Insurance

News on the state's largest health insurers; the effects of health care reform on coverage; rising premium costs.

RECENT POSTS

For Hospitals And Clinics: Insurance To Protect Against Losses From Ebola

A Boston-based insurance broker is rolling out a new policy for Ebola-related losses at hospitals and clinics across the country.

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

A Braintree cop places police tape around a Harvard Vanguard Medical Associates sign on Sunday. A patient there complained of Ebola-like symptoms, briefly closing the center. (Steven Senne/AP)

How much money might hospitals lose during an Ebola-related quarantine? And will patients use hospitals that treat the virus? Phil Edmundson at William Gallagher Associates developed Ebola insurance to address these risks.

“People may choose to put off their health care, or to get it at an alternative facility, if they feel there’s a reason to suspect Ebola in a given clinic or hospital,” Edmundson said.

Ebola policies could run half a million dollars or more for large hospitals. They will not cover the cost of closing off wards, training staff or overtime.

Other insurers are offering similar coverage for theaters, restaurants, hotels and other public spaces that may have to close if they have a customer with Ebola.

“All Massachusetts hospitals have general insurance policies and liability policies in place for extreme events,” the Massachusetts Hospital Association said in a statement.

The group said it’s aware that hospitals in the state may be evaluating whether “additional insurance for Ebola-specific events” is necessary.

More Coverage:

Selling Mass. On A New Idea: Shop For Care

(Screenshot from Get The Deal On Care)

(Screenshot from Get The Deal On Care)

Could Massachusetts be the only government in the world trying to persuade citizens to shop for health care? I’m scanning Google, trying to come up with another country, province, city…maybe some remote island that has decided: It’s time to learn how to get the best deal you can on care.

Nope, I can’t come up with any other place.

But here it is: Get The Deal on Care. In addition to the website, you may see ads on the T, Twitter or Facebook that will encourage patients to become more savvy consumers of health care.

“We’re at the beginning of a movement here,” said Barbara Anthony, undersecretary for consumer affairs and business regulation, referring to a provision in a Massachusetts law that took effect Oct. 1. It requires all insurers to make real-time prices available to members online and over the phone, and provide members their cost for the service, taking into account co-pays and deductibles.

“We hear about the dawn of patient-centered care,” she said. “We want to put patients in the driver seat. Well, you can’t put consumers or patients in the driver seat if they don’t have information.”
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Health Connector Website Update, By The Numbers

Confidence: That’s the mantra among state and private contractors working to replace the Health Connector website that failed so spectacularly last year.

Today, just over a month before the new site is set to go live, Gov. Deval Patrick’s special assistant, Maydad Cohen, will update the Connector board, using numbers to bolster confidence that the roll-out will go smoothly. Speaking of numbers…

91.5 percent — the current rate of site tests that end successfully — a hypothetical member enrolls.

12,671 — the number of concurrent users the new site will be ready to handle (or 46,036 per hour). “Concurrent,” in IT terms, means the number of people who could push a button on the site, triggering some kind of action, at the same time. Website managers say this is double the capacity they expect to need. They are aiming for “overkill.”

74,000 — the number of people who can browse the site (but not all clicking buttons at once) at any given time. This is double the 37,000 who visited the failed site last year on its opening day.

Under 3 seconds — the maximum time website managers say users will have to wait for a response after clicking to a new page. Continue reading

Judge Wrestles With Partners Deal

Suffolk Superior Court Judge Janet Sanders is wrestling with a decision that will shape the health care industry in Massachusetts for at least a decade.

On the face of it, Sanders is reviewing a customary settlement in an anti-trust case. Partners HealthCare and Attorney General Martha Coakley reached an agreement to avoid a lengthy court fight. The agreement would allow Partners to acquire at least three hospitals and hire more physicians in exchange for limits on price increases and unchecked expansion through the next decade.

“[Sanders] has two choices: either enter it or not enter it,” says Partners attorney Bruce Sokler of Mintz Levin. “It’s not like she can rewrite the decree or decide what the right answer is for health care. There are other forums for that in the commonwealth.”

But this case, Commonwealth of Massachusetts v. Partners HealthCare et al, is not proceeding like any routine anti-trust matter.

