New York State residents who meet certain eligibility standards may enroll in an Essential Plan, a program for low-income New Yorkers enrolling in coverage through NY State of Health, the state’s official health plan marketplace.
Enrollment for the Essential Plan is open all year long.
How much does an Essential Plan cost?
Eligible consumers will pay either a $20 monthly premium or $0, depending on their income. Some plans include additional benefits such as adult dental and vision coverage for additional premium.
For hundreds of field agents and representatives from insurance carriers and technology platforms, the conference was an opportunity to meet their peers in the Medicare space, explore the latest tech solutions, and stay abreast of industry trends and new legislative mandates. For those insurance professionals who couldn’t make it to this year’s event, here are my top takeaways from the 2019 summit:
Tech-driven distribution is growing and agents need to get on board.
Insurance agents, especially those serving the Medicare market, have historically offered fewer technology solutions than the rest of the health insurance industry, mainly due to seniors’ disfavor of online plan shopping and enrollment experiences. That is quickly changing, as baby boomers, contrary to generations of seniors before them, are embracing digital tools. This conference stressed that to adapt to this changing, more tech-savvy environment, agents need to manage an omnichannel strategy for the optimization of plan distribution across age cohorts. Call centers, field agents and consumer-facing online shopping and enrollment platforms were highlighted across several sessions.
Medicare tech platforms are booming
Medicare tech platforms — websites enabling brokers to quote, shop for and enroll members in Medigap and Medicare Advantage plans — are increasingly popular and this conference is where these solutions are showcased to agents, as the end-users. Connecture, MediCareful (by Ritter Insurance) and CSG Actuarial were all in attendance, as each platform is focused on arming agents and consumers with the information necessary to enroll in the right plan based on each consumer’s specific requirements.
Vericred recently announced a Medicare Advantage rating API, enabling Medicare platforms and other InsurTech companies to build innovative solutions that serve the fast-growing Medicare-eligible population. Using Vericred as their data foundation, technology companies building Medicare Advantage plan search and quoting solutions can now do so without acquiring and maintaining the necessary underlying data and logic.
Senior dental was a major talking point at this year’s forum
Senior dental was a big push at this year’s conference. Agents are looking to cross-sell beyond the traditional medical and life insurance products and many dental carriers are starting to bring on senior-specific products.
Cross-selling was a topic for discussion in general. Supplemental policies such as accident, critical illness and hospital indemnity are now a part of all of the FMO’s strategy to cross-sell into their Medicare Advantage customers.
MACRA is coming!
The acronym MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. Congress included this to reform the Medicare payment system to share more health care costs with policyholders by no longer allowing “newly eligible” beneficiaries to obtain a Medicare supplement plan that covers the Part B deductible. It also will transition away from using Social Security numbers as identifiers to reduce the risk of identity theft and fraud. MACRA will also change the way Medicare pays health care providers, compensating them on quality of care as opposed to the number of services they perform.
Overall, the summit was an exciting opportunity to engage all participants within the Medicare space, and to discover how technology is fundamentally changing how insurance brokers quote, sell and enroll members in Medicare plans. I’m already looking forward to next year’s 12th Medicare Supplement Insurance Industry Conference, but between then and now, Vericred is positioned to be a high-level resource for brokers to better understand how digital technologies and data are transforming the Medicare landscape.
Interested in building digital user experiences for the Medicare Advantage market? Check out Vericred’s digital toolkit, which includes use cases on developing solutions for this growing insurance market.
**NOTE: Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
Empowering users to quickly and dynamically analyze what percentage of employees would be affected by switching networks
NEW YORK–(BUSINESS WIRE)–Vericred, a data services platform powering the digital distribution of health insurance and employee benefits, announced today the immediate availability of its Disruption Analysis API. Vericred’s new API enables InsurTech companies to build decision support tools that help their users — primarily brokers and employers — assess what percentage of an employee population would be affected, positively or adversely, by switching health or dental insurance networks.
