Arizona Health Insurance Exchange Rates

[Yagents]

Add Humana to the list, but no pricing available
Lower priced plans are probably the catastrophic plans for under age 30
Higher priced plans are Platinum plans for folks 64


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RATE COMPARISONS

Company, minimum, maximum, average

» Aetna, $79, $806, $240.

» Blue Cross Blue Shield of Arizona,

$71, $1,489, $264.

» Cigna, $114, $1,693, $314.

» Health Net, $82, $897, $240.

» Meritus PPO, $131, $1,749, $334.

» Meritus PPO (catastrophic cov*erage), $106, $961, $225.

Sources: Arizona Department of Insurance, Republic research

 

[AllenChicago]

Big switch from PPO to HMO for 2016 is in the works for Arizona.

ref: http://www.azcentral.com/story/mone...rance-costs-insurers-switching-hmos/73092228/

 

[Yagents]

Big switch from PPO to HMO for 2016 is in the works for Arizona.

ref: http://www.azcentral.com/story/money/business/consumers/2015/10/02/arizona-health-insurance-costs-insurers-switching-hmos/73092228/

Link doesn't work. Can't find story

 

[AllenChicago]

It was there earlier today, Yagents. The article contained nice chart, listing Arizona health insurance company's premium increases and which ones were moving from PPO to HMO. I can't find it anywhere on the website tonight.

Perhaps the AZCentral.com people jumped the gun by publishing that info too soon, and had to take to page down.
ac

 

[Yagents]

Perhaps the AZCentral.com people jumped the gun by publishing that info too soon, and had to take to page down.
ac

They felt it was a front page Sunday lead in newspaper format. But go to the AZ central home page, and it's buried. The agent at the end nailed this year's "story". Weed out the best of the junk.

Why 4 major Arizona insurance carriers are dropping PPO plans in favor of HMO plans

Why 4 major Arizona insurance carriers are dropping PPO plans in favor of HMO plans
Ken Alltucker, The Republic | azcentral.com 8:39 p.m. MST October 3, 2015
Health insurance



Four major health insurance companies will discontinue preferred-provider plans for tens of thousands of Arizonans next year on the federal marketplace.

Instead, they’ll sell pared-down, health maintenance organization plans that limit the doctors and hospitals that consumers can visit at lower, in-network rates.

Erin Klug, of the Arizona Department of Insurance, said that Aetna, Blue Cross Blue Shield, Cigna and Meritus won't offer PPO plans on the federal marketplace in Arizona next year. However, Health Net and UnitedHealthcare's All Savers Insurance have filed paperwork to sell PPO plans in 2016, pending federal approval, Klug said.

HMOs dominated Arizona’s insurance market in the 1990s, before consumer backlash over these more restrictive plans fueled the popularity of PPO plans. PPOs gave consumers a broader choice of doctors, hospitals and specialists but also coincided with an era of inflated medical spending.

As Arizona insurers seek to trim losses on Affordable Care Act marketplace plans but still keep plans affordable for consumers, they increasingly are dropping PPOs in favor of HMOs that are often paired with smaller networks of doctors and hospitals.

Blue Cross Blue Shield of Arizona already has mailed out notices to the first wave of about 37,000 PPO customers explaining that they'll be assigned to new HMO plans beginning next year. Blue Cross Blue Shield officials said they tried to match their customers to plans that were a good fit with price, doctors and hospitals. Consumers will have the option to shop for other plans during the three-month open enrollment, which begins next month.

“We need to make changes in the individual market that reflects what our consumers demand,” said Jeff Stelnik, Blue Cross Blue Shield of Arizona's senior vice president of strategy, sales and marketing.

RELATED: Providing businesses with affordable health-care plans

Health insurers are operating in a different market than the pre-2014 days. Then, they could protect their profits by denying or limiting coverage for those with chronic health conditions. The federal health law forbids insurers from denying coverage based on an individual’s health. Insurers say that has created insurance pools with some consumers who heavily use medical care, whether a specialist, a hospital or expensive prescription drugs.

Many companies that sold health insurance plans through the federal marketplace in Arizona reported substantial financial losses in 2014, according to filings with the National Association of Insurance Commissioners.

Blue Cross Blue Shield of Arizona reported an underwriting loss of more than $33 million. The insurer’s losses on individual plans — those sold on or off the federal marketplace — reached about $90 million in 2014, company officials said. Those losses were offset by plans sold to businesses, federal employees and seniors. Even though the insurer had an underwriting loss, it made a profit of $4 million due to returns on investments.

Other Arizona insurers had larger losses in 2014. Health Net reported a net loss of nearly $79 million in Arizona, Cigna lost $16.9 million and the startup, non-profit health insurance cooperative Meritus lost more than $16 million, according to the NAIC report. The report did not provide separate financial figures for different areas of an insurer's business, such as individual marketplace plans or larger group plans sold to businesses.

The federal health law has three programs — called reinsurance, risk adjustment and risk corridor — designed to help stabilize premiums for consumers and discourage insurers from dropping out of the market.

Some health insurers will get lucrative payments from these programs designed to counter the extra cost from taking on high-risk patients.

