Insurance

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

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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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New Concerns About Coakley-Partners Deal

There are new concerns about an agreement Attorney General Martha Coakley negotiated to try and control the prices and market power of Partners HealthCare. The implication, from a commission created to help reduce health spending, is that the deal does not go far enough.

“Without lasting change to the market structures,” the Health Policy Commission (HPC) writes in comments to be filed in court, “price caps may not be effective in keeping costs down.”

Price caps?

The commission dug in on a portion of the deal Coakley reached with Partners — the part that says network prices could not rise faster than inflation for six and a half years.

“Prices themselves, they are important,” said commission chairman Stuart Altman, “but they’re not the end of the game.”

To explain why, picture a colleague, neighbor, maybe your grandmother — someone who’s had hip replacement surgery. Now picture two hospitals.

“In one place,” said Altman, “a hip costs $10,000 to replace. In another, it’s $15,000.”

Under Coakley’s deal, prices at each of these Partners hospitals would rise slowly. But there’s nothing to keep Partners from sending more patients to the $15,000 facility. If more patients have hips replaced at the higher-cost hospital, then total health care costs would go up, even if prices don’t.

“Total medical expenditures, when we finally figure it out, is going to up by a lot, but yet the price increases were fine,” Altman said.

Coakley would have someone monitoring Partners, who could, in theory, intervene if a significant number of patients shift from lower- to higher-cost hospitals. But that monitor would only have access to spending for patients covered by a global budget, which Partners says is about 25 percent of its business.
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Judge Delays Review Of Partners HealthCare Deal

Update 6:35 p.m.: A judge has granted Attorney General Martha Coakley’s request for an extension. The comment period will now close Sept. 15, and Coakley will have until Sept. 25 to file comments from her office after seeing the full Health Policy Commission report. A new hearing has been set for Sept. 29.

Our original post continues:

BOSTON — Massachusetts Attorney General Martha Coakley is asking a judge to postpone reviewing a settlement between her office and Partners HealthCare that would allow the hospital network to acquire three new hospitals.

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Coakley’s motion asks a judge to wait until September to hold a hearing on the deal, which aims to limit the market clout of the state’s largest hospital network in exchange for allowing it to acquire South Shore Hospital and Hallmark Health.

A spokesman for the attorney general says Coakley has seen findings from a preliminary review of the deal from the state’s Health Policy Commission, and she believes the court should consider the full report.

The statement reads in full:

Our office always retained the option to seek to renegotiate portions of this agreement as it relates to Hallmark following a Final Report by the Health Policy Commission.  After reviewing the preliminary findings by the HPC, we believe it is in the interest of the public and the parties involved to wait for the final report before any final consent judgment is considered by the court.

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Cautious Optimism That New State Insurance Site Will Work

connector

An image from a previous interface for the Connector.

The first test of a new Massachusetts health insurance website was a success, a top state official says, leaving him cautiously optimistic that it will be up and running for a critical Nov. 15 deadline. That’s Opening Day for anyone who plans to buy insurance through the Health Connector, or is seeking free or subsidized coverage.

But Maydad Cohen, a top aide to Gov. Deval Patrick, says he’s not sure yet if the site, developed by hCentive, will be ready. So the state will continue to build out both a state and federal option for one more month. If the hCentive site clears a second test in early August, Massachusetts will drop plans to merge with the federal HealthCare.gov for 2015. Work would continue on the state site so that it would be ready for 2016.

Cohen is scheduled to update the Connector board Thursday morning, two months after the state gave up on the idea of trying to fix a site built by Canada-based CGI that never worked.

Some 230,000 residents who could not sign up for insurance online were placed in a temporary coverage plan because the state could not figure out what, if any, insurance assistance program they might qualify for. Each of those men and women will have to a reapply through a new site this November. And 101,000 residents who qualified for subsidized coverage last year, and whose plans have been extended this year, will also have to apply again.

Cohen says the cost of building out two options will be less than the original $121 million estimate, but he can’t say how much. An update on how much the state is spending to keep 230,000 people in temporary coverage is expected at Thursday’s board meeting.

AG Deal With Partners Filed In Court: Restricts Growth, Costs

Massachusetts Attorney General Martha Coakley on Tuesday reached an agreement with Partners HealthCare that she says will alter the hospital network’s negotiating power for years to come.

The deal would resolve an antitrust investigation by the attorney general’s office and ultimately allow Partners to acquire South Shore Hospital.

“Our office was the first to shine a light on the ability of Partners to charge higher prices based on its negotiating power,” Coakley said in a statement. “Today’s resolution is the first action of its kind to directly address that market dysfunction.”

But many in the health care industry say they’re frustrated and angry about the process.

The Rev. Burns Stanfield, president of the Greater Boston Interfaith Organization, says the group is disappointed the agreement bypassed the state’s Health Policy Commission

“A proper review would need to have the agreement available before it is submitted to the judge, and for the Health Policy Commission to be invited to weigh in,” he said.

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