Health insurance is a type of insurance coverage that covers the cost of an insured individual's medical and surgical expenses. Depending on the type of health insurance coverage, either the insured pays costs out-of-pocket and is then reimbursed, or the insurer makes payments directly to the provider. In health insurance terminology, the "provider" is a clinic, hospital, doctor, laboratory, health care practitioner, or pharmacy. The "insured" is the owner of the health insurance policy; the person with the health insurance coverage. In countries without universal health care coverage, such as the USA, health insurance is commonly included in employer benefit packages and seen as an employment perk. Everybody at some time in their life, and often on many occasions, will need some kind of medical attention and treatment. When medical care is required, ideally the patient should be able to concentrate on getting better, rather than wondering whether he/she has got the resources to pay … [Read more...] about What Is Health Insurance?
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Dive Brief: The state of Oregon is considering giving up on its state-run ACA exchange and using HealthCare.gov instead, USA Today reports. The Cover Oregon technology options workgroup is recommending using the federal exchange to enroll people in private health plans, and leveraging the current state exchange technology for Medicaid instead. To date the state has spent at least $134 million on its exchange site, USA Today said. Oregon spent another $7 million processing paper after the contractor that built the site, Oracle Corp., was unable to fix the state site. Dive Insight: Fortunately for the ACA program, most state-based health insurance exchanges have been successful, and several, including Vermont, Connecticut and the District of Columbia, exceeded 2014 enrollment goals by March 1, according to a report from the Robert Wood Johnson Foundation and the Urban Institute. However, there have been a few states where the exchange the state built … [Read more...] about Oregon might switch to federal health insurance exchange
Dive Brief: A RAND Corp. survey has found that there was an estimated net gain of 9.3 million American adults with health insurance from September 2013 to mid-March. According to researchers the increase came from enrollment in the ACA marketplaces, Medicaid and employer-based health insurance. Of those who had previously been uninsured but got insured by mid-March, 7.2 million received employer-based insurance, 3.6 million got Medicaid, and 1.4 million bought policies through the ACA exchanges. Dive Insight: Here's some interesting data. Apparently, the bulk of Americans who got health insurance got the policies through their employer, not the state or the exchange marketplaces. (Though it's worth noting that these numbers don't account for the surge in enrollment in ACA plans just before the March 31 deadline.) It's hard to tell what phenomenon accounts for the millions of people who got employer-based during this period, other than to assume that they all got new … [Read more...] about Survey estimates gain of 9.3M insured
While the health insurance marketplace is well-populated already by the big guns of the industry, at least one startup feels it can beat them at their own game. New York-based Oscar Insurance Corp., which sells itself as a friendlier, more accessible brand of health plan, has already raised $155 million in venture capital since its launch last October. Oscar features include a pretty, easy to use website with a Google Maps-style doctor-finder, free phone calls to doctors 24/7 and a service that allows users to compare prices of commodity services like MRIs. According to Forbes, the health plan, which operates solely in New York state at the moment, has about 16,000 customers who pay an average of $4,500 per year, pegging its revenue at around $72 million. More impressively, Oscar's valuation sits about $800 million, or an 11X multiple on sales. All that for a company whose senior management has no insurance experience, as far as I can tell. To my view, Oscar's valuation … [Read more...] about Oscar: The new insurance model for Obamacare?
