Blog Posts by Shaun

  • Nevada, Illinois, Washington, Tennessee, South Dakota and Oregon - six US states will receive $181 federal grant for the federal government to set up their health insurance exchanges. With this grant, the total value for the federal grant allocated to US states for setting up state health insurance exchanges, has reached $1.1 billion over the last two years. Till now 34 US states have received federal grant money from the US government for setting up insurance exchanges.

    While five of the six states - Tennessee, Oregon, Nevada, and Illinois & South Dakota have received Level 1 exchange establishment grant, Washington has received a Level II establishment grant. Washington is the second US state to have received the Level II grant, which is awarded to states that have shown progress in setting up health insurance exchanges. While the Level 1 establishment grant is applicable for 1 year, states that are awarded Level II establishment grant are applicable to receive federal funding for

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  • The United States of America has over 50 million people who do not possess health insurance. Escalating healthcare costs, families discontinuing health coverage to rein in costs, employees losing employer sponsored coverage, recession etc., have all contributed to the growing number of uninsured in America. President Obama's Affordable Care Act of 2010 had pledged to cover at least 32 million uninsured Americans through the health insurance exchanges.

    The federal government has granted US states the autonomy to design their state exchanges as per the state exchange administrators deem fit. To maintain consistency in operational principles and ensure compliance with federal mandates, the US Department of CCIIO has released a an exchange blueprint document that provides states some common guidelines on how to approach and proceed with the exchange design approval and implementation programs.

    Beginning January 1, 2014, the state health insurance exchanges are scheduled to launch across

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  • Why Private Health Insurance Exchanges Are Still a Good Deal?

    Quite a few private health carriers operating in the healthcare landscape have strategically planned ahead to invest in private health exchanges. While some of these leading carriers have already established their health insurance exchanges, several others are actively hunting for a comprehensive, private exchange application or private exchange hosting solutions. But, a few health care experts are wondering if setting up private health exchanges is still a viable business plan considering that the state based health insurance exchanges are ready to kick-off in January 1, 2014.

    Setting up private health exchanges is still a sustainable business plan because of several design and operational differences between the state-based HIX and the private health insurance exchanges, which work to the advantage of private insurance exchanges.

    The private health exchanges have an early bird advantage over the state based health insurance exchanges. Several private exchanges are already operating

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  • Health Insurance Exchanges, the one-stop online marketplaces to sell commercial health insurance, are set to come into operation by January 1, 2014. In addition to finalizing the infrastructural and design aspects and requirements, states also need to decide whether they will be setting up an exchange on their own or would prefer deferring it to the federal government. Not only this, the states also need to decide if they will have a single health insurance exchange that serves the entire state, multiple exchanges that cater to different regions within a state, or a multi-state exchange that serves two or more states.

    Considering the administrative and operational intricacies and technical complexities involved in the setting up and operating an exchange, it is difficult to imagine how operating more than two exchanges in a particular state would aid in efficient use of state resources.

    It is possible that certain health plans may be available in only a select few regions within the

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  • Health Insurance Exchanges Vs SHOP Exchanges - a View

    Anyone who has been following the U.S. healthcare landscape closely is well aware that President Obama's Affordable Care Act of 2010, mandates U.S. states to set up online insurance marketplaces. The marketplaces or 'exchanges' for both individuals and small businesses are to be addressed as - Health Insurance Exchange (HIX) and Small Business Health Option Program (SHOP) Exchange, respectively.

    The fundamental principle behind setting such exchanges is to make the U.S. consumers well-informed about the health insurance choices available to them, so that they can take an educated decision while purchasing a plan for themselves, their families or employees. Both HIX and SHOP will serve the basic purpose of providing affordable insurance options to individuals, groups and small businesses. The exchanges will allow consumers to avail of high-quality health plan choices from various insurers and carriers, albeit at standardized rates.

    Although the basic premise on which both health

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  • Affordable Care Act that had once been touted as Medicare Advantage nemesis has strengthened the Medicare Advantage plans instead. Now senior U.S. citizens have more choices available in Medicare Advantage plans that offer better quality of care at reduced premium rates.