For one thing:

“This is the first time I’ve ever had this kind of opposition to a consent decree,” Sanders said during a hearing Monday.

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How Mass. Plans To Re-Enroll 450,000 Residents In Health Insurance

All of the estimated 450,000 Massachusetts residents who get health insurance through the Health Connector or MassHealth — some of whom have been in a confusing phase of temporary coverage this year — will soon begin the process of applying for coverage for 2015.

If the state’s new health insurance website is up and running — which the Patrick administration promises it will be — then residents will be able to beginning applying online Nov. 15. If the website still isn’t working, or using a computer isn’t convenient, then you’ll have to fill out a paper application.

Either way, you might want to keep a copy of this timeline handy through January. There are several different deadlines that may be tricky to remember. Here’s an explanation:

(Click to enlarge)

(Click to enlarge)

The key on the bottom left of the chart describes each diamond. Pay close attention to the red diamonds — these are the working end dates for your coverage. I say “working” because these dates assume insurers and the federal government grant the state’s request for extensions.

The state is seeking the extensions so it can spread out the re-enrollment period to avoid overloading members or the system. All the plans through the Connector and MassHealth are currently set to end on Dec. 31, but your coverage may be good for a few more weeks if the extensions are approved. Make sure to look for the coverage end date on any letters you receive.

If you have a commercial health plan through the Connector, find the gray QHP (qualified health plan) box on the top left of timeline and follow the timeline across. Look for your open enrollment package in the mail in early November. Your coverage ends on Dec. 31.

If you had a Commonwealth Care plan last year that has been continued this year, then look for the gold box. The state hopes to extend your coverage through January, so you’ll have two-plus months to review your coverage options.

If you have temporary coverage through MassHealth, then you will be reminded to re-enroll in waves based on when you signed up. You’ll fall into the purple, blue or green boxes above. According to this timeline, your coverage is expected to end sometime between Jan. 15, 2015 and Feb. 15, 2015. But again, the state does not yet have approval for that extension.

The Patrick administration is also waiting to hear if the federal government will give Massachusetts another $80 million to build the new health insurance website, or the $18 million requested to fund outreach, ads and other enrollment efforts.

Related Coverage:

A First-Year Victory In The Mass. Fight To Control Health Costs

(Source: Center for Health Information and Analysis)

(Source: Center for Health Information and Analysis)

Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate.

The number that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth of 3.6 percent, and well below the increases seen for at least a decade.

“So all of that’s really good news,” says Aron Boros, executive director at the Center for Health Information and Analysis (CHIA), which is releasing the first calculation of state health care expenditures. “It really seems like…the growth in health care spending is slowing.”

Why? It could be the pressure of the new law.

“We have to believe that’s the year,” Boros says, “that insurers and providers are trying their hardest to keep cost increases down.”

But then, health care spending was down across the U.S., not just in Massachusetts, last year.

“There’s not strong evidence that it’s different in Massachusetts; we really seem to be in line with those national trends,” Boros adds. “People are either going to doctors and hospitals a little less frequently, or they’re going to lower-cost settings a little more frequently.”

The result: Health insurance premiums were flat overall in 2013.

2013 average premiums:

Individual: $461 PMPM (1.8% increase 2012-2013)

Small group (1-50 enrollees): $421 PMPM (0.4% increase)

Mid-size group (51-100 enrollees): $444 PMPM (0.5% increase)

Large group (101-499 enrollees): $433 PMPM (-0.2% decrease)

Jumbo group (500+ enrollees): $423 PMPM (-0.8% decrease)

“2013 was a year in which we were able to exhale,” says Jon Hurst, president of the Retailers Association of Massachusetts. But he’s worried the break on rates was short-lived. This year, Hurst’s members are reporting premium increases that average 12 percent.

“If we’re going back to these double-digit increases that so many small businesses suffered through for most of the last decade, we have very large concerns,” Hurst says. “What’s going to happen to the small business marketplace in Massachusetts?” Continue reading

Mass. Health Wonks, Start Your Engines! Contest To Guess Rise In Costs

money

This Tuesday, Sept. 2, we will know … Did Massachusetts succeed or fail in its first year of trying to keep health care costs in line with all the other things we spend money on?