Disruption analysis, traditionally, has been a complex process through which employers and insurance brokers evaluate how the transition to a different group health insurance (or dental) network would impact employees’ in-network access to their most important doctors, health systems and hospitals. Analyzing plans in this manner has rarely been accessible within the small group environment, as it was typically a high-cost and inefficient process.
Vericred’s latest API, however, empowers InsurTech companies — which include online insurance marketplaces and quoting platforms — to build user-facing solutions that make disruption analysis far more streamlined and automated. Rather than having to build and maintain the underlying data and logic themselves, InsurTechs can leverage Vericred’s API to develop these features, easily and within an accelerated timeline.
“Traditionally, it’s been expensive, time-consuming and labor-intensive for brokers and employers to examine how switching to a new insurance plan would disrupt members’ in-network access to their preferred doctors and dentists,” said Michael W. Levin, Vericred’s co-founder and CEO. “Using our new Disruption Analysis API, InsurTech companies can effortlessly bring to their customers features that are imperative in today’s complex insurance market.”
According to the Kaiser Family Foundation’s 2018 Employer Health Benefits Survey, 61 percent of employers offering health benefits had shopped for a new health plan during the past year, with 25 percent of those businesses choosing to change carriers. Further, it is likely that more businesses will reconsider their options in 2020 and beyond, as the Trump Administration’s new policy on HRAs will afford employers another alternative to traditional group plans. As open enrollment approaches, companies will require disruption analysis and other support tools to best analyze how switching group plans, or transitioning from a group plan to the individual market, would impact their employees’ in-network access to providers.
The Disruption Analysis API — which includes all major medical and dental networks — joins Overlap Analysis and Shop-by-Doctor as the third component of Vericred’s suite of provider-network solutions.
Vericred (www.vericred.com) is building infrastructure for the digital distribution of health insurance and employee benefits. The Vericred Platform serves as a data translation layer between insurance carriers and technology companies that are transforming the way health insurance and employee benefits are quoted, sold, enrolled and managed. Vericred offers robust solutions for technology companies focused on the under 65 individual, Medicaid and Medicare markets, as well as the group market. For more information visit www.vericred.com or interact with us on Twitter, Facebook and LinkedIn.
**NOTE: Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
NEW YORK–(BUSINESS WIRE)–Decent announced today a new partnership to distribute — through the Vericred platform — its affordable health plans for self-employed people in Austin, Texas, to hundreds of brokers, quoting platforms and online insurance marketplaces.
Vericred is a data services company connecting its health plan partners, such as Decent, with InsurTech platforms that are transforming the way health insurance is quoted, sold and enrolled. Rather than build one-to-one connections with each individual InsurTech company to enable the exchange of plan design, rate, and network data, Decent is leveraging Vericred’s platform to do so.
“Self-employed people need affordable health insurance. Decent is partnering with Vericred to bring it to them, in Texas and beyond,” said Decent CEO Nick Soman. “We heard from several digital insurance companies that Vericred is the easiest, most streamlined way to ensure our plans are accurately represented across their platforms. This partnership makes it a no-brainer for online brokers and insurance exchanges to add Decent’s market-leading plans.”
Decent’s ACA-compliant, off-exchange plans include the Austin market’s lowest-premium bronze-level plan for most self-employed enrollees who don’t qualify for ACA subsidies, and an affordable silver-level plan with low monthly premiums.
“Working with Vericred enables Decent to focus its resources on building the best health insurance products for the gig economy instead of developing technology to work with brokers and other InsurTech companies,” said Michael W. Levin, Vericred’s co-founder and CEO. “By partnering with Vericred, Decent has immediate access to all of the tech companies on the platform, and those companies to the Decent products.”
This partnership will also benefit Vericred’s customers, who, through Vericred’s modern API, may now quote and sell Decent’s affordable coverage plans.
Decent and Vericred plan to grow their partnership to deliver new plans across expanded geographies in the next year. If you have questions, please contact hello@decent.com or sales@vericred.com.
