Category: Blog

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

By Courtney Williams, Vericred Director of Carrier Relations

I recently traveled to Tampa for the 2019 FAHU Educational Symposium and Network Event, an annual gathering bringing together Florida-based health insurance and ancillary carriers, insurance brokers and agents, as well as technology vendors within the InsurTech, HRtech and BenTech spaces.

For brokers and those representing insurance carriers, the conference was an opportunity to evaluate the latest tech platforms and remain informed of industry trends and new legislative rulings. For industry professionals who couldn’t make it to this year’s event, here is my top takeaway from the 2019 Florida Association of Health Underwriters (FAHU) symposium: All brokers and employers will use a benefits technology (BenTech) platform within the next five years.

With digital BenTech platforms improving the quality and scope of their applications, tech-enabled insurance brokers — both those serving the group and individual markets — are identifying and benefiting from the advantages these digital tools can deliver. During the FAHU conference, a panel on “How Technology is Changing the Way We Do Business,” moderated by Chad Schneider of Jellyvision, examined the rise of BenTech, HR and broker platforms and the ways in which technology is altering broker, employer and employee expectations. All of these stakeholders, the panel agreed, now require technology solutions that bring transparency, customization, efficiency and self-service to benefits-related processes that, previously, lacked those elements.

According to the panel, which included David Reid of Ease, Mandy Manno of Asure Software and Frank Mengert of ebm, adoption of BenTech platforms is fairly prevalent among brokers and employers, and they expect any remaining holdouts to embrace such technologies within the next five years. Leveraging BenTech has become a business imperative.

This primary takeaway aligns with Vericred’s own recent survey of health insurance brokers, which examined the use of digital quoting platforms and rating engines, the number of carriers brokers are appointed with, and other questions regarding how technology is changing how brokers conduct business. The study revealed that 97 percent of brokers generally quote multiple carriers, two-thirds use a quoting or rating engine, and 85 percent are appointed with five or more medical carriers. For tech-enabled brokers, quoting and rating engines are not just digital tools: they also deliver material advantages, as 77 percent of brokers said that using technology differentiates them over their competitors.

Overall, the conference was an opportunity to engage brokers and insurance carriers, and to discover that benefits technology and digital solutions are transforming how health plans, and other benefits, are quoted, sold and managed. As we near the annual open enrollment period, Vericred is positioned to be a high-level resource for brokers, carriers and InsurTech platforms to better understand how digital technologies and data are changing the health insurance and employee benefits landscape. We look forward to hearing from you, or seeing you at FAHU’s next event!

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.

Eligibility requirements — individuals must be:

• New York State residents
• Able to meet the Essential Plan income requirements
• Lawfully present in the U.S.
• 19-64 years old
• Not eligible for Medicaid or Child Health Plus
• Not eligible for employer and other coverage

Covered Services:

• Free preventive care
• Inpatient care
• Outpatient services
• Maternity and newborn care
• Emergency services
• Lab and imaging
• Prescription drugs
• Rehabilitative and habilitative services
• Mental health and substance use disorder services
• Wellness and chronic disease management services

Is there a specific enrollment period?

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 more information about the Essential Plan:

NY State of Health – Essential Plan at a Glance

NY State of Health – Essential Plan Fact Sheet

Map detailing which carriers offer Essential Plans in which NY counties

Source: https://nystateofhealth.ny.gov/

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

By Patrick Kelly, Vericred’s Director of Sales

I recently traveled to Atlanta for The 11th National Conference for the Medicare Supplement Insurance Industry, an annual summit bringing together professionals who market, sell, price, administer and support Medicare supplement insurance.

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.

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.

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.

**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.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

A few weeks ago, I shared an analysis we developed at Vericred that explored the accuracy with which hospital websites disclose the health plans where they participate in-network. The results were very revealing, so we decided to extend that analysis to examine the quality of Machine Readable Directories (“MRDs”) mandated by CMS for plans sold through Healthcare.gov. MRDs are used on healthcare.gov to enable shopping for a health plan based on the doctor(s) or hospital(s) you want to keep.

We learned that MRDs are not much better than hospital websites as a source of whether or not a hospital is truly in-network.

We analyzed the MRDs from the four carriers offering Individual under 65 (ACA or “Obamacare”) plans around Columbus Ohio on healthcare.gov.  We examined the accuracy with which each carrier included, or excluded, the 29 hospitals in their respective MRDs. As the source of truