As states across the country prepare for the opening of state- or federally-run health insurance exchanges on October 1st, most are gearing up with education and advertising campaigns to inform consumers of their options. To further aid consumers, the Department of Health and Human Services recently granted $67 million to nonprofits and other groups and organizations embedded in communities to train “navigators” to help consumers evaluate and select health insurance plans. Meanwhile, insurance carriers continue to evaluate the benefits of submitting plans to the public exchanges, with some carriers opting out as the October deadline draws nearer.

The State Exchange Table continues to provide the latest information on carrier participation and plan rates.

Latest Developments:

State Run Exchanges-

California: Covered California signed contracts with 12 insurance providers, among them the four largest carriers in the state  — Anthem, Health Net Inc., Kaiser Permanente, and Blue Cross. Ventura County Health Care Plan (VCHCP) has opted not to participate in the state-run marketplace for the first plan year, but Covered California said it would consider a bid from the carrier in 2015 should it choose to submit one. For more on the background of VCHCP’s decision, click here.

Colorado: On August 16th, the Colorado Department of Insurance (DOI) released final plan rates for its state-run healthcare exchange, Connect For Health Colorado. Eighteen insurance carriers offering 541 plans have been approved to offer coverage to individuals, families and small businesses. Plans will be available both on and off the exchange. For a more detailed breakdown of the rates, see the Colorado DOI’s official summary.

Connecticut: Health insurance provider Aetna withdrew its proposal to participate in Access Health CT. Despite its initial plan to offer coverage under the state exchange, the company announced its decision to withdraw on August 5th, citing price reduction requests by state officials. “Unfortunately, we believe the modifications to the rates filed by Aetna will not allow us to collect enough premiums to cover the cost of the plans and meet the service expectations of our customers,” said an Aetna spokesperson.

DC: The District of Columbia awarded $375,000 to the local Planned Parenthood branch, Planned Parenthood of Metropolitan Washington DC, to help individuals navigate the new healthcare exchange marketplace and to enroll in a plan. Planned Parenthood was one of 35 organizations selected to be trained and allocated funding to become “DC Health Link Assisters,” as part of DC’s state-run exchange DC Health Link.

Idaho: Idaho governor C.L. Otter confirmed that the state would be running its own health insurance exchange, despite previous discussion of participating in the federally-run exchange. “We have decided to build and operate a voluntary, state-based health insurance exchange rather than defaulting to total federal control,” said Governor Otter.  The state recently received a $20.3 million grant from the Department of Health and Human Services to implement the state-based exchange.

Kentucky: Gov. Steve Beshear announced that individuals, families, and small businesses will have access to 60 representatives (slated to be scaled up to 100 representatives by October 1st) via a call center based out of Lexington as a part of Kynect, Kentucky’s state-run health insurance exchange. Phone support will supplement online and in-person assistance, according to a promotional video on the website.

Minnesota: Minnesota has taken a creative approach to informing its residents about MNSure, its state-run health insurance exchange, using two characters from popular mythology, Paul Bunyan and Babe the blue ox, to spread the message. Short PSAs feature Paul and Babe getting into mishaps, illustrating the campaign’s tagline “10,000 reasons to get health insurance.” This campaign is aimed at the approximately 1 million Minnesotans currently without health insurance, who will eligible to enroll in MNSure starting October 1st.

New Mexico: The New Mexico Health Insurance Exchange board selected BVK, a Wisconsin-based public relations firm, to handle marketing the state’s health insurance exchange to the state’s approximately 83,000 uninsured residents. According to some estimates, the contract with BVK could reach as high as $7.7 million.

New York: New York recently announced the name of its new healthcare exchange, NY State of Health, playing on the popular 1976 Billy Joel song “New York State of Mind.”   “We wanted a name that was distinctive and unique to New York and is emotional and not just functional description,” said Leo Mamorsky, executive group account director with DDB New York  which is handling advertising  for the exchange.  Creating a strong incentive for individuals to enroll in the new, state-run exchange, state officials also announced that average monthly premium rates would be approximately half the price of premiums for individuals today who buy their own insurance.

Rhode Island: Rhode Island has opted to offer health insurance to its residents through its own state-run exchange, HealthSource RI. One of the biggest carriers participating in the program, Blue Cross and Blue Shield, recently partnered with Walgreens pharmacy in a statewide education campaign, providing information about the law and how enrollment will work.