The federal Centers for Medicare and Medicaid Services announced in June it would pay $7.9 billion to 437 insurers nationwide under the reinsurance program, which collects funds from all insurers and distributes money to insurers to offset the medical costs of patients whose claims exceed $45,000. Insurers that signed up more high-risk patients in 2014 expected to get tens of millions of dollars in reinsurance payments, CMS records show.

Reporter Laura Ungar explores why Americans pay so much for health care. Send us your own question using #askusatoday on Twitter or you can also post your question on the USA TODAY Opinion Facebook page. We might answer it in a video!

Even with these federal risk programs in place, health insurers are trying to stabilize their finances through a combination of rate increases and a shift toward lower-cost plans like HMOs, which typically charge lower monthly premiums than PPOs.

“Insurers are recognizing that in order to be competitive, they have to offer lower-cost plans,” said Cynthia Cox, associate director of health reform and private insurance for Kaiser Family Foundation. “It’s much easier for insurers to contain cost when there is an HMO plan.”

That is one reason why health insurers may be scaling back networks by shifting from PPOs to HMOs and increasing rates for 2016.

The Arizona Department of Insurance already has reviewed and approved plans and rates for next year, but the details on these won't be known until the federal government signs off on all marketplace plans, likely before mid-October. The three-month enrollment period begins Nov. 1.

Health insurers say that because the marketplace did not start until Jan. 1, 2014, there has been an element of guesswork in establishing plans and setting rates. Arizona had some of the lowest-priced plans among states that use the federal marketplace.

"It's really hard to price," said Tom Zumtobel, CEO of the Meritus, which launched with the financial backing of federal loans. "You have to assume what your risk is going to be. You have to do your best to figure out who will be attracted to your plan."

Meritus is an example of the frenzied nature of marketplace pricing over the first two years, and the market changes that consumer will see next year.
PNI1217-met ACA outreach

More than 120,000 Arizona residents signed up for private health insurance through the federal marketplace during the first year of the Affordable Care Act and paid among the lowest rates in the nation.More than 309,000 Arizonans are covered through the state's Medicaid program, which expanded under the law. Job growth followed as a result of both the aging population and the health-care expansion, and the health-care field was among the state's fastest-growing throughout 2014. (Photo: David Kadlubowski/The Republic)

The non-profit's plans were priced higher than many other insurers' in 2014 and it signed up fewer than 3,600 people that year. Meritus slashed its rates this year, and enrollment soared to nearly 58,000 as of mid-September, according to Zumtobel.

Meritus initially decided to keep rate increases for 2016 to less than 10 percent for all of its plans, assuming it would receive financial relief from the federal government's "risk corridor" program.

"We booked a significant amount of receivables to come in under the risk corridor," Zumtobel said. "We started to lose faith in the credibility of that. We increased rates to offset that."

The Centers for Medicare and Medicaid Services said last month that it would delay the public release of the risk-corridor payment data until it verifies figures are correct. The federal agency has not said when the payment information will be released.

Meritus will try to stabilize finances by eliminating its marketplace PPO plans next year and implementing rate hikes ranging from 10.5 percent to 27.6 percent for 26 HMO offerings, Zumtobel said.

Health insurance cooperatives such as Meritus were established by the federal health-care law and backed by federal loans to provide competition to private health plans. But the vast majority have struggled to meet enrollment and profit projections, according to a Health and Human Services Inspector General report issued in July.

Zumtobel said Meritus' biggest challenge has been managing a startup that had relatively little enrollment during the first year and explosive growth during the second year.

"We have to figure out a way to grow more conservatively," said Zumtobel.

Other insurers, too, are taking a close look at the types of health insurance plans that resonate with customers.

Cigna won't sell PPO plans on the federal marketplace in 2016, but those plans will be sold to customers who buy plans outside the marketplace. Consumers must use the marketplace if they want to collect federal subsidies to offset monthly premiums. Those subsidies are based on a person's income, with more generous subsidies for lower-income earners. People who earn more than four times the federal poverty level are not eligible for subsidies.

Cigna will sell HMO plans in Maricopa County that include Cigna's medical providers to "offer competitively-priced plans and also provide quality, integrated care and service," spokesman Joseph Mondy said.

Blue Cross Blue Shield will route its customers to HMO plans that have distinct networks of doctors, hospitals and other health providers. One HMO network includes doctors and hospitals from two health systems, Banner Health and HonorHealth. The other network includes a network of providers from Abrazo Health, Dignity Health and IASIS Healthcare.

Those two networks represent about 90 percent of all doctors, hospitals and other providers in Maricopa County, and the insurer will attempt to pair customers with plans that include their doctors, Stelnik said.

Some health insurance brokers expect there will be some angst among consumers who prefer the flexibility of PPO plans but will be routed to HMO plans with smaller networks.

Michael Malasnik, a broker who is familiar with the marketplace plans, said consumers should scrutinize plan details to find a plan that fits their needs. He added that some HMO plans are "open network" plans that allow patients to see a specialist without a referral from a primary-care doctors, while some HMO plans require a referral.

"If you are stuck in an HMO but you want to have freedom, you may want to look into an open-access HMO," he said.