Thursday, May 21, 2015

Georgia On My Mind

For the last 5+ years Humana has been my "go to" carrier for individual health insurance. Although I
have scaled back my under 65 health insurance business, I still used them almost exclusively throughout 2014 and 2015.

This will be my last year to write any traditional health insurance. After 40 years in this business, switching from large employer group plans to small group and individual coverage, starting in 2016 and going forward my focus will be exclusively helping those age 65 and older searching for answers to their questions about Medicare.

Humana has been good for my clients, and mostly for me as well, but it is not without hiccups.

Through all of the changes that have occurred in this industry, and internal changes at Humana, they have been rock solid.

But it appears their days are numbered, at least with regard to individual health insurance in Georgia.
Georgia is Humana Inc.’s second-biggest market for insurance policies sold under the health law, and the home of what may be its biggest misstep. The company is now attempting a turnaround as it tries to make its strategy of selling coverage directly to consumers a success. 
If it can’t, it will quit the state. - Bloomberg

This can't be good news for Georgia residents that currently have Obamacare plans through Humana.

Until now, Humana has not only had competitive rates and good value but has also had the broadest access to health care.

While other carriers focused on skinny provider networks, Humana continued to deliver almost unfettered access to a large number of medical providers throughout the state.

Apparently that will end come 2016.

For the last 2 years Humana sold a significant number of policies to individuals that order health insurance from the dollar menu. They wrote a lot of off-exchange business (which is all I do) but also gobbled up more than their share of subsidized policyholders.
Humana, which touts its skills at selling health insurance directly to individuals, ran into trouble in Georgia after charging too little for plans it sold on the state’s new marketplace. Customers came running. 
Unfortunately, more of them were sicker than Humana expected. Flooded with patients, Humana let them see doctors who aren’t in its networks. That’s expensive -- health insurers make deals with doctors and hospitals to add them to their networks, negotiating lower prices in return for business. 
The out-of-network generosity cost the insurer.

Non-par claims are not the only thing that sunk this ship.

Under Obamacare non-par claims are paid at the same rate as par claims. There are no consumer penalties for using providers outside the network.

But when a policyholder does use a non-par provider that provider is allowed to balance bill and the consumer is on the hook for the differential.
 If Humana withdraws from states like Georgia, “then you’ve wasted all your time and effort in building a business that goes away.”

That same argument is not just limited to Humana, this is true for anyone, including agents, that are still hanging on to the hope that change will be good for them.

Some will argue that Obamacare was designed to unravel the current health care financing system and drive agents from the industry.

Looks like it is time to hang a "Mission Accomplished" banner over the White House.

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