving Markets
- Thread starter Ann H
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I can't speak for any special interest groups but I have several clients who take Humira ($2500 a dose) and enrolled them in plans where the first dose of the year (which is paid by Humira under the Patient Assistance Program with a $5 copay) goes towards the plan deductible and makes the rest of the year virtually $0 cost for the client-this means the insurance company is absorbing the cost of Humira for 11 of the 12 months and spending far more than the premium on claims.
This isn't an Indy ACA issue. I have clients on the group side doing the same thing.
What a mess.
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Political plays #2. The DOJ is blocking the Aetna/Humana merger under the reasoning of stopping them from dominating a market. The DOJ often does this often in mergers & acquisitions to force divestiture of assets. Aetna/Humana are now complying by contracting to divest itself of MAPD assets to Molina if the merger goes through. That means they want to merge. That also means that if they satisfy the DOJ's lawsuit, they can withdraw from any ACA exchanges they want to and not tick off the Feds. If the Feds are ticked off anyway, the Feds would have to refile another lawsuit with another reason for blocking the merger. It would be kind of hard for the Feds to say the merger causes dominance in the market, then turn around and say that Aetna being the only (or almost only) carrier in ACA exchanges isn't dominating a market.
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Good job!! We are paid to help our clients. The carriers design and price the plans. They should expect the agents to know a good deal when it comes along.