About Decent
Decent (www.decent.com) administers affordable health plans for self-employed people — including sole proprietors, freelancers, and independent (1099) contractors. Plans are designed around unlimited direct primary care (DPC), which is built into members’ monthly premium. Decent plans are currently available in Austin, Texas. For more information visit www.decent.com or find us on Twitter, Facebook and LinkedIn.
About Vericred
Vericred (www.vericred.com) is building infrastructure for the digital distribution of health insurance and employee benefits. The Vericred platform serves as a data translation layer between insurance carriers and technology companies that are transforming the way health insurance and employee benefits are quoted, sold, enrolled and managed. Vericred offers robust solutions for technology companies focused on the under 65 individual, Medicaid and Medicare markets, as well as the group market. For more information visit www.vericred.com or interact with us on Twitter, Facebook and LinkedIn.
**NOTE: Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
Enabling BenAdmin and InsurTech platforms to add shop-by-dentist and dentist search functionality
NEW YORK–(BUSINESS WIRE)–Vericred, a data services platform powering the digital distribution of health insurance and employee benefits, announced today the immediate availability of dental network data. Vericred’s dental network data enables technology companies — which include benefits administration platforms, online insurance marketplaces and many other InsurTech firms — to add shop-by-dentist and dentist search functionality without having to build and maintain the underlying datasets and logic.
Using Vericred’s platform — which includes all major dental networks — as their data foundation, technology companies can now effortlessly build and maintain solutions that assist employers, employees, consumers and brokers to shop for and manage dental insurance options. Vericred’s dental network APIs enable insurance marketplaces to offer their end users shop-by-dentist functionality – a feature that allows consumers to evaluate dental plan options based on whether specific dental providers are in-network.
“For many Americans shopping for dental insurance, their top priority is finding a plan in which their current dentist participates in-network. Sorting through a myriad of plan and dental network options to arrive at the right choice can be a time-consuming and frustrating process,” said Michael W. Levin, Vericred’s co-founder and CEO. “We’re focused on providing solutions that enable our technology customers to more efficiently build features, like shop-by-dentist, that are valuable to their end users.”
Vericred’s dental network data also powers dental provider search functionality on BenAdmin platforms, enabling employees to find in-network dentists without leaving the tech platform from which their benefits are administered. Currently, most employees must contact their insurance carrier directly to identify in-network dental providers. Vericred simplifies the process by offering dental-network APIs, so that BenAdmin platforms can build new features that eliminate this step for employees.
Vericred dental network data for individual and group dental plans is delivered through a suite of APIs. These data work independently from, and in coordination with, Vericred’s dental rating API, which delivers detailed dental plan benefit and rate information.
Vericred (www.vericred.com) is building infrastructure for the digital distribution of health insurance and employee benefits. The Vericred Platform serves as a data translation layer between insurance carriers and technology companies that are transforming the way health insurance and employee benefits are quoted, sold, enrolled and managed. Vericred offers robust solutions for technology companies focused on the under 65 individual, Medicaid and Medicare markets, as well as the group market. For more information visit www.vericred.com or interact with us on Twitter, Facebook and LinkedIn.
I**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
n this VeriStat series, we are exploring the Medicare Advantage market. In our last post, we showed that there is widespread availability of Medicare Advantage plans and that most shoppers can choose between plans offered by a range of insurance carriers. In this post, we examine premiums on the Medicare Advantage market.
The data science team at Vericred analyzed premiums for Medicare Advantage plans available to those shopping as individuals.* The results show that there are a large number of plans available at a comparable price to Original Medicare. More than half of Medicare Advantage plans do not charge an additional health premium, and nearly half do not charge a drug premium. Taking into account the counties where plans are offered, 95% of the over-65 population in the United States has access to at least one plan that includes drug coverage and has both zero health and zero drug premiums. Of the plans that do charge additional premiums, the majority of health and drug premiums are each under $50 per month.