Washington: Washington state has garnered some criticism recently for rejecting five plans offered by insurers under the new state-run exchange, Washington Health Benefit Exchange.  It also approved 4 new plans, but there are concerns that the total of 31 plans approved will provide insufficient competition and result in higher costs for low income populations in the state.  State Insurance Commissioner Mike Kreidler says of the plans, “They’re quality plans with good benefits. More people will be able to get covered than ever before and the plans are higher quality and offer better value.”

Federally Facilitated Exchanges-

Alaska: Two Alaskan non-profit organizations have been granted $300,000 each as part of the federal Navigator program. The grants are allocated for training Navigators to help uninsured populations understand health insurance exchanges and enroll in plans.  In Alaska, The United Way of Anchorage and the Alaska Native Tribal Health Consortium will be responsible for helping populations navigate the new system in urban and rural areas respectively.

Kansas: State officials encourage insurance agents and brokers to complete an online training course that will allow them to sell insurance. “If they want to sell on the individual marketplace and be paid commissions on those sales, they have to go through the training,” said Linda Sheppard, director of health care policy and analysis at the Kansas Insurance Department. Agents and brokers must complete the free training in order to gain access to the approximately 326,885 uninsured and eligible Kansans, come the October 1st enrollment date.

Montana: State officials released prices for health insurance under the federally-run exchange.  As a reference point, “rates show that a 30-year-old could buy plans varying in cost from about $200 a month to $300 a month.”  Rates vary depending on the cost of deductibles and copays under plans offered by three insurance carriers in the state, Blue Cross Blue Shield of Montana, PacificSource and the Montana Health CO-OP.

North Carolina: Despite continued confusion about the options to be offered under the federally-run health insurance exchange in October, North Carolina has announced a widespread outreach effort to inform its residents of their available options for health insurance coverage.  “It would be a shame to have people who want health insurance and didn’t realize it was available to them,” said Marilyn Tavenner, administrator of the U.S. Centers for Medicare and Medicaid Services. Outreach to include implementation of a $7.1 million federal grant to 36 organizations to train navigators.

Texas: Texas received $10.8 million as part of the U.S. Department of Health and Human Services for the Affordable Care Act’s “navigator” program, with $580,000 designated for the Migrant Health Promotion, a nonprofit described as providing culturally-appropriate health education and outreach and sustainable community development to migrant populations. Texas opted out of a state-run exchange, so health insurance will be offered to their residents via a federally-run exchange starting October 1st.

Utah: Regence Blue Cross Blue Shield of Utah will no longer be an offering in the state’s small business health insurance exchange, a program known as Avenue H.  The carrier declined to state why it opted out of the exchange, which is run by the state.  The individual exchange, by contrast, is run by the federal government.  Back in May 2013, Utah was the first state to be approved for this dual method of coverage.


[photo credit: Exchange Decisions By State]

There are two sides to every story.

On the one hand, there is the exposé by the Washington Post last month that accused a closed- door committee of the American Medical Association (AMA) of inflating its estimates of times it should take physicians to perform various medical procedures. This is important because physician payments for procedures under Medicare, by law, are based on “time and intensity” — the more time a procedure takes, the more money physicians get from Medicare for performing it. According to the Post article, the Centers for Medicare and Medicaid Services (CMS) relies almost exclusively on the recommendations of this volunteer committee when it sets those payments.

On the other, in a recent opinion piece in USA Today, Dr. Ardis Dee Hoven, the new president of the AMA, defended the committee by arguing for the importance of physician input. With the rapid advances in medical science and technology in patient care, there is a pressing need to evaluate new services and, according to Dr. Hoven, there is “simply no substitute for physicians’ clinical expertise when gauging how much work and resources go into one medical service compared with another.”

In defending its assertions, the Post wrote about a physician in Florida who in 2012 performed 12 colonoscopies and four other procedures in a typical day — noting that if the procedures took the amount of time that the AMA estimated they should, the physician would be working 26 hour days. In fact, said the Post based on available data, “Florida records show 78 doctors — gastroenterologists, ophthalmologists, orthopedic surgeons and others — who performed at least 24 hours worth of procedures on an average workday.”