Dive Brief: According to a press release by the American Medical Association, WellPoint Inc.—soon to be Anthem—is the largest health insurer by market share in 82 of 388 metropolitan areas in the nation. In 41% of US metropolitan areas, WellPoint has at least a 50% share of the commercial health insurance market. The organization had a market share advantage in more than twice the number of metropolitan areas as its two closest competitors, Health Care Service Corp. and UnitedHealth Group. The results came from a study meant to help understand competition in heath insurance markets across the country. The purpose is to highlight markets where insurers' mergers and acquisitions may result in anti-competitive price hikes. The report found that nearly three-quarters of the metropolitan areas in the report are "highly concentrated," lacking insurer competition. 45 states had two health insurers that accounted for 50% or more of the commercial market; 17 states had a … [Read more...] about AMA study finds lack of competition in insurance markets
Dive Brief: Starbucks is now among the few high-profile U.S. employers to offer its employees health plan choices through a private health insurance exchange, The Wall Street Journal reported. Starting in October, eligible Starbucks employees (those working at least 20 hours per week) will be able to select from as many as six carriers and five levels of coverage. The company was not aiming for cost savings but to offer employees options because “people intuitively like choice,” Starbucks VP of global benefits Ron Crawford told the Journal. Dive Insight: Starbucks stands out for its move because relatively few large companies have switched to private exchanges; others include Walgreens, Sears Holdings Corp. and Darden Restaurants Inc., the Journal noted. Just 8 million people enrolled in private health exchanges for 2016, falling far short … [Read more...] about Starbucks move raises visibility of private health exchanges
Dive Brief: Executives saw their compensation rise last year, despite continued losses on their ACA business, at Health Care Service Corp. (HCSC), which operates Blue Cross and Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas, according to a recent analysis by Modern Healthcare. The company's top 10 executives saw their combined earnings rise 57%, going from a total of $36.1 million in 2014 to $56.7 million in 2015, the findings showed. The largest compensation package went to CEO Patricia Hemingway Hall, who has since retired. She increased her earnings by 42%, from $11.7 million in 2014 to $16.6 million in 2015. Dive Insight: The move at HCSC comes as executive pay in healthcare, health insurance and pharmaceuticals draws increasing scrutiny. Nonprofit health systems are taking particular heat, and industry watchdogs have been looking at whether rising executive pay is contributing to rising healthcare costs, while … [Read more...] about Report: Top pay soars at Health Care Service Corp. amid ACA losses
Dive Brief: The Seventh Circuit Court recently rejected a $300 million antitrust suit by Peoria, Ill.-based Methodist Health Service Corp. against competitor OSF Saint Francis Medical Center. A three-judge appellate court panel upheld a summary lower court judgment in favor of St. Francis in the case that involved the two largest hospitals in Peoria. Methodist filed the suit against St. Francis more than four years ago that charged the “larger and more profitable” hospital violated the Sherman Act to the detriment of Methodist. Dive Insight: Hospitals across the U.S. have been merging at a faster pace in recent years at least in part to gain more leverage with health insurance companies for negotiating reimbursements. But St. Francis is already a large hospital, and Methodist's suit is an example of the kind of issues large hospitals and health systems can encounter. The judges found no evidence that St. Francis' signed long-term exclusive … [Read more...] about Court rejects Methodist Health Service’s $300M antitrust case against competitor
A Rhode Island federal judge has ruled that two insurers must pay out on the $30 million claim hospital operator Lifespan Corp. filed after it was ordered to pay this sum due to a partnership break up. The $29.6 million judgment against Lifespan stems from the collapse of its relationship with the New England Medical Center, for which it had served as corporate parent. A court ruled that Lifespan had breached its duty to the state Attorney General, and was grossly negligent in failing to negotiate with health insurers in ways that would bring in more money for the medical center. Insurers National Union Fire Insurance and RLI Insurance had contended that they didn't have to pay the claim Lifespan filed after the judgment due to several coverage exceptions, notably the CFO's work with Morgan Stanley to develop an interest rate swap that would finance the medical center. The insurers had alleged that the swap generated an unlawful advantage, which would have allowed them to refuse … [Read more...] about Lifespan Corp. wins $30M judgment from insurer
Health savings accounts (HSAs) have been around since the early 2000s, but that doesn't mean consumers understand how to use them or other tax-advantaged healthcare accounts, according to a new survey of health professionals. The idea behind HSAs is to provide consumers with incentives to manage their own health care costs through a federal tax-free savings account to pay medical expenses with a high-deductible health plan. Yet, despite increasing enrollment in these accounts, a survey of more than 300 healthcare- industry professionals, conducted by Acclaris Corp., confirmed a “clear lack of consumer knowledge about consumer-driven healthcare accounts – especially health savings accounts.” HSAs were first introduced in 2003 as part of the Medicare Prescription Drug Improvement and Modernization Act. An annual census by American’s Health Insurance Plans of U.S. health companies showed that 17.4 million people were enrolled in a health savings … [Read more...] about HSAs still perplex consumers, health professionals say