Author Topic: Obamacare Master thread  (Read 42644 times)

Offline ExGingi

  • Dansdeals Lifetime Presidential Platinum Elite
  • *********
  • Join Date: Nov 2015
  • Posts: 5549
  • Total likes: 865
  • DansDeals.com Hat Tips 6
    • View Profile
  • Location: 770
Re: Obamacare Master thread
« Reply #615 on: March 14, 2019, 07:27:21 AM »
How does one go about receiving these emails?
IDK. Maybe by becoming certified/authorized to sell on the exchange. Though I suppose there might be other ways (thereís a phone number and email address at the bottom).

Quote
Why were they the original benchmark?
IDK. Possibly because they had the biggest network and might have been the largest insurer (Oxford/UHC).

Quote
Their QHP network is (very) different than their EP network?
QHP network is the Oxford Metro network IINM. EP and Medicaid is the Community network. My evidence is extremely anecdotal based on local PCPs and client feedback.

Quote
Why did they significantly raise their premiums (when others haven't)? How do you know a lot of folks who signed up earlier kept them as their premiums rose?
I donít know that they significantly raised their premiums. On the contrary, their premiums have been amongst the highest since the inception of the NYS exchange (Iíve contended that it was due to their experience, while other players were underpricing (and weíve seen failures)). The Metro network was introduced in order to contain costs.

Quote
Fidelis is indeed the lowest cost provider WITH A DECENT NETWORK. But I've found their network to be quite lacking and poor compared to United and to HealthFirst.
FTFY.

As for the network, which counties are you comparing, and are you talking QHP or Medicaid/EP? In NYC thereís no comparison, itís hands down Fidelis (for QHP). The only insurer with a (possibility) better network is Empire Blue Cross Blue Shield (I am talking NYC) and their premiums are significantly higher than Fidelis (FWIW, Empire used to be non-profit years ago, and then switched. Fidelis is non-profit).

Quote
That really isn't that odd. EP (and Medicaid) plans all cost the same regardless of which carrier you choose. As such cost is a non-factor so consumers will simply choose the one with the best networks that works for them, with inertia being a factor.
FTFY.
« Last Edit: March 14, 2019, 07:37:22 AM by ExGingi »
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline Moe Ginsburg

  • Dansdeals Gold Elite
  • ***
  • Join Date: Jul 2013
  • Posts: 158
  • Total likes: 7
  • DansDeals.com Hat Tips 0
    • View Profile
Re: Obamacare Master thread
« Reply #616 on: March 15, 2019, 10:41:09 AM »

I donít know that they significantly raised their premiums. On the contrary, their premiums have been amongst the highest since the inception of the NYS exchange (Iíve contended that it was due to their experience, while other players were underpricing (and weíve seen failures)). The Metro network was introduced in order to contain costs.


How does HealthFirst and Fidelis significantly undercut United and Empire BCBS' premiums and remain able to continue with their lower premiums year after year while United and Empire cannot?
Quote
FTFY.

As for the network, which counties are you comparing, and are you talking QHP or Medicaid/EP? In NYC thereís no comparison, itís hands down Fidelis (for QHP). The only insurer with a (possibility) better network is Empire Blue Cross Blue Shield (I am talking NYC) and their premiums are significantly higher than Fidelis (FWIW, Empire used to be non-profit years ago, and then switched. Fidelis is non-profit).


I'm referring to NYC. And in NYC I believe Fidelis is the lowest cost carrier regardless of network (decent or not) but HealthFirst costs only a very small amount more than Fidelis. And I've found Fidelis' network lacking compared to both HealthFirst and United. AFAIK that is applicable to both QHP and EP. When I checked with doctors many accept HF and UHC but not Fidelis. (Ironically among dentists I've found the opposite, with more accepting Fidelis. But that's only relevant if getting dental too on the marketplace, and even then it is a secondary consideration to the medical network.)
« Last Edit: March 15, 2019, 10:47:03 AM by Moe Ginsburg »

Offline ExGingi

  • Dansdeals Lifetime Presidential Platinum Elite
  • *********
  • Join Date: Nov 2015
  • Posts: 5549
  • Total likes: 865
  • DansDeals.com Hat Tips 6
    • View Profile
  • Location: 770
Re: Obamacare Master thread
« Reply #617 on: March 15, 2019, 12:31:03 PM »
How does HealthFirst and Fidelis significantly undercut United and Empire BCBS' premiums and remain able to continue with their lower premiums year after year while United and Empire cannot?
I am not an actuary. IINM there might be at least one around DDF. The rates are highly regulated so there's not that much leeway there. Though two possible points might be that both Fidelis and Healthfirst are not for profit insurers, and they both begin with a strong presence in the Medicare market, slowly penatrating into the individual Metal level market (and now Healthfirst seems to be going into small group coverage as well). Another difference might be in the reimbursement rates, which is why UHC/Oxford has 3 networks in NYC Freedom, Liberty and Metro. I've found Liberty to be as good as Freedom in most cases (even though the official provider count of the Freedom network is larger), which the Metro network is limited, with many doctors not participating.

I'm referring to NYC. And in NYC I believe Fidelis is the lowest cost carrier regardless of network (decent or not) but HealthFirst costs only a very small amount more than Fidelis. And I've found Fidelis' network lacking compared to both HealthFirst and United. AFAIK that is applicable to both QHP and EP. When I checked with doctors many accept HF and UHC but not Fidelis. (Ironically among dentists I've found the opposite, with more accepting Fidelis. But that's only relevant if getting dental too on the marketplace, and even then it is a secondary consideration to the medical network.)
As I said, my evidence is extremely anecdotal and local. The bottom line for many people in my community is that the most significant medical office in Crown Heights doesn't take HealthFirst or UHC QHP, while they do take Fidelis.

What you mention about dental is interesting, and again this seems to be extremely provider specific. My kids dentist will only take UHC Community Plan (and no private paid insurance, or other Medicaid/EP). I do have a client that switched from Fidelis to Healthfirst due to the fact that Healthfirst offers adult dental as an option.
I've been waiting over 5 years with bated breath for someone to say that!
-- Dan

Offline Moe Ginsburg

  • Dansdeals Gold Elite
  • ***
  • Join Date: Jul 2013
  • Posts: 158
  • Total likes: 7
  • DansDeals.com Hat Tips 0
    • View Profile
Re: Obamacare Master thread
« Reply #618 on: March 16, 2019, 09:59:17 PM »
Another difference might be in the reimbursement rates, which is why UHC/Oxford has 3 networks in NYC Freedom, Liberty and Metro. I've found Liberty to be as good as Freedom in most cases (even though the official provider count of the Freedom network is larger), which the Metro network is limited, with many doctors not participating.

Between Medicaid, EP, QHP, small business and large business, which networks does UHC/Oxford offer with which plans?

Quote
What you mention about dental is interesting, and again this seems to be extremely provider specific. My kids dentist will only take UHC Community Plan (and no private paid insurance, or other Medicaid/EP). I do have a client that switched from Fidelis to Healthfirst due to the fact that Healthfirst offers adult dental as an option.

I should've stated that my above dental network comparison was only between Fidelis and HealthFirst. UHC community plan I've found actually has a better dental network than both of the aforementioned.

That said, generally speaking most or many people are better off forgoing adult dental from the marketplace and either paying out of pocket or getting a non-marketplace dental plan.

Even getting a separate QHP dental plan off the marketplace from your marketplace health plan is usually better. New York doesn't allow a separate QHP dental plan in the marketplace than your healthplan (though it does allow it by EP.) Adding adult dental unto the same plan as your health plan can cause a higher combined health+dental deductible than worthwhile.
« Last Edit: March 16, 2019, 10:28:11 PM by Moe Ginsburg »

Offline Moe Ginsburg

  • Dansdeals Gold Elite
  • ***
  • Join Date: Jul 2013
  • Posts: 158
  • Total likes: 7
  • DansDeals.com Hat Tips 0
    • View Profile
Re: Obamacare Master thread
« Reply #619 on: March 27, 2019, 11:47:11 PM »
(FWIW, Empire used to be non-profit years ago, and then switched. Fidelis is non-profit).


Fidelis also became for-profit:

https://www.prnewswire.com/news-releases/centene-completes-transaction-with-fidelis-care-300675485.html