    Earlier this month, the Centers for Medicare & Medicaid Services announced that the average premium rates for Medicare Advantage premiums have fallen by 7%. Not only that, the enrollment in Medicare Advantage plans witnessed an increase of around 10% over the past one year.

    The fall in premium rates and increase in enrollment figures are in line with the September 2011 projection figures. Over the past year, average premium rates have fallen to $31.54, from the last year value of $33.97. As of February 2012, there are 12.8 million Medicare Advantage enrollees as compared to 11.7 million in 2011.

    While the Medicare Advantage plans remain robust as far as the high enrollment and low premium rates are concerned, the

    Read More »from Medicare Advantage in 2012 – Marching Ahead Stronger Than Ever
  • As is common knowledge, ACA proposed health insurance exchanges will be web based market places where consumers can compare and purchase health insurance plans and can avail of various federal subsidies. While the exchanges may be fundamentally similar, the manner in which the exchanges allow participating plans to sell plans through them, will establish whether an exchange is an active buyer or a passive buyer.

    The White House has granted states the flexibility to design their own exchanges. While there is a lot of data and explanations available detailing how these health insurance exchanges will be valuable for U.S. healthcare landscape, there is very little data available on setting up these exchanges. As no clear guidelines are available on HIX design principles, all the 50 states can come up with widely dissimilar insurance exchanges which may be glaringly different in their structure, plan offerings, functionalities, services offered, ease of use etc.

    The established state

    Read More »from Active Vs Passive Health Insurance Exchanges and Their Common Challenges
  • A study conducted last month by The New England Journal of Medicine concluded that Medicare Advantage plans that offer ancillary benefits such as gym memberships witness higher enrollments viz-a-viz other plans with no subsidiary wellness features.

    The study analyzed data collected from 11 Medicare Advantage plans that offer fitness benefits and 11 Medicare Advantage plans that offer no such programs. The survey compiled and researched data from 2002 to 2008 and analyzed health status of members enrolled in a plan, that didn't offer gym membership initially but later introduced gym membership under its wellness package.

    The percentage of people who reported very good to excellent health status was 6.1 percentage points higher among the 755 people who enrolled in plans with gym benefits, as compared to 4,097 people who had enrolled in plans before the gym benefits were added.

    On the contrary, the percentage figures for new plan enrollees - who reported physical movement limitations

    Read More »from Medicare Advantage Plans with Fitness Programs Observe Higher Enrollments
  • Establishing Successful Healthcare Insurance Exchanges

    Healthcare Insurance Exchanges, the online market places scheduled to launch on January 1, 2014 will be designed to provide low-cost health insurance options to millions of uninsured Americans. While the exchanges will give buyers more flexibility and control over choosing their insurance plans, they will also promote more transparency and competition among health plans. The Health Insurance Exchanges once launched, may alter the face of the ailing U.S. healthcare industry.

    However the U.S. states need to rise up to the challenge of meeting the federal deadline of setting up fully operative exchanges by January 1, 2014. Not only that, the U.S. states have been mandated to submit a well-structured proposal by January 1, 2013 - outlining the design the state exchanges will operate on.

    With both the deadlines slowly edging closer, states need to gear up in their HIX efforts to propose at least a basic plan of how their exchange will operate. While Massachusetts and Utah already have

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  • Insurers Charge Ahead to Set Up Private Insurance Exchanges

    With State Health Exchange deadline still a couple of years ahead, several health plans have cited their intentions to set up their own private health insurance exchanges in near future to lock in the large pool of individuals seeking health insurance.

    With hardly a few fully operational exchanges in U.S. currently, the U.S. exchange market is still in its nascent stage and if tapped into aggressively, it can offer health plans a chance to pull in physician networks, small and large businesses, individuals and groups seeking insurance, before the state health exchanges even come into effect.

    The strategic move is also wise considering the fact that the government sponsored Exchanges and Small Business Health Options (SHOP) exchanges which are to go live in 2014, may upend the individual and small business market share of most health plans.

    The newly set-up private exchanges are likely to operate on similar guidelines as the ACA proposed State Exchanges, but with the key difference

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