The Post also noted that the AMA committee is not open to the public, and therefore it is difficult to discern the committee’s methods or its true motives.

In her USA Today piece, Dr. Hoven noted that CMS is open to public input from anyone. She explained the committee’s lack of transparency as an effort to avoid political pressure that could influence its decisions. She also highlighted the cost-saving aspect of the committee’s recommendations, writing that the committee recently freed up “more than $2.5 billion to be redistributed to other services…” when it reviewed “1,300 such services and recommended reductions to more than 500 that were previously overvalued.”

Bottom line, the AMA evaluating Medicare services is either an example of the fox guarding the chicken coop or of a government agency responsibly taking the advice of the people who best know the complexities of medical services and procedures.

Maybe it’s a little of both. What do you think?

The October 1st deadline is fast approaching for the first wave of health insurance enrollments using public exchanges, as provided for by the Affordable Care Act (ACA). Towers Watson will be part of this effort thanks to a web broker entity agreement with the Centers for Medicare and Medicaid Services (CMS), which manages the federally facilitated exchanges on behalf of 36 states.

The agreement authorizes Towers Watson to seamlessly integrate its exchange platform with federal eligibility systems so that it can assist individuals as they shop for and enroll in subsidized coverage through the federal exchange.

Because many working or newly retired Americans either don’t qualify for their employer’s health plan, or choose not to enroll in it, being able to connect them to public exchanges lets employers provide a way for part-time and seasonal employees, non-Medicare eligible retirees and their dependents to learn about the health insurance options available to them, qualify for subsidies if they are eligible, and enroll in health coverage on the federal exchange.

For more information, see the Towers Watson press release.

Reports from the Wall Street Journal last month indicated that doctors are increasingly opting out of the Medicare program. But new numbers from CMS indicate that doctor’s biggest issue may not lie with Medicare, but instead with Medicaid.

The Wall Street Journal article reported that the number of doctors leaving the Medicare program has risen from 3,700 in 2009 to 9,539 in 2012. We wrote about this issue a few weeks ago.

While more doctors are leaving the program, there are also many more joining it. CMS reported that, “the number of physicians who agreed to accept Medicare patients continues to grow year-over-year, from 705,568 in 2012 to 735,041 in 2013.” In just the past year, 30,000 doctors entered Medicare, vastly outweighing the 6,000 that opted out over the past 3 years.

While Medicare payments may continue to be an issue for doctors, Medicare patients remain a vital part of many doctors’ practices. Reid Blackwelder, president-elect of the American Academy of Family Physicians, stated that Medicare patients make up 24% of the patient population for AAFP members.

So Medicare isn’t perfect, reimbursement rates and the annual doc-fix are still a point of contention for doctors, but the importance of Medicare patients keeps the majority of doctors in the program.

Medicaid participation tells a different story.

Reports show that less than 70% of the nation’s doctors accepted Medicaid in 2012. And the numbers aren’t getting any better. In a new Health Affairs Study, it was found that about 33% of primary care physicians didn’t accept new Medicaid patients last year.

Reimbursement rates for Medicaid patients are low; payments for procedures are much higher through private insurance than the same procedure for a Medicaid patient. The Affordable Care Act provides a 30% pay hike to primary care physicians who treat Medicaid patients, but the growing number of Medicaid recipients is also a concern. As many as 16 million Americans are expected to gain coverage through Medicaid in the coming years, and doctors may be faced with more patients than they can manage.

The good news is that the availability of doctors who accept Medicare patients appears to be adequate, and will continue to be so. Instead, perhaps the focus needs to be placed on helping doctors continue to accept, and prepare for the increasing numbers of Medicaid patients.

To read more:

The opening date for the exchanges inches closer and the states continue to make announcements regarding the carriers, plans, and rates on their exchanges. Advertising and outreach campaigns are also swinging into high gear across the nation, hoping to raise awareness and promote participation. The State Exchange Table summarizes the latest information on carrier participation and plan rates as they occur.

Latest Developments:

State Run Exchanges-

California: California’s largest health insurer for small businesses, Anthem Blue Cross, says it will not be participating on the state’s small business marketplace this fall. Because it is no longer a condition for insurance companies to participate on both the small business and the individual marketplaces, Anthem has chosen to sell only on the individual market.

