Will Aetna Withdraw from FFM?

[Yagents]

Big interview on CNBC today with Aetna CEO................. laying the groundwork.........for a withdrawal?

Aetna could be forced out of Obamacare: CEO Mark Bertolini

Aetna considers withdrawal from federal insurance marketplace - Wichita Business Journal

 

[VolAgent]

So, 5 months into Obamacare and they have to submit rates for next year. Which means they had to develop the rates 3-4 months in, and you basically have to exclude the first month as no one could use their policy because it wasn't properly input, no IDs cards and no payment.

So carriers have to develop next years rates off two months worth of usage???

That seems a bit of an impossible task, to develop rates off usage from February and March.

 

[Yagents]

So, 5 months into Obamacare and they have to submit rates for next year. Which means they had to develop the rates 3-4 months in, and you basically have to exclude the first month as no one could use their policy because it wasn't properly input, no IDs cards and no payment.

So carriers have to develop next years rates off two months worth of usage???

That seems a bit of an impossible task, to develop rates off usage from February and March.

And that May date is already a 1 month extension. The reason why next years OEP was delayed until Nov 15th, is HHS wanted to allow carriers as much time to gather more claims data, so they pushed it up from April to May.

What I don't get is why do they need 6 months to review and reload?

And, the claims will be highest in the first few months of the year due to the new GI and pent up demand.

 

[VolAgent]

And that May date is already a 1 month extension. The reason why next years OEP was delayed until Nov 15th, is HHS wanted to allow carriers as much time to gather more claims data, so they pushed it up from April to May.

What I don't get is why do they need 6 months to review and reload?

And, the claims will be highest in the first few months of the year due to the new GI and pent up demand.

They need plenty of time to beat up the carriers over increases and to try and keep down the rate increases.

 

[houcoogster]

There must be something else at work here. This seems way too premature right now...a lot of policies won't even be effective until 4-1 or 5-1 and those will be much healthier people too. Who knows what's going on behind the scenes. I wonder how many surgeries have been scheduled already, and when those will occur...who knows what all he's looking at.

It seems like he's just putting shareholder's fears of taking a bath in HIX losses to rest.

Either way they're not competitive in my area so no biggie.

 

[Nikita]

Very interesting comments on Advantage plans...

 

[somarco]

Unless HHS is demanding 2015 rates this early, I see this more as a shot across the bow. Any projection for 2015 at this point is pure fantasy. They won't have a handle on losses until sometime in the 2nd quarter, if then.

Delayed sign up. Much delayed premium payments. No premium payments. Early lapses (especially following early, large claims). The first 4 months ratio's will clearly be distorted, especially the subsidized business. It would not surprise me to see 200% - 300% paid loss ratio's for that time frame and no way to even come close to interpolating the data and projecting out 16 months.

If HHS get's too heavy handed they won't have anyone at next years party.

 

[AllenChicago]

When you give an insurer your SSN and DOB during enrollment, don't they have enough information to see your major-claims history and Prescription usage? The online authorization form that the applicant signs at the end of the process grants insurers a lot of investigative power, even though they can no longer use to affect the coverage or premiums.

If this is the case, AETNA and all other insurers know what they're likely to experience in medical costs with each enrollee, don't they?

Aetna's Bertolini was never 100% onboard with the Exchanges anyway. They don't require any Aetna-specific agent training or certification, and their premiums are as high and higher than our state's Land of Lincoln cooperative.

Aetna will submit a 50% Premium increase request to the Feds/States. They'll turn it down. The company will give proper advance notice, and then withdraw from the Exchanges (and maybe most of the off-exchange IFP market too) some months later. Bertolini will then pay off the CEO of United Healthcare for losing the bet they made over whether going on the Exchanges was a smart/dumb idea.

United Healthcare blamed ObamaScare related expenses and mandates for cancelling out the successes enjoyed by it's Senior Sales division in 2013. Aetna and Aetna's shareholders want to get away from this radioactive monster ASAP.
-ac

 

[somarco]

OK, I didn't know Aetna was participating in any exchanges. That's a bit surprising given their posturing on Obamacare almost from the start.

50% won't be sufficient, especially for a player with a small block.

I haven't looked at an Aetna app, but Humana doesn't have a HIPAA release. I find that a bit odd since they will have access to PHI once they start paying claims.

Even if a carrier had access to prior claim info, what would they do with it? Seems a waste of time and effort to pull that information if they are going to have to pay the claim any way.

 

[ABC]

My guess is Aetna is not writing any numbers. Could be multiple of reasons for this. The Gov. is funding 80% of the claims the 1st 3 years. My guess is the CEO has no clue what is happening in the trenches.
If they were smart, they would go after the off the exchange business. That is where there is a lot of opportunities.