Health Connector

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Mass. Health Insurers Report Losses; Many Premiums To Rise By 3 Percent

Health insurance rate changes for the small group market in Mass. The Q1 rates also apply to individual coverage for 2015. (Source: Mass. Office of Consumer Affairs and Business Regulation)

Health insurance rate changes for the last quarter of 2014 for the small group market in Mass. The Q1 rates also apply to individual coverage for 2015. (Source: Mass. Office of Consumer Affairs and Business Regulation)

Premiums for Massachusetts small businesses and residents who buy insurance on their own are going up.

The average increase for Jan. 1 is 3.1 percent. But this is just the base rate. Your rates could be higher or lower, depending on how much you or your fellow employees have spent on health care this year.

Insurers say premiums are going up because residents are using more care. What’s known as “utilization” in the insurance world dropped during the recession, but appears to be creeping up again. Then, say insurers, there’s the cost of some expensive new drugs, such as Sovaldi to treat Hepatitis C; taxes related to the Affordable Care Act; and the expense of dealing with the Health Connector’s failed website.

Although the average increase for Jan. 1 is just over three percent, there’s quite a range.

Shop carefully. Many of the cheaper plans will have a high deductible, so if you have a chronic disease or lots of young children, you may not want this option. You can save money by choosing a plan that limits where you seek care, but check to see if your doctor(s) are in the covered network.

Also today, the state’s three largest health plans reported that they’ve lost money so far this year.

Blue Cross Blue Shield posted a net loss of $32.2 million for the second quarter and $91.4 million loss for the first six months of the year.

“Our second quarter results reflect our continued commitment to delivering more affordable premiums to our members while we absorb costs associated with complying the ACA,” said Allen Maltz, Blue Cross CFO.

Harvard Pilgrim’s net loss through June is $10.4 million. Continue reading

Deadline Extended For Mass. Residents Bedeviled By Health Connector Site

State House News Service’s Matt Murphy reports that residents who had trouble signing up for health insurance through the state’s troubled Health Connector website now have a little more time to do so:

Massachusetts residents who have had difficulty signing up through the Health Connector for unsubsidized health insurance coverage will be given an extra two weeks to enroll under an extension plan to be presented Thursday, two days after President Barack Obama announced a similar reprieve for frustrated consumers on the national level.

Sarah Iselin, the special advisor who Gov. Deval Patrick put in charge of fixing the state’s dysfunctional health insurance sign-up website, plans to discuss the change to the state’s open enrollment process on Thursday when the Health Connector board meets.

Mass. Health Connector website

Mass. Health Connector website

Residents who have had trouble completing enrollment to due technical problems with the website will be allowed to shop online for unsubsidized plans through April 15, with payment due April 23 for coverage starting on May 1.

The open enrollment deadline was supposed to arrive on Monday, but the Obama administration announced this week that those who encountered problems shopping through the federal online marketplace would be given a similar two-week extension.

Murphy also reports that the Connector has been able to eliminate a massive backlog of paper applications from residents looking for subsidized health insurance:

After starting with a backlog of 72,000 applications in February and receiving an additional 1,000 applications a day, Connector staff, with the help of hundreds of workers brought on board through the consultant Optum, cleared the remaining 21,000 applications over the past week and officials are confident they can now keep up with new requests as they arrive.

Come On, Massachusetts, Get This Pregnant Woman Covered

UPDATE 1/9:
Jessica Stanford is now on MassHealth and has her first prenatal visit next week. She says she qualified for free coverage because she’s pregnant. Her husband still doesn’t know if he has temporary coverage and hasn’t been told if he qualifies for a ConnectorCare plan. That’s frustrating, says Jessica, “but we do not need to spend time fighting that battle. Our priority was to make sure I could see a doctor as soon as possible.”

Connector 1

Jessica Stanford of Sharon, Mass., is 40 and newly pregnant. She’d really like to see a doctor soon because she’s had several miscarriages and developed gestational diabetes during her last pregnancy. But she doesn’t have health insurance and is worried about racking up medical bills.