We showed in our last post that there is a large amount of competition on the Medicare Advantage market. Our premium analysis shows that— perhaps because of this competition— premiums on the Medicare Advantage market are generally low. There is widespread availability of zero premium plans, and nearly all older adults have access to at least one of them. In our next post, we will examine Medicare Advantage plan benefits to see how these vary and how they differ from Original Medicare.
*For this post we excluded plans offered only to groups and those with special eligibility criteria.
Interested in building digital user experiences for the Medicare Advantage market? Check out Vericred’s digital toolkit, which includes use cases on developing solutions for this growing insurance market.
**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
New to Medicare Advantage? Check out our recent blog to better understand Medicare Advantage basics and why these plans are increasingly popular.
Medicare Advantage is a growing business. Enrollment has nearly doubled in the past decade and has nearly quadrupled since the early 2000s. There are over 22 million people enrolled in Medicare Advantage in 2019* and it is poised to keep growing as the large baby boomer population continues to age into Medicare. By 2035, those 65 and older are projected to make up nearly one quarter of the United States population. For this VeriStat series, we will be examining various aspects of Medicare Advantage plan offerings. In this first post, we explore the geographic availability of plans and determine how many options potential enrollees can choose between.
The data science team at Vericred assessed how many health insurance carriers are offering Medicare Advantage products in each county this year. We used population estimates for those aged 65 and over to determine the number of choices available to the older adults.
The results show that there is widespread availability of Medicare Advantage plans. Nearly all (99%) of older adults have access to at least one Medicare Advantage plan. Only 2% live in a county where just one carrier offers plans, and 87% can choose between Medicare Advantage plans offered by four or more carriers. Unsurprisingly, counties with more options tend to be those located in more densely populated areas.
The widespread availability of Medicare Advantage plans to those shopping for healthcare as individuals contrasts dramatically with the more limited choices available to those just under the age cutoff for Medicare. While there are no “bare counties” (counties with no plans) on the individual ACA market, 16% of those under age 65 live in a county where only one carrier offers plans, and only 40% can choose between plans offered by four or more carriers.
Medicare beneficiaries and soon-to-be beneficiaries should keep an eye on Medicare Advantage. The market is growing rapidly, and beneficiaries have a large number of options to choose from. In our next several posts, we will dig into Medicare Advantage plans’ premiums, plan designs, and networks to uncover some of the differences both between Medicare Advantage and Original Medicare and across different Medicare Advantage offerings.
* About two thirds of 2019 enrollments were in individual plans that are open for general enrollment. For this post we excluded plans offered only to groups and those with special eligibility criteria.
Interested in building digital user experiences for the Medicare Advantage market? Check out Vericred’s digital toolkit, which includes use cases on developing solutions for this growing insurance market.
**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
We’ve made it our mission to enable technology companies to build innovative solutions that bring transparency, efficiency and decision support to the health insurance and employee benefits spaces. Earlier this week we launched our Medicare Advantage Rating API, which will now allow InsurTech and digital health platforms to deliver plan search, quoting and other features to seniors, employers and brokers in the flourishing over-65 market.
Using Vericred as their data foundation, technology companies including online brokers can use the new API to build Medicare Advantage solutions to better support the 22 million Americans now enrolled in Medicare Advantage plans. Let’s dive in to better understand Medicare Advantage basics and why these plans are increasingly popular.
Medicare Advantage — also known as Medicare Part C — is a privately administrated type of Medicare, which is the United States government’s federal health insurance program for Americans age 65 and older and younger people meeting certain criteria.
Traditional Medicare consists of two parts:
Part A – Hospital Insurance: Most beneficiaries are eligible for Part A premium-free, which covers inpatient hospital stays, care in a nursing facility and hospice services.
Part B – Medical Insurance: Part B covers outpatient medical care, such as preventive services, doctors’ visits, laboratory and diagnostic tests, vaccinations and outpatient procedures. The premium for Part B is $135.50 monthly for most people, but those in higher income brackets pay as much as $460.50 per month.
