In health insurance, to a great extent, price is king.
The monthly premium that people will have to pay for insurance is a pivotal factor in how they pick a health plan – or whether they choose to buy coverage at all.
The apparent impact of the cost of premiums is noticeable in the enrollment patterns in Georgia’s insurance exchange, as seen in the first year of its existence under the Affordable Care Act.
A map of exchange enrollment in Georgia in 2014 shows generally low participation rates in rural South Georgia, even though these counties have high percentages of uninsured residents.
Map of Georgia exchange enrollment in 2014. Credit: Enroll America
For the current plan year, southwest Georgia in particular had high premiums compared with other Georgia regions. In fact, it had among the highest premiums in the nation.
Two southwestern regions had monthly premiums of $345 and $377 for a particular Silver plan for a 21-year-old, Bill Custer, a health insurance expert at Georgia State University, told reporters in Atlanta on Tuesday. full story
Charles Armbrust had severe headaches from what was eventually diagnosed as a brain aneurysm. He received surgery at Grady Memorial Hospital in Atlanta.
“Grady saved my life – that’s the bottom line,’’ said the former patient.
A video of a tearful Armbrust expressing his gratitude for his medical care is posted on a Grady web page describing problems that the health system says it’s experiencing in reaching a new contract with Blue Cross and Blue Shield of Georgia. Armbrust’s insurer is Blue Cross.
Grady Memorial Hospital
The powerful video is part of a campaign by Grady to call attention to low reimbursements from Georgia’s largest health insurer.
Those payments are lower than Blue Cross rates for other comparable hospitals in Atlanta and throughout the state, says Grady CEO John Haupert.
For trauma services, “it’s much lower than other hospitals,’’ Haupert told GHN on Monday. Overall, he said, Grady loses money when it treats most Blue Cross and Blue Shield of Georgia patients.
Haupert said the two sides have been negotiating for a year. While these talks are continuing, he said, Grady has sent Blue Cross a termination notice that would be triggered Nov. 25.
Both Grady and Blue Cross say they hope an agreement is reached before the November deadline. The contract affects Grady’s hospital and other facilities, but not its physicians. full story
Blue Cross and Blue Shield of Georgia is dropping its Medicare Advantage plan for next year for retirees in the State Health Benefit Plan.
That means UnitedHealthcare will be the sole provider of the Advantage plans for 2015. (Blue Cross is the sole provider for 2014.)
The Georgia Department of Community Health is informing retiree health plan members about the Blue Cross move through email and letter this month, letting them know that the decision won’t affect the coverage in effect for the current year.
Medicare Advantage is a health plan offered by a private company that contracts with the federally administered Medicare program to provide benefits. The majority of the 54 million people on Medicare are in the traditional Medicare program, with about 30 percent enrolled in an Advantage plan, according to the Kaiser Family Foundation.
More than 102,000 people are in Medicare Advantage plans under Georgia’s State Health Benefit Plan, according to Community Health, which runs the health plan.
Blue Cross said Monday that its decision to discontinue its Advantage plan was made jointly with the SHBP.
Still, in a comparison of next year’s rates, Blue Cross had premiums that were much higher than United’s. full story
Two nonprofit organizations will divide $3.3 million in federal money to provide “navigators” to help consumers enroll in the Georgia health insurance exchange this fall, the federal government announced Monday.
Navigators provide face-to-face, in-person help for consumers seeking information about the exchanges.
SEEDCO (Structured Employment Economic Development Corporation) will receive nearly $2.2 million, roughly the same as it received last year as a navigator grantee.
The second grantee will be an alliance led by Macon-based Community Health Works and consisting of cancer coalitions and other organizations. It will get $1.1 million.
Nationally, U.S. Health and Human Services Secretary Sylvia M. Burwell announced $60 million in navigator grant awards to 90 organizations in states with federally facilitated and state partnership exchanges. Also known as marketplaces, the exchanges were created under the Affordable Care Act, sometimes known as Obamacare. full story
More than 20,000 Georgians have until next Friday to provide missing information or they will lose their insurance exchange coverage Sept. 30.
The regional administrator of the federal Centers for Medicare and Medicaid Services told GHN on Friday that most of the data discrepancies involve immigration or citizenship issues.
Letters requesting further information were mailed earlier in August to 310,000 people in three dozen states that have their insurance exchange run by the federal government. The exchanges were created under the Affordable Care Act.
Georgia’s total of 20,900 people getting the notices was the third-highest total in the nation, after Florida’s 93,800 and Texas’ 52,700.
Renard Murray, the regional CMS administrator, said the federal agency has been working on getting this information for months, and that as many as seven letters requesting data have been sent to some people. full story