Last Thursday, California released rates on its small business health insurance exchange. Average premiums for a 40 year old employee in the Los Angeles area could fall by as much as 17%.

To get a comprehensive look at California’s rates, pricing regions, and participating insurers, click here

DC: Another insurer, Kaiser Permanente, announces dropped rates on the DC exchange. This makes three out of four carriers on the DC exchange with lowered rates since preliminary rates were announced last month. Rates will decrease by 4.4 percent for small-business employees and half a percent for individuals.

Idaho: Nine insurers will sell medical and dental plans on the Idaho health insurance exchange. Altius Health Plans, Blue Cross of Idaho, BridgeSpan Health Company, PacificSource Health Plans and SelectHealth will sell medical plans on the exchange. BEST Life and Health Insurance Company, Blue Cross of Idaho, Delta Dental of Idaho, Dentegra Insurance Company, PacificSource Health Plans and The Guardian Life Insurance Company of America will sell dental.

Maryland: Rates on the Maryland exchange have been reduced by as much as 33%. The new rates will bring costs down, and monthly premiums for a 25-year-old nonsmoker buying a “bronze plan” in the Baltimore area will range from $131 to $237. For a 50-year-old nonsmoker buying a silver plan, prices range from $267 to $470 per month.

Washington: Four insurers have been approved to sell plans on Washington’s state exchange. BridgeSpan Health Company (an affiliate of Cambia Health Solutions, the parent company of Regence BlueShield), Group Health Cooperative, Lifewise Health Plan of Washington and Premera Blue Cross will sell plans on the individual marketplace. Rates on the marketplace may cost more than plans available today, but residents are expected to gain increased choice. A single 40-year-old non-smoker in King County could pay premiums ranging from $213 a month to $351. A 21-year-old single non-smoker could pay from $166 to $274, and a similar 60-year-old from $451 to $744 a month.

Partnership Exchanges-

Delaware: Delaware has approved three insurance companies to sell plans on its health insurance exchange. Highmark Blue Cross Blue Shield, Coventry Health and Life Insurance, and Coventry Health Care of Delaware will sell plans whose premium rates will be announced next month.

Federally Facilitated Exchanges-

Florida: Rates on the Florida exchange are expected to rise by 5 to 20 percent for small businesses and 20 to 30 percent on the individual marketplace. Average state-wide silver level plan premiums range from $315-$464.

Georgia: Two health insurance companies, Aetna and Coventry, have exited Georgia’s federally facilitated exchange. There are still five remaining carriers offering plans on the state’s exchange.

Indiana: Premium rates on Indiana’s exchange will jump by as much as 72% and could reach up to $570 for the most comprehensive plans. Although plans on the Indiana exchange are not “cheap,” the numbers are not outrageous, as they largely align with the rest of the nation’s rates. Estimates indicate that 45 percent of Indiana’s enrollees will pick bronze and 38 percent take up a silver plan. Although Indiana has not released information on metal-level premiums, estimates project that a 47-year-old male who does not smoke would be charged, on average, $307 per month. Sample plans from another plan, MDWise, predict a 47-year-old man will be charged $294 and $391 for a bronze and silver plan respectively.

Maine: Unlike many states that are launching high powered advertising efforts (California, Oregon, Vermont), Maine does not have any plans to market or advertise the Affordable Care Act this fall. The state has granted $2 million to community groups and health centers to promote and educate citizens about the health care law, but is taking a “hands-off” approach when it comes to advertising and wide outreach efforts.

Mississippi: Insurance carrier Humana announced that it will provide coverage options in 36 Mississippi counties that would have otherwise been left out of the exchange. Mississippi is home to some of the poorest and sickest populations in the nation, and the agreement with Humana guarantees that all counties in the state will have at least one company offering insurance on its exchange.

North Carolina: Three insurance companies will sell plans on the North Carolina state exchange: Blue Cross and Blue Shield of North Carolina, Coventry Health Care of the Carolinas and First Carolina Care Insurance Co. The state has approved plan rates for the three companies but has chosen not to publically release rate information until the exchanges go live in October.

