United Health Care - Opting Out of Most Exchanges!

[Ann H]

So another thought that I have had on this. Today so many folks who are uninsured just head to the emerg room when they get sick. What will happen to those folks who opt for paying the penalty [tax] and decline being insured, and say in 2015 they get ill... go to that same emerg room with 0 coverage; will they still be seen and treated or turned away?

The EMTLA (Emergency Medical Treatment and Labor Act of 1986) requires emergency rooms that participate in Medicare (most ER's in the US) to accept emergency patients without regard to their ability to pay or their insurance. The ER must provide 3 things: screening, emergency care and appropriate transfers. They must also provide stabilizing care and cannot transfer a patient until they are stabilized. Usually the patient is released or transferred to a county hospital or other government facility for those who cannot pay for private health care. If it is NOT an emergency, they are not required to treat you if you cannot pay. Note that this law applies to hospitals, not to clinics, doctor's offices, etc.

 

[Yagents]

As you can see, NAHU stated it is still being determined. But I recall in my initial readings/education on this beast, that HHS is not going to allow insurers to pick and choose which market (on or off exchange) they prefer to play in. Especially since the wealthier, tend to be healthier. HHS won't let the lower income/sick be kicked to the curb.

But, who really knows......just don't be surprised if that's the case.

 

[bill3173]

At best it is a 3-4 year death spiral for that block of business.

Yes, I'd say three years under ordinary circumstances, but something this big, could crash them(on and individual basis) sooner.

What would be the prize for the carrier that stayed in the longest?

 

[taterpeeler]

Yes, I'd say three years under ordinary circumstances, but something this big, could crash them(on and individual basis) sooner.

What would be the prize for the carrier that stayed in the longest?

a free ohio obamaphone

 

[Yagents]

Best to plan for a fall off in production the 2nd half of the year, or ramp up my short term MM sales. States are saying NO, and insurers are starting to say maybe/No.

No product, No state involvement, no sale.

WellPoint plans for exchange wait effect | LifeHealthPro
Stephen Hemsley, the president of UnitedHealth, made a point during his company's call of emphasizing that UnitedHealth would participate in state exchange programs only in states in which doing so seemed to be likely to produce a reasonable return on capital.
Executives at WellPoint, the holder of Blue Cross or Blue Shield licenses in 14 states, expressed similar sentiments with different wording.
Kenneth Goulet, president of WellPoint's commercial and individual business, said WellPoint is working with the exchange regulators in the company's 14 core market states.
"While we feel that, really, the underlying economic constructs and the structure in each state will drive our decision about whether we participate there or not, we're going in with a very positive attitude," Goulet said. "We're going in with the assumption that we'll participate anywhere where that economically makes sense."
Deveydt said WellPoint is thinking that the changes coming as a result of PPACA in 2014 could have an effect on individual policy enrollment decisions this year.
"We ... anticipate some membership loss in the individual market during the second half of the year as some people may choose to withhold buying coverage until the exchange is open," Deveydt said.
The level of individual sales in the second half of the year could be "minimal," Deveydt said.
WellPoint believes pricing insured business to reflect the effects the PPACA exchange system might have is the prudent thing to do, Deveydt said.
The individual business that does go to the exchanges likely would be relatively low-margin business, and the migration of that business to the exchanges would probably not hurt earnings, Deveydt said.

 

[insurehound]

Maybe UHC is just getting into another market? Like building Exchanges.

Contractor building federal Obamacare exchange has a big ol' conflict of interest « Hot Air
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Ann, I would hate to compete against you. Same goes with Dave

 

[Ann H]

Ann, I would hate to compete against you. Same goes with Dave

It's far more enjoyable to help other agents succeed than to compete with them anyway!


Per an article in Forbes, carrier participation in the exchanges may be lower than we thought. This article also brings up the issue of narrow networks (which I think will happen) and premium spikes.

Believe it or not, Aetna's involvement in the exchanges is more aggressive than its peers. UnitedHealth Group stated that it would only get involved in a "few" states; Humana said that it would get involved in ten.

Bertolini also elaborated on the type of insurance that Aetna would provide on Obamacare's exchanges. "It's about having the right products at the right cost structure, [with] narrow networks, low-cost networks," he said. That is to say, Aetna's exchange products will aggressively steer patients to low-cost doctors and hospitals so as to keep premiums low. That's, indeed, what insurers are rightly incentivized to do when individual consumers are shopping for their own insurance.

Within its exchange products, Aetna expects to reimburse hospitals and doctors at rates akin to government programs, rather than the much higher rates reserved for traditional commercial insurance. "We're contracting…at a rate normally between Medicare and Medicaid for the exchange population," said Frank McCauley.

McCauley's counterparts at Humana don't think that insurers will be able to get away with ultra-low Medicaid rates on the exchanges. "If you go down to Nashville and you ask [hospital chain] HCA about that, they'll laugh you out of the room," said Humana executive Bruce Perkins at Humana's November analyst meeting. "This idea that it's going to be Medicaid rates—that's a joke."

Obamacare's exchanges need serious reforms in order to function

If exchange rates do end up in between Medicare and Medicaid, Americans who enroll in the exchanges will have the worst of both worlds: a costly insurance product that doesn't grant them access to a wide range of doctors and hospitals, making it difficult to get access to needed care.​

Aetna CEO Bertolini: Get Ready for 'Rate Shock' as Some Health Insurance Premiums to Double in 2014 - Forbes

 

[AllenChicago]

A "Narrow Network" that will only include the cheap doctors and hospitals is a non-starter once the public realizes that's what they're about to sign up for at the exchange.

Except for those in rural areas, I don't think most people are willing to drive 50+ miles for a Mammogram, MRI, etc.. For less expensive tests, it MIGHT be better to go where it's most convenient and pay the out-of-network price.

I wonder if large groups will be affected by this narrowing of the networks? 70% of covered Americans are with large employer groups. The more people who are negatively affected, the quicker we can get ObamaCare moved to the trash can where it belongs.
ac

p.s. I've had a few of those "cheap" doctors as health/life clients over the years. Nice guys, but I wouldn't want them operating on me.

 

[taterpeeler]

here is the deal.... bottom line allen and ann, don't matter ow restrictive the network is, the public will just have to deal with it... no recourse... as I tell my 3 year old, suck it up.

now, in regards to these networks... wait till they slap the formulary list on the drugs... this is all good cause now as an agent you play mix and match with plans on who has their doctors and drugs...... like I have been a shouting....... CAN YOU SAY MEDICARE ADVANTAGE

if you aint ever sold em this is what the mapd agent does daily, mix and match

 

[AllenChicago]

TaterPeeler, it sounds like we're about to become even MORE valuable to the public than we are now. The fly in the ointment might be helping them with determining the subsidy they're entitled to? This will really slow down the sales process, IMO. What do you think?
-Allen