Skip to main content

Impact - MLRs (Medical Loss Ratios)

I am watching President Obama sign the new health insurance (care) reform bill on CNN. I wanted to share some things I have heard recently that may eventually impact the number of carriers in California selling individual and family plans either through exchanges or privately, or both.

While carriers (insurance companies) can boast an overall MLR (medical loss ratio) above 85%, this number is generally inclusive of all sectors of insurance (large group, small group, individual and senior). However, when small group and individual (especially individual) is segregated out, the MLR often falls well below 80% with an average running about 74% on individual and family health plans.

"MLR" is the ratio of premiums paid in to what is paid out for medical care and wellness. The current reform will require in 2011 that all carriers selling individual and family plans must meet 80% MLR in that market. That means every company selling health plans in California by 2011 must be spending at least 80 cents of every dollar received in premiums on healthcare and related expenses.

I will save the reduction in administrative costs necessary for another post. Needless to say it certainly is probable that reduction in those expenses, including agent commissions, will occur.

My concern is if and how some carriers will be able to meet the new MLR.

I suspect that some carriers may choose to exit the market in California instead of trying to achieve 80% MLR on individual & family health coverage.
I will be curious to see who is left standing between now and 2014.

Comments

Popular posts from this blog

Anthem Blue Cross (CA) Adding SilverSneakers® Fitness Program

Anthem Blue Cross (CA) announced this morning that they will be adding the SilverSneakers Fitness Program to California Medicare Supplement Plans A, F, and N.  The added benefit will begin on January 1st, 2017. 

Once approved for release into the market, more states have been added to the list as existing and new members in our marketed plans will enjoy the value-added benefits of the SilverSneakers Fitness program at no additional cost! Effective January 1, 2017, California members in our marketed plans will enjoy SilverSneakers, too.  The program offers members their choice of paths to better health. For those who enjoy a traditional workout setting, SilverSneakers offers access to more than 13,000 fitness locations across the country, including use of classes and guidance from a Program AdvisorTM. In addition, for those who can’t get to a fitness center, SilverSneakers Steps® kits focus on at-home or on-the-go general fitness, walking, strength training or yoga. And if that is not …

Anthem Blue Cross Announces Innovative F Medicare Supplement Plan for CA

Anthem Blue Cross (CA) has announced that they are releasing a new Medicare Supplement (Medigap) Plan for California residents.  The plan will be available beginning January 1st, 2018.

'Innovative F' will offer benefits not covered by a Medicare Supplement base plan.  These will include a hearing benefit (exam, fitting and allowance) and a vision benefit (exam, lens co-pay and allowances for frames and contact lenses).

Anthem states that the Innovative F will have a very competitive premium rate.  Innovative F will include the Silver Sneakers fitness program and will be eligible for the Plan F 'new to Medicare' $20 per month first year discount.  

http://www.davefluker.com/innovative-f-supplement.html



Dave
www.davefluker.com





What Multi State Plan (MSP) Really Means (Covered CA)

Lots of confusion on this term and many people think it involves coverage across state lines.  It does not.

This explanation from Anthem Blue Cross is the best one I have seen:



The U.S. Office of Personnel Management (OPM) Multi-State Plan Program (MSPP) was recently established under the Affordable Care Act. It directs the OPM to contract with health insurance carriers to offer at least two plans (one at the silver level and one at the gold level) in each local exchange. The MSPP is intended to promote competition in the Marketplace and help ensure consumers have more high-quality, affordable health insurance options. All MSPP plans will include “a Multi-State Plan” at the end of their name when listed on the exchange - this designates it as an OPM-sponsored plans.  It does NOT mean that consumers selecting the plan will have health plan coverage in multiple states.Select silver and gold level Individual plans that our company currently offers have been designated as OPM-sponsored MSPP…