The Challenges of Pricing Health Insurance for the 2014 Exchanges

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Expert Voices Essay – NIHCM Foundation

By Ann Miller RN MHA

The PP-ACA has introduced sweeping market changes that bring new uncertainty to the task of developing premiums for products to be offered in the health insurance exchanges beginning in 2014. The added complexity greatly increases the chances that these premiums will be off the mark.

In this essay, Alice Rosenblatt explains how actuaries set premiums, shows how key provisions of the ACA will affect their pricing for the October 2013 open enrollment period and describes what’s at stake if they don’t get it right.

Read more…

PDF: http://nihcm.org/images/stories/The_Challenges_of_Pricing_Health_Insurance_for_the_2014_Exchanges.pdf

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3 Responses

  1. Higher Hurdle to Deduct Medical Care is Near

    http://online.wsj.com/article/SB10001424127887324851704578131394051135884.html

    Rajesh

    Like

  2. Docs complain of lower pay by exchange plans

    Did you know that some insurance companies have have reduced payment rates in some plans to keep premiums affordable.

    http://www.medicalpracticeinsider.com/news/doctors-complain-they-will-be-paid-less-exchange-plans?email=MARCINKOADVISORS@MSN.COM&GroupID=90115

    Apparently, physicians will make up for lower pay by seeing more patients, since the plans tend to have smaller networks of doctors!

    Reasonable or not?

    Ann Miller RN MHA

    Like

  3. Age Distribution of Health-Exchange Enrollees Compared to Age Distribution of Uninsured

    Uninsured Population in 2012 Healthcare.gov Enrollees Through December 28th, 2013

    << 18 12% 6%
    18-24 16% 9%
    25-34 25% 15%
    35-44 19% 15%
    45-54 17% 22%
    55-64 11% 33%

    Source: The Wall Street Journal, Health Sign-Ups Skew Older, Raising Fears of Higher Costs, January 14, 2014

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