Ohio: Ohio announced yesterday that the premiums on its federally facilitated exchange will jump by as much as 40%. This substantial rate increase announcement has been refuted by democratic lawmakers as incomplete. Ohio chose to take the average prices of gold and platinum plans that the majority of Ohioans won’t purchase. They also didn’t take into account tax credits provided by the federal government to ease the cost of insurance. The Ohio Insurance Department says the average premium in the individual market is currently $236.29 per month. The new average under the health care law will be $336.44, the department says.

South Dakota: Three insurers will sell plans on South Dakota’s health insurance exchange. Avera Health Plans Inc., Sanford Health Plan and South Dakota State Medical Holding Company, Inc. (DAKOTACARE) will sell plans on both the individual and small business (SHOP) marketplaces. The three insurers will offer a total of 56 plans. An average 21 year old could expect to pay $182 for a catastrophic plan, $305 for a silver plan or $333 for a premium platinum plan. An average 40 year old could pay $390 for a silver level plan and $405 for a platinum plan. And an average 60 year old could pay $830 for a silver plan and $860 for a premium level plan.

Virginia: Virginia will spend the second lowest amount per capita on education and outreach efforts for the Affordable Care Act’s state exchange. The $3.9 million in spending amounts to only 49 cents per resident. The only state spending less is Wisconsin, which is spending 46 cents per person. The overall trend shows that states opting for federally facilitated exchanges and those that are especially resistant to the health care law are receiving less in federal grant money. Private organizations and non-profit groups will provide additional outreach money and materials to Virginians to help get them enrolled in October.

Click here to view the consolidated information on the State Exchange Table

We’ve heard a lot about exchanges in the media, especially as the implementation date approaches for the first wave of the Affordable Care Act (ACA). With phrases like “public exchanges” and “online marketplaces” making headlines, it raises the question – what are exchanges and how do they work?

One group of people that knows is the Medicare-eligible retirees who have purchased individual private Medicare plans on our exchange. In a survey of 567 of our retirees fielded between July 27-July 29, 2013, respondents demonstrated a clear understanding of exchanges, with 46.4 percent identifying them as “a marketplace that makes it easier to compare healthcare plans from different health insurance companies.” Just 12.4 percent responded, “I don’t know.”

Based on their experience with our private exchange solution, 52.3 percent of retirees said they consider “exchanges a welcome addition to the U.S. health insurance system.” Just under a quarter (23.5%) even said, “I wish my employer had allowed me to select and enroll in health insurance plans through an exchange when I was an active employee.”

Our retirees also reported that they are using web-based decision support tools when evaluating and comparing health insurance plans. While our retirees historically preferred talking with benefit advisors over the phone to evaluate plans on exchange – and that has not changed – a large number of respondents to our recent survey said they also compared different plans using the exchange website (47.8 percent).

When it comes to purchasing a plan, however, just 8 percent said they purchased online on their own, with no help from a benefit advisor. This reinforces our long-held belief that while technology powers health insurance exchanges – and helps people compare plans, make purchase decisions and enroll in plans – technology is no substitute for direct human interaction.

As we’ve said many times before, an exchange is more than an interactive website.

Details on survey questions and answers follow.

Which statement best describes a health insurance exchange?

A marketplace that makes it easier to compare
health plans from different health insurance companies

A marketplace that promotes competition between
health insurance companies that results in lower

A marketplace where buyers have more choice
in health plans

An organized marketplace for buying and selling
health insurance

I don’t know

Based on what you know about health insurance exchanges, which of the following statements are true? (Please select all that apply.)

Health insurance exchanges are a welcome
addition to the U.S. health insurance system

I prefer to purchase my private Medicare plans
through an exchange

Everyone should have access to a health
insurance exchange

I wish my employer had allowed me to select
and enroll in health insurance plans through
an when I was an active employee

Health insurance exchanges are unnecessarily
adding little or nothing of value to our
health insurance system

When you evaluated or purchased a health plan on an exchange, which of the following types of support did you use before making your purchase? (Please select all that apply.)

Talked on the telephone with a benefit advisor

Compared different plans using the exchange

Reviewed ratings of health insurance plans and

Talked with family members or friends

Read articles, blogs or forums online

When you evaluated or purchased health insurance plans on an exchange, did you:

Evaluate and purchase plans only with
the help of a benefit advisor

Evaluate and purchase plans online by
yourself with no help from a benefit advisor

A combination of the two