Enacted as part of the Medicare Modernization Act of 2003, Part D adds coverage for self-administered prescription drugs. Part D plans can be purchased to supplement Original Medicare (Parts A and B) or bundled into a Medicare Advantage Plan.
What is Medicare Advantage (Medicare Part C)?
Medicare Advantage is a program in which individuals who qualify for Medicare can enroll in alternative, certified health plans offered by private insurance companies instead of the government-run Original Medicare plan (Part A + Part B). These plans include Part A, Part B, and usually Part D.
What services do Medicare Advantage plans cover?
Medicare Advantage plans are regulated by the Centers for Medicare and Medicaid Services (CMS) and must cover all of the services — except hospice — that Medicare Parts A and B cover. In addition, many Medicare Advantage plans also cover benefits not included in Original Medicare, such as vision, hearing and dental coverage, in-home support, wellness programs, and other supplemental services.
How does Medicare Advantage work?
The U.S. government (Medicare) pays the private insurance carrier offering the Medicare Advantage plan a fixed monthly fee for each enrolled member. Members are then provided coverage through the private carrier rather than through the government. Unlike with Original Medicare, which permits members to visit any healthcare provider who accepts Medicare, Medicare Advantage enrollees may be limited only to doctors, specialists and hospitals within their private insurance carrier’s provider network.
How much do enrollees pay?
Most Medicare Advantage beneficiaries pay monthly premiums to their private insurance carrier that vary depending on the specific plan in which they’re enrolled. These premiums can range from just a few dollars to hundreds of dollars per month. Some “zero premium” plans do not require members to pay a separate Medicare Advantage premium at all, but nevertheless these plans are not free, as enrollees must continue to pay the $135.50 (or more) Part B premium. Some Medicare Advantage plans go even further and pay some or all of the Part B premium, reducing the amount the beneficiary pays to the government each month for Medicare coverage. According to CMS, the average monthly Medicare Advantage premium (not including Part B) is $28, a six percent decrease compared with 2018.
In addition to premiums, beneficiaries are also responsible for paying a portion of the healthcare costs they incur. Under Original Medicare, enrollees are responsible for paying 20% of the costs of most services and have no out-of-pocket limit. Medicare Advantage plans, however, often charge members a set dollar amount — instead of a fixed percent — for most services and have an annual out-of-pocket maximum, after which the insurance carrier will pay for all covered costs.
Why is Medicare Advantage becoming more popular?
By providing supplemental, flexible benefits, and low premiums, Medicare Advantage plans have proven attractive to Medicare enrollees. According to CMS, the number of Medicare Advantage enrollees nationwide has expanded this year to an all-time high of about 22 million, a 32 percent increase since 2015. This represents about 36 percent of all Medicare beneficiaries.
Up Next: VeriStat series on Medicare Advantage plans and benefits
As we’ve explored above, Medicare Advantage is an expanding, popular and diverse alternative to Original Medicare, albeit with a different cost-sharing structure and wide-ranging benefits. Next, our VeriStat series jumps into deeper analysis to further investigate the intricate Medicare Advantage market and its various plan designs.
Interested in building digital user experiences for the Medicare Advantage market? Check out Vericred’s digital toolkit, which includes use cases on developing solutions for this growing insurance market.
**NOTE: Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
NEW YORK–(BUSINESS WIRE)–Vericred, a data services platform powering the digital distribution of health insurance and employee benefits, announced today a Medicare Advantage rating API enabling InsurTech and digital health companies to build innovative solutions that serve the fast-growing Medicare-eligible population.
Using Vericred as their data foundation, technology companies building Medicare Advantage plan search and quoting solutions can now do so without acquiring and maintaining the necessary underlying data and logic. Vericred’s Medicare Advantage API returns detailed information for all relevant Medicare Advantage plans, including plan type, star rating, premiums, and cost sharing for in-network and out-of-network services. Further, the API enables powerful plan search functionality including shop-by-doctor and shop-by-drug, delivering actionable insights into provider and drug coverage of each plan.
