Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Health Insurance Exchange

Payers Face 9.6% Underwriting Loss on Health Insurance Exchange

March 23, 2017 - Underwriting margins for payers selling individual plans on the health insurance exchange dropped from a 6 percent earned premium loss in 2014 to a 9.6 percent loss in 2015, Milliman recently reported. The financial losses stemmed from the Affordable Care Act’s risk corridor program funding shortfall. Without full risk corridor funding in 2015, the proportion of individual health insurance...


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Payers Face 9.6% Underwriting Loss on Health Insurance Exchange

by Jacqueline Belliveau

Underwriting margins for payers selling individual plans on the health insurance exchange dropped from a 6 percent earned premium loss in 2014 to a 9.6 percent loss in 2015, Milliman recently reported. The financial losses stemmed from the Affordable...

2017 ACA Open Enrollment Data Shows 12.2M Marketplace Signups

by Thomas Beaton

During the 2017 ACA Open Enrollment Period (OEP), more than 12.2 million healthcare consumers purchased or renewed insurance through Healthcare.gov or their local state exchanges, said CMS in a new data brief.   Marketplace consumers either...

HHS Offers Waivers for Health Insurance Exchange Stability

by Jacqueline Belliveau

The Department of Health and Human Services (HHS) recently encouraged states to apply for State Innovation Waivers as a way to stabilize the health insurance exchanges and boost consumer access health plans and services. States should particularly...

ACA Consumers Dissatisfied After Private Payer Exchange Exit

by Thomas Beaton

Consumer satisfaction with the Affordable Care Act fell following the departure of three private payers from the health insurance exchange, according to recent findings from Black Book. The survey comprises feedback from 34,800 consumers continually...

CMS Proposes New Rule to Stabilize Health Insurance Exchanges

by Jacqueline Belliveau

CMS recently announced a proposed rule designed to help stabilize health insurance exchanges by promoting more coverage options and improving the risk pool for insurers. The proposed rule comes just one day after Humana publicized its decision...

Humana to Leave ACA Health Insurance Exchanges by 2018

by Thomas Beaton

Humana will halt sales of individual health insurance plans through the Affordable Care Act’s exchanges by 2018, which will leave more than 150,000 Humana customers without a carrier.   Amid ongoing political uncertainty, Humana said...

Shareholder Class Action Lawsuit Filed Against Aetna

by Vera Gruessner

A shareholder class action lawsuit has been filed against the national health insurance company Aetna Inc., according to a press release from the law firm of Kessler Topaz Meltzer & Check, LLP. The announcement came earlier this...

Key Best Practices for Success on the Health Insurance Exchanges

by Vera Gruessner

Which healthcare insurers are succeeding in the health insurance exchanges? What best practices can be taken from these payers? The weekly newsletter Washington Health Policy Week in Review published an editorial answering these questions by...

6.4 Million Enrollees Sign Up on Affordable Care Act Exchanges

by Vera Gruessner

As of December 21, a total of 6.4 million consumers have enrolled in health plans through the Affordable Care Act exchanges on HealthCare.gov, reported the Centers for Medicare & Medicaid Services (CMS) in a fact sheet. The number of enrollees...

ACA Health Insurance Exchanges Bring Challenges for 2017

by Vera Gruessner

The Affordable Care Act (ACA) health insurance exchanges will have some key differences next year. Health insurance companies have faced various obstacles when selling health plans through the exchanges. These challenges include a higher risk...

How 4 Healthcare Payers Fare in 2016’s Health Insurance Market

by Vera Gruessner

The health insurance market has gone through significant changes in 2016. A number of payers have pulled back from the health insurance exchanges such as UnitedHealth and Humana. The Department of Justice has also filed lawsuits against the mergers...

Patient Engagement Helps Payers on Affordable Care Act Exchanges

by Vera Gruessner

Many health insurance companies selling health plans through the Affordable Care Act exchanges have been seeing higher and higher rates of financial losses. Some payers such as Aetna, Humana, and UnitedHealth Group have even pulled back from...

Payers See High Financial Losses on Health Insurance Exchanges

by Vera Gruessner

Healthcare payers have been facing significant financial losses on the health insurance exchanges in recent years. UnitedHealth Group lost $475 million in 2015 and was predicting a loss of $650 million in 2016, according to Kaiser Health News....

Payers Continue to Drop Out of the Health Insurance Exchanges

by Vera Gruessner

Healthcare payers have seen significant obstacles when it comes to operating on the public health insurance exchanges with large, national insurance companies losing money through this marketplace. Below we outline some key insurers that have...

How Health Payers Could Help Reduce High Out-of-Pocket Costs

by Vera Gruessner

A major problem still impacting consumers within the health insurance market is the potential for seeing high out-of-pocket costs. Many individuals are still underinsured despite the significant decrease in the uninsured rate around the country...

Affordable Care Act Replacement Seeks Automatic Enrollment

by Vera Gruessner

Since the Presidential election of Donald J. Trump, a number of differing viewpoints came out emphasizing how the Patient Protection and Affordable Care Act will be impacted. For the last several years, the Republican Party has attempted to repeal...

Anthem-Cigna Health Insurance Merger Suit Starts on November 21

by Vera Gruessner

The lawsuit against the Anthem-Cigna health insurance merger had its first pretrial conference this past Monday, according to The Coalition to Protect Patient Choice. Judge Amy Berman Jackson said that the two parties met to have a discussion...

Health Insurance Exchanges Require Engagement, Narrow Networks

by Vera Gruessner

Since some private health payers are struggling with enrollment and the ability to make a profit on the health insurance exchanges, engaging consumers, reducing the administrative burden, and creating a narrow provider network will become an...

Blue Cross to Expand Value-Based Care Reimbursement in 2017

by Vera Gruessner

The coming years will further position the medical industry including payers to adopt value-based care reimbursement models and new healthcare delivery systems partially due to the reforms that came about from the Patient Protection and Affordable...

How Payers Could Compete in Midst of Health Insurance Mergers

by Vera Gruessner

Among the payers facing a Department of Justice lawsuit against their health insurance mergers, Aetna and Humana have requested sanctions due to the government allegedly delaying the release of documents the two insurers need. The Motion for...

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