Stanford applied for subsidized coverage in early December. She keeps calling the Connector to find out about her enrollment status. One customer rep told Stanford she could take her application number to a doctor’s office for proof that the state will cover her, at least temporarily, but Stanford wants something more certain.

The Connector says it has extended coverage, through March, to 254,000 residents who applied for free or subsidized insurance and all residents who have had government backed coverage.

The agency is sending out letters explaining a temporary coverage plan that begins today (Jan. 1) for 22,371 residents who, like Stanford, are applying for the first time. Continue reading

When The Full Sticker Shock Of Health Coverage Hits Our Family

medical bill

(Attercop311/ Flickr Creative Commons)

As the new state Health Policy Commission begins its work to bring down health care costs, here’s one Massachusetts family’s reminder of why the issue is so urgent. The excruciatingly high prices of both insurance and care mean that some must choose between health insurance and a new furnace, or health insurance and a car. This is not an abstract policy issue; it is a daily burden with major effects. One mother’s story:

By Sara Cushing
Guest contributor

A few weeks ago I resigned from my job as a project manager at one of the largest health care delivery systems in the United States. I have worked in different capacities in the health care industry in the Boston area for the last eleven years, but decided to leave my career because I wanted a change — to follow my dream of becoming a writer.

Many things needed to be considered about such a family-life-altering decision, including one that hadn’t been a concern of mine in the past: what my family’s next steps would be in purchasing health insurance. I have always carried the health insurance — a very robust PPO (“paid provider option”) family plan that was largely subsidized by my employer.

Sara Cushing

Writer Sara Cushing

The direct cost to me (paid bi-weekly on a pre-tax basis) was roughly $400 a month. In discussing my career departure with my husband, we knew that the monthly cost for a similar plan purchased through the Health Connector (the Massachusetts state agency that acts as a vehicle to allow uninsured residents to purchase health insurance through local health insurance companies) would likely be higher. Much higher.

Try something closer to $1700. About the same as our monthly mortgage. About half of what my take-home pay used to be — money that was no longer coming in. And we see no way around it.

Because my husband is in a higher income bracket we’re not eligible for subsidized coverage though the state; and because my husband is a contract employee, his employer doesn’t provide subsidized health care coverage.

This means that we’re looking at the same cost for a family plan whether we buy through his employer; the Health Connector; or through my employer’s COBRA plan (which allows me to purchase the same health care coverage as offered by my employer for up to 18 months after ending employment, though I am responsible for 102% of the cost — the additional 2% is for administrative fees).

I live in Massachusetts, where legislation was passed a few years ago mandating health care coverage for all residents. The legislation helped to create the Health Connector agency so that people could purchase health insurance in larger risk-pools instead of directly from health insurance companies, to allow for more competitive pricing and coverage options for individuals and families.

This all sounds great, right? What many people do not understand, however, is just how steep the monthly premium cost gets, just how painful a $1700 bite out of a family budget can be. Continue reading

The Connector: $80M Savings Through Limiting Choices, Tougher Contracts

Connector Chief Glen Shor

WBUR’s Martha Bebinger reports that the state is not budgeting any additional money for subsidized health insurance that covers low to moderate income residents. Instead, it’s relying on insurance plans due out today which provide the same benefits with no increased cost.

She explains:

For most of us, the price of insurance went up at least 7-10% this year. But plans that cover moderate income residents through Commonwealth Care are holding rates flat by limiting where patients can go, negotiating tougher contracts with hospitals, and with better oversight of the sickest patients. Glen Shor runs, who runs the state’s Health Connector says: “We’re very excited to test new models for delivering coverage in a more effective manner. We hope there’s something to learn from this experiment that can help other cost containment efforts.”

Shor says the state will save $80 million dollars by level funding Commonwealth Care.

The limits placed on where patients can seek care may be significant. The Boston Globe reports:

Shor said that a proposed limited-network contract from Network Health excludes all hospitals in the Partners HealthCare system except two, on Martha’s Vineyard and Nantucket.