Posted on 06/18/2013 2:47:00 PM PDT by tobyhill
Aetna Inc. said it would stop selling individual health insurance policies in California next month, and nearly 50,000 existing policyholders will have to find new coverage by January.
The company's announcement Monday comes a month after it opted not to participate in California's new state-run insurance market for consumers, a key component of the new federal healthcare law.
Aetna was a distant fourth in the state's individual health market with a 5.2% market share in 2011, according to Citigroup data. Anthem Blue Cross, Kaiser Permanente and Blue Shield of California dominate that business with a collective 87% market share in the state.
Aetna said it would continue to sell health plans in California to small and large employers as well as offer products related to Medicare, dental and life insurance. A company spokeswoman said it was "fully committed to serving the needs of our 1.5 million members in the state."
The company said it expected to have about 49,000 individual policyholders in the state by December. Regardless of its decision, it estimated that up to 30% of those customers would seek other insurance through Covered California, the state-run health exchange that opens Jan. 1.
(Excerpt) Read more at latimes.com ...
Another one bites the dust...
Plan proceeding as expected. Eventual goal. Single Payer.
“If you like your doctor, you will be able to keep your doctor. Period. If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.” -Obama
“If you like your health care plan, you will be able to keep it.”
No one likes Aetna.
Those exchanges really are heating up the competition, aren’t they? Hooo boy.
Selling individual policies makes them subject to the HIPAA law which requires them to sell an individual policy without underwriting to those folks who lose their group coverage. Essentially, they’ll just be dumping another group of high-utilization subscribers into the state pool.
>> “If you like your health care plan, you will be able to keep your health care plan.”
Now now, let’s be fair: Obummer never said you wouldn’t have to *move to a different state* to keep your health plan, did he? ;-)
“Selling individual policies makes them subject to the HIPAA law which requires them to sell an individual policy without underwriting to those folks who lose their group coverage. Essentially, they’ll just be dumping another group of high-utilization subscribers into the state pool.”
I read the article to find out why they left the market, and, annoyingly, the article didn’t say. It appears that you have given the reason, but I don’t understand the reason. I’d be grateful if you could elaborate for somebody who does not speak insurance. Is the key “without underwriting?” What does that mean?
I lost my health care plan two years ago when I was forced to subsidize health care for the adult offspring of my co-workers and was also forced to forgo lifetime limits on my coverage which were in place to keep premium costs down. This year, I lost out on my ability to contribute to my FSA which will result in a $625 tax on this year’s health care costs.
Obamacare is working as designed.
Aetna is NOT the only insurer to bail on individual health policies in CA as of 1/1/14. Today’s L.A. Times (blecchh) mentioned two or three other insurers who will also bail on CA. Offhand I don’t recall the specific names but they are definitely names I’ve heard of.......
Yes, Obama’s plan is working............ /sarcasm
under our plan you can keep the insurance that you have
The business of insurance essentially involves finding some adverse event, such as getting sick, carefully figuring out what the true likelyhood of it happening is, then setting premiums that’ll let you pay off the claim and still have enough left to make a profit for yourself. In the health insurance business, one part of that process involves figuring out exactly what the health status of a prospective customer is, because customers more likely to get sick are customers more likely to have an expensive claim, and the more expensive claims you get the higher your rates have to be. Underwriting is the process by which that risk assessment is carried out.
So insurers will establish rules about pre-existing conditions, or they’ll ask a series of specific questions from those who apply as a means of quantifying their risks. They can then deal with those risks by either charging more to those likely to cost the company more, or just refusing to take on the risk of insuring them. Either way, the effort is to keep the risk of large claims among the pool of people they insure at a level where the premiums cover it.
The HIPAA law requires that any individual insurer in California has to insure an individual who’s lost his employer provided coverage. As a consequence, Aetna risks getting stuck with a group of high risk members if it stays in the individual insurance business. They were probably able to “make it up in volume” before, but with Obamacare seriously eroding the number of people shopping for individual coverage, and with the ability to sidestep the HIPAA requirement by just not being in the individual policy business, it probably made sense for them to just exit that market. The fact that they wouldn’t be leaving those folks out in the cold because the exchange companies will have to take them without underwriting may have figured in there too.
Hope that was clearer.
This was back a few weeks ago (note it pertains to not offering policies through the exchange). The three held only 7% of market share.
Now that was an informative reply! It is what I wanted to read in the article; but which was not there.
Many thanks.
Yes, just 7% of providers of individual health in CA.
Seems insignificant yet I and several people I know are affected and that’s just a few people out of millions in the state. It adds up.
Fewer choices in the exchanges equals less competition and higher prices. But we knew this would happen.
I worked in legal for Blue Cross of CA for well over a decade. We knew back in 1999 (and earlier) that all of this would happen. Disgusting.
RE UnitedHealth, Aetna and Cigna opt out of California insurance exchange
This was back a few weeks ago (note it pertains to not offering policies through the exchange). The three held only 7% of market share.
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