In 2013, health care costs were not supposed to grow more than 3.6 percent.

So what do you think, did Massachusetts make it?

Weigh in below in the comments section, and enter our contest.

The winner will be the person who is closest (you can go over) on both of the following questions:

First, how much did health-care spending increase in 2013? Please submit to the first decimal place (for example, 0.7 percent, 1.7 percent, 4.3 percent, 6.6 percent, etc.).

Second, what was the total amount of money spent on health care in Massachusetts last year? Think double-digit billions.

Remember, the state’s calculations for both of the above will not include out-of-pocket expenses (except those related to insurance), health-care research dollars or public health spending.

The answers will come on Tuesday from the state’s Center for Health Information and Analysis.

Your prize…lunch with CHIA director Aron Boros at the hospital or health insurance cafeteria of your choice. And I might tag along too.

Mass. Seeks $80M More From Feds For Health Website

Massachusetts will ask the federal government for another $80 million to build a new health insurance shopping website tied to the Affordable Care Act.

Massachusetts received $174 million for multi-state planning and a website that never worked.
The state has about $65 million left, but says it will need the additional money to build a new site.

So the total cost of the site — which is expected to be ready for the next open enrollment period that begins Nov. 15 — will be roughly $254 million. If the federal government agrees to the additional expense, it would end up spending about $224 million for the insurance exchange. The balance, about $30 million, would come out of the state’s capital budget.*

Project directors from hCentive, the company building out the new site, walked the Health Connector board through a demo Thursday morning. There were a few glitches, but a sample user was able to compare plans and enroll. The site has not been tested yet with the hundreds of users who are expected to log in when the next open enrollment period begins on Nov. 15. Continue reading

Mass. Pledges New State-Run Insurance Website Will Work

The decision is in: Massachusetts will go with a new state-run health insurance website.

The Patrick administration revealed Friday that it is no longer building out the option of sending residents shopping for coverage to the federal health insurance site, HealthCare.gov.

“We are poised to offer consumers a streamlined, single point-of-entry shopping experience for health care plans in time for fall 2014 Open Enrollment,” Gov. Deval Patrick wrote in a letter to federal officials, dated Thursday.

About 450,000 residents are expected to use the state’s new site, built with the Virginia-based company hCentive, when it is set to go live Nov. 15. The residents include:

— at least 251,000 residents who’ve tried to enroll for free or subsidized coverage since last October and are in a temporary plan through MassHealth (this coverage expires Dec. 31);

— another 98,000 people who were in Commonwealth Care when the website failed and have remained in those plans (this coverage also expires Dec. 31);

— and residents who purchase private insurance through the Health Connector.

Many of these people are wary of state promises. They waited months after applying for coverage online, not sure if they had health insurance. Continue reading

Mass. Substance Abuse Bill Responds To Tide Of Sadness And Fear

Massachusetts State House (Wikimedia Commons)

Massachusetts State House (Wikimedia Commons)

In response to stories that seem to be on the rise in communities across the state — stories of parents trying to revive children after a heroin overdose, of young people seeking treatment their insurance plan won’t cover, and of babies born addicted to opiates — state lawmakers on the last day of their formal session approved a bill they say will help save the lives of those addicted to heroin, prescription painkillers and alcohol.

The measure, among several major bills passed just after midnight Friday, requires insurers to pay for any care a doctor decides is medically necessary. Insurers say this and other requirements included in the bill are a mistake.

In outlining the House and Senate compromise on the substance abuse bill Thursday afternoon, Sen. John Keenan of Quincy talked about his father.

“He was a good, decent, hard-working man, he was a great husband, a great father, but he was an alcoholic.” Keenan remembered an afternoon when his family told his father he had to get help. His dad resisted, but finally agreed. Someone got on the phone and found him a bed in a treatment program that was paid for by the Keenan’s insurance plan.

“That very day changed lives. My father had 26 years of sobriety before he passed away last year,” Keenan said. “He had 26 years with my mother, 26 years as a great father, 26 years with his seven children and their spouses, and 26 years as a great papa to his 20 grandchildren. So this can work.”

“This” being a requirement that insurers pay for up to 14 days of overnight detox and rehabilitation treatment as well as counseling, medication and any other services a clinician says are “medically necessary.”

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