United Health Care - Opting Out of Most Exchanges!

[taterpeeler]

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

Exactly... We become the know all... Will it take more time? Yes, on the front end...not the back end..... I spend hellish amounts of time with underwriting and placement based on medical history and other bull crap now but with my mapd clients once we get to the plan we are good with little Mickey Mouse application with only one question and one signature

 

[AllenChicago]

Sounds good! Let's hope that our state exchange(s) have a decent compensation plan that rewards us accordingly.
ac

 

[Yagents]

It doesn't look like we'll have anything to sell. Time to consider fee based consulting if things fall apart

Health Plan Week | AIS Health
Quote of the Day [FONT=Verdana, Arial, Helvetica, sans-serif]"Aetna has already declared that they do not believe their future is selling health insurance coverage in an environment where margins and profits are regulated by an 85% medical loss ratio. They believe their revenues and earnings growth will be from the sale of their intellectual and system assets to the ACOs and exchanges and from offshore opportunities. Cigna has expressed similar strategies."[/FONT]
[FONT=Verdana, Arial, Helvetica, sans-serif]Peter Hayes, principal at the consulting firm of Healthcare Solutions, told AIS's [/FONT]Health Plan Week[FONT=Verdana, Arial, Helvetica, sans-serif].[/FONT]

 

[ABC]

Interesting,

The big issue is no one knows how these exchange are going to look. What company is going to commit to something they know very little about?

When I hear a carrier say limited markets, that tell me they are going into the areas they have the deepest network discounts.
You can kiss any carrier that is renting a network goodbye.

I doubt, most state based exchanges will be able to operate after a few years. The state will not have the funds to operate after the fed stops giving them money.

The Federal exchange is key to entire mess. How that is developed will determine if we producers stay in business.

 

[CHUMPS FROM OXFORD]

GET OUT OF INDIVIDUAL HEALTH INSURANCE SALES! Most of you have made the transition (or are in the process). You will survive although 2013 and 2014 will be challenging.

My EBook (when available) will guide you. It will be free, of course.

 

[Ann H]

For quite a while, I've personally thought that narrow networks would be a part of the exchange. The reason is the smorgasborg concept where you can eat all you want. When people have rich premium subsidies and cost-sharing subsidies they have little skin in the game. They want medical services at their demand, and they want the best. Insurers cannot control consumption. That's why Medicaid and Medicare Advantage plans with $0 premium use the HMO concept of PCP gatekeepers, referrals to specialists, narrow networks, and precertifications - to control consumption. So, these carriers will be looking for markets where ACO's (today's HMO) are already established, where narrow networks are available, where the exchanges are more carrier friendly, and where profitability is possible. Like TaterPeeler keeps saying, this is the MAPD market under age 65 now.

 

[Dave020]

This is in line with what CA HBEX told me. The carrier plans sold exclusively outside of the CA exchange will be different plans with different networks, drug benefits, formularies and so on.

They only have to conform with AV, EHB and a metal tier but can vary in many other ways.

 

[Ann H]

This is in line with what CA HBEX told me. The carrier plans sold exclusively outside of the CA exchange will be different plans with different networks, drug benefits, formularies and so on.

They only have to conform with AV, EHB and a metal tier but can vary in many other ways.

And that is another HUGE twist and turn in this never ending roller coaster.

With rich subsidies for premiums and cost-sharing, many will have little choice but to take an exchange plan with different networks, formularies etc. Cost sharing subsidies are for those under 250% of FPL. Premium subsidies are for those under 400% of FPL.

Those with slightly higher incomes will get partial premium subsidies, and some of them may choose the lower cost HMO-style coverage and others choose to pay more outside the exchange.

Some employers may choose to keep the group plan rather than send employees to narrow-network exchange plans. Certainly those with lower-paid workers will dump the group plan, but employers who employ family members or who employ mostly medium to higher paid employees will look carefully at the benefits of keeping a group plan outside the exchange. Or the employer may do a defined contribution arrangement and let employees buy their own coverage inside or outside the exchange.

It gives us a lot wider choice when better networks & benefits can be sold outside the exchange.

 

[Yagents]

Here's an article stating that the exchanges will NOT be like travelocity, instead, it will be like TurboTax, a complicated mess (I agree). Disturbing though, is more people will trust an 800# vs a licensed/experienced agent. We are right down there next to car salesman. People are stupid, and bad agents give us a bad name. Fixing CHAOS will be our new job.

TurboTax, Not Travelocity, May Be Better Analogy For Health Exchanges - Kaiser Health News
Of the 414 people surveyed, 80 said they'd feel comfortable turning to exchange staff for support, and 16 said they would not.
In contrast, 162 said they would specifically not trust an insurance agent or broker, and only 47 said they would.
The trustworthy source of advice named by most people, 138, was doctors, nurses and health facility staff, versus 52 people saying they would not trust them. Colorado's exchange board includes a physician, who has said he doesn't think doctors in general know enough about health insurance policies to give good advice to consumers.
More than half in the discussion group were under 30 years old. When asked "who helps you choose a health plan now?" 215 said "parents," and 105 said a family member. Only 17 said they turned to the Internet for help picking a health plan now, fewer than named brokers/agents (22), employers (45) or "myself/nobody" (44).

 

[Ann H]

Here's an article stating that the exchanges will NOT be like travelocity, instead, it will be like TurboTax, a complicated mess (I agree). Disturbing though, is more people will trust an 800# vs a licensed/experienced agent. We are right down there next to car salesman. People are stupid, and bad agents give us a bad name. Fixing CHAOS will be our new job.

TurboTax, Not Travelocity, May Be Better Analogy For Health Exchanges - Kaiser Health News
Of the 414 people surveyed, 80 said they'd feel comfortable turning to exchange staff for support, and 16 said they would not.
In contrast, 162 said they would specifically not trust an insurance agent or broker, and only 47 said they would.
The trustworthy source of advice named by most people, 138, was doctors, nurses and health facility staff, versus 52 people saying they would not trust them. Colorado's exchange board includes a physician, who has said he doesn't think doctors in general know enough about health insurance policies to give good advice to consumers.
More than half in the discussion group were under 30 years old. When asked "who helps you choose a health plan now?" 215 said "parents," and 105 said a family member. Only 17 said they turned to the Internet for help picking a health plan now, fewer than named brokers/agents (22), employers (45) or "myself/nobody" (44).

Argh... I was really listening to the study results until the last paragraph that said, "More than half in the discussion group were under 30 years old." Granted, the 30 and under haven't always learned to go to a professional, and they tend to surf the web (and trust what they read there) more.

As the gap widens between exchange business and non-exchange business, we might need to have different business models to properly service clients who clearly want advice and are considering non-exchange products versus a lookie-lou or surfer who will probably just go to the exchange anyway.