“There are more coverage options in the Medicare space than ever before, and as a result, plan choice can be a particularly complex and daunting process for seniors and brokers alike,” said Michael W. Levin, Vericred’s co-founder and CEO. “Vericred’s Medicare Advantage API enables InsurTech platforms, online brokers and other innovators to develop solutions for this growing and intricate market. This data infrastructure, upon which our customers build their consumer and broker-facing products, will open new opportunities and functionality for our wide-ranging roster of clients.”
Medicare Advantage – also known as Medicare Part C – is a program in which individuals who qualify for Medicare enroll in certified health plans offered by private insurance companies, instead of the government-run Medicare plan. By providing supplemental, flexible benefits and low premiums, Medicare Advantage plans have proven increasingly attractive to Medicare enrollees. Nationwide, according to the Centers for Medicare & Medicaid Services (CMS), the number of Medicare Advantage enrollees has expanded this year to an all-time high of about 22 million, a 32 percent increase since 2015, and 91 percent of Medicare beneficiaries have access to 10 or more Medicare Advantage plans.
Additional plan options have generated a diverse, competitive over-65 insurance market where insurance carriers now vie for enrollees by offering differentiated benefits, such as vision and dental coverage, in-home support services and wellness programs. Vericred’s comprehensive Medicare Advantage API supports technology companies with the critical data required to serve seniors, employers and brokers in this burgeoning market.
About Vericred
Vericred (www.vericred.com) is a data services platform powering the digital distribution of health insurance and employee benefits. Vericred serves as a data translation layer between insurance carriers and technology companies that are transforming the way health insurance and employee benefits are quoted, sold, enrolled and managed. Vericred offers robust solutions for technology companies focused on the under 65 individual, Medicaid and Medicare markets, as well as the group market. For more information visit www.vericred.com or interact with us on Twitter, Facebook and LinkedIn.
**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**
This is the sixth year in which individual health insurance plans have been offered under the Affordable Care Act. The early years of the market were characterized by significant fluctuations in carrier participation and premiums as players adjusted their strategies in response to the new environment. In this Veristat post, we examine the national trend in premiums from 2018 to 2019 in the individual market and the way in which county-level premium changes relate to carrier entry and exit.
The data science team at Vericred analyzed the lowest premiums available in each county for an individual plan sold on the federal or state exchanges in 2018 and 2019 for a 40-year-old nonsmoker. We excluded catastrophic plans, as they are only available to those under age 30 or with a hardship exemption.
The results show that the median US county saw a decrease of 2% (-$7) for its lowest cost plan. This stands in stark contrast to previous years, when premiums rose sharply. Also in contrast to prior years, this year saw ample carrier entry. There were 16 carrier entrances to new states and 34 instances of carriers expanding their service areas within a state. Conversely, no carrier left a state entirely, and there were only 7 instances of existing carriers contracting their service areas within a state. As a result, almost one in four counties had more carriers providing plans in 2019 compared with 2018 and only 1% had fewer carrier options.
On balance, the counties with increased competition showed decreased premiums. The median county with more carriers in 2019 than 2018 had a 6% ($21) decrease in its lowest premium. Conversely, the much smaller number of counties with decreased competition tended to show increased premiums. The median county with fewer carriers had a 7% ($25) increase in its lowest premium. The counties with no change in competition showed very little change in premiums. The median county with the same number of carriers in 2018 and 2019 had less than a 1% increase ($1) in its lowest premium.
The individual ACA market appears to have stabilized in 2019, particularly in contrast to the carrier exits and large premium increases seen in previous years. This year saw substantially more carrier entry than exit, and premiums generally remained similar to their 2018 levels. Almost a quarter of counties had more competition in 2019 that 2018, and these counties tended to see decreased premiums. It remains to be seen if this stability will continue into 2020 as the market continues to react to changes in the ACA landscape including the zeroing of the individual mandate and the increased availability of short-term health insurance plans.
