Author Archives: Reeve Conover

Why United healthcare is leaving the PPACA

While its not official, it is very clear that United Healthcare intends to leave the individual health marketplace next January 1.  Here is why:

  1.  Partial year insureds-  they sign up, run up a bunch of claims, and then stop paying premiums.  For example, they join, pay $400 a month for three months, have $100,000 heart surgery, and then stop paying premiums and cancel the insurance.  They are, by the way, free to do this every year!
  2. The exchanges are not attracting healthy individuals.  less than 30 percent of all enrollments are under age 34 – meaning more claims for less premiuns.
  3. Grandfathers Policies- while many states have recently allowed a big increase on these plans, as long as they exist, these (more likely healthy) people are not required to join the PPACA plans.
  4. Risk Corridor Payments- The bill promised a safety net on high claims, but paid only 12.5% of the promised amount.  That leaves a $2.5 billion shortfall – and that assumes the 12.5% ever actually gets paid (not as of today).  This is exactly the problem that put the Co-ops out of business (can you say HealthRepublic and Consumers Choice?)
  5. Pricing models- most people are buying the lowest price plans.

The only question I have is – are they the only major carrier that drops out?


Blue Cross SC Rate increase on grandfathered plans!

2016 Rate Notifications for Under 65 Grandfathered Plans
BlueCross BlueShield of South Carolina is applying a 19 percent rate increase for Under 65, grandfathered plans ONLY (plans and freestanding drug benefits that became effective before March 23, 2010).
Under 65, non-grandfathered plans (plans that became effective between March 24, 2010 and December 15, 2013) WILL NOT receive a rate increase.

The effect of high deductible health plans on your finances

The high deductible plans so prevalent since the advent of ObamaCare are having a dramatic impact on Americans.  The concept that you have to have health insurance, that has a deductible so high you cannot really use it, has been written about alot.

Less than half of all households above the poverty level have enough assets to cover an out-of-pocket maximum of $3,000 to $6,000, considered a moderate level, according to a March analysis by the Kaiser Family Foundation.

Does a high deductible health plan cause people to bypass medically needed care?  Read this article from the Charlotte Observer and learn more.

NYU leaves United Compass Network


We have been advised that NYU is no longer in our UHC Compass Individual exchange network as of 1/1/16 as United Healthcare was unable to agree on an updated contract. Letters have gone out to exchange members to advise them of the change.

For members currently involved in an ongoing course of treatment or pregnancy in their second or third trimester, they may be able to continue to receive covered services through Continuity of Care benefits.

Oxford now enforcing drug card rules

As you may be aware, in 2014 Oxford small group NY and Conn went to a mandatory generic Rx card, which they called the “Ancillary charge program”.  If you wanted a name brand drug and there was a generic available you were supposed to pay the difference (the ancillary charge) in cost between the name brand and the generic, even if the doctor write DAW (dispense as written).  This was never properly adjudicated by Optum Rx, so members in some instances have been getting name brand drugs for the 3rd Tier copay instead of paying the difference in price between the name brand and the generic.

They have caught the error and are correcting it  now as of Jan 1st, 2016 to adjudicate scripts as they had set it up originally to do.  So now it’s more important than ever to make sure members discuss Rx options with their provider  so they are best prepared for this.  Oxford reports that “Impacted members received {a} letter in December of 2015 – outlining the drug(s) they are currently taking, that will be enforced as part of the program.



Blog Archives

Reeve Conover is a Registered Representative. Securities offered through Cambridge Investment Research, Inc., a Broker/dealer member FINRA/SPIC. Cambridge and Conover Consulting are not affiliated. Licensed in SC, NC, NY, CT, NJ, and CA. - SIPC - Brokercheck