Posts Tagged - ‘massachusetts health insurance’

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Statistics About Massachusetts’ Uninsured

Wednesday, August 18th, 2010
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Largely due to the state’s first-in-the-nation healthcare reform, Massachusetts residents are the most likely in America to have a health insurance plan. Still, the expansion has not succeeded in providing universal coverage. Why?

A recent study from the Urban Institute and the Robert Wood Johnson Foundation’s State Access Reform Evaluation looked to identify the 4.1 percent who were still uninsured.

Here are their findings on the average Massachusetts resident without health insurance:

  • From 19 to 64 years old
  • male
  • an ethnic or racial minority (African-American, Hispanic, etc.)
  • unmarried
  • lack of proficency in the English language; either their own or that of an adult who lives with them
  • less educated
  • not a U.S. citizen
  • more likely to be unemployed
  • could be eligible for public Medicaid coverage

The study’s authors believe that the state’s message may not be getting across to its attempted demographic. Suggestions include rewriting the program information in order for it to be understandable with a 4th to 8th grade reading level.

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Massachusetts Man Doesn’t Buy Health Insurance Plan, Sues Govt.

Thursday, August 12th, 2010
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This may be a sign of things to come: a man who defied Massachusetts’ individual mandate by not buying a health insurance plan is contesting his $2,000 fine in court. He already tried the formal appeals process to get the fine reversed, but to no avail.

Michael Merlina claims that the $800 monthly premium for him and his wife under the Massachusetts Health Insurance Connector’s most affordable option was too expensive. Meanwhile, the couple’s combined income wasn’t low enough to qualify for heavily discounted state health care for the poor.

National healthcare reform will phase in a similar requirement in 2014. It includes elements of–but differs from–the Massachusetts model. It remains to be seen if it will have a similar impact for those caught between the cracks.

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Health Insurance Company Harvard Pilgrim Agrees To Lower Rates

Monday, July 5th, 2010

Image: Guerilla Billboards

Regulators have been facing off with health insurance companies over proposed premium increases that the former consider excessive, and the latter think are necessary to continue doing business.

Apparently, compromise is possible. Harvard Pilgrim Health Care agreed to a settlement with the state of Massachusetts that limits their individual and small group health insurance rate increases. The decrease is insignificant: their initial requests ranged from 8% to 12%, while the new deal has increases of 7% to 11%.

Since earlier caps on premiums set by the state were rejected on appeal, the insurer could’ve kept fighting. However, they chose to move on instead–although they will still lose money under the agreement. Thankfully for consumers, Harvard Pilgrim (the second-largest insurance provider in the state) also agreed not to retroactively bill policyholders since April for the higher rates.

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How To Prevent Short Term Health Insurance Buyers From Gaming The System

Wednesday, June 30th, 2010

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With reform beginning to take effect, subsidized guaranteed issue insurance for people with pre-existing conditions is set to become available. Unfortunately, there is a serious concern: the issue of people gaming the system.

In some places, such as Massachusetts, people will buy short term health insurance when they are knowingly sick and cancel shortly after they receive treatment (under one year later). Insurers pay for their treatments, while receiving little in premiums for reimbursement. Therefore, the costs are passed onto steadily insured consumers.

The prevalence of this practice has skyrocketed over the past several years. Legislators are proposing several solutions, including an open-enrollment period that would allow individuals to buy temporary coverage solely during one or two months out of the year. There would be exceptions included for major life changes.

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Health Insurance Rate Cap Denied In Mass.

Friday, June 25th, 2010

Consumers looking for affordable health insurance on the open market won some and lost some today. This is an example of the later: a state insurance appeal board just overturned a cap on rates that was set by Gov. Deval Patrick in Massachusetts.

The rate cap was intended to put a lid on seemingly endlessly rising health insurance rates. Massachusetts health insurance companies claimed that the cap would irreparably damage their businesses.

The appeal board sided with Harvard Pilgrim Health Care, which was worried that increasing health care costs combined with the cap would make them insolvent. That insurer’s proposed rate increases were considered reasonable given those concerns. They are now free to implement the premium hikes, initially scheduled to become effective on April 1st. However, the three-month period they were meant for is about to finish–although they may charge the higher rates retroactively.

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Massachusetts Health Insurance Coverage Rates Stay Steady

Wednesday, June 9th, 2010

Like the rest of the country, the state of Massachusetts has been battered by the recession. Many people are jobless, which would normally leave them uninsured prior to healthcare reform.

However, the percentage of residents with Massachusetts health insurance has remained largely steady. This is partially due to reform decoupling health coverage with employment. The 4.8% of uninsured residents in 2009 is the lowest percentage in the nation, and is similar to 2008 figures. Racial minorities are just as likely to be insured as Caucasians.

Their own reform experience may be a ray of hope for the nation.

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Massachusetts Health Insurance Company Settles On Increase

Monday, June 7th, 2010

After initially asking for an 11% increase in its small group and individual health insurance rates, Neighborhood Health Plan has reached a settlement that allows them to raise those premiums by about 7%.

Neighborhood was one of six major Massachusetts health insurance companies that appealed and sued the state’s insurance commissioner when their proposals were denied in April. Now, they have bowed out of those efforts.

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More Increases Requested By Massachusetts Health Insurance Companies

Friday, June 4th, 2010

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After butting heads with the state government and Governor Deval Patrick’s office, several Massachusetts health insurance companies have once again proposed double-digit rate increases.

Blue Cross Blue Shield of Massachusetts wants an average increase of 12%, and Harvard Pilgrim Health Care wants ones that reach up to 11.9%. These are similar to the previously proposed hikes that were rejected two months ago. They say that they’ve been losing money since then.

If their requests are approved this time around, the higher premiums will apply to health insurance plans sold for three months, beginning July 1st.

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Massachusetts Health Insurance Companies’ Surpluses Rise

Monday, May 3rd, 2010

Image: Massachusetts Charter Public School Association

In a 10-year study period, beginning in 1999 and ending last year, the major health insurance companies in Massachusetts finished with a four-fold increase in their surplus reserves. By the end of the study period, their total surplus was $2.5 billion.

Consumers are worried that the soaring premiums over the past decade have gone toward those figures, and made it more difficult to find affordable health insurance. However, industry representatives claim that the reserves are necessary to make up for operating losses over the past year.

The state passed healthcare reform legislation midway through the study period. Its impact on the finances of Massachusetts health insurance providers was not explored by the investigation.

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Will Your Health Insurance Company Drop Some Hospitals?

Thursday, April 22nd, 2010

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A growing trend in the health insurance industry is to eliminate certain elite hospitals from their provider networks. They believe that refusing to cover those hospitals–that charge significantly higher rates for services than the average–will save money for them and their consumers.

Massachusetts is promoting these so-called restricted provider networks, with a 10-20% discount on health insurance plan premiums. These plans also promote using free-standing imaging centers for medical scans.

Elite hospitals are truly superior in some areas, but their outcomes are similar to more affordable community hospitals in others. Proponents of this strategy feel that diverting some patients from these teaching hospitals will encourage them to clamp down on medical costs in order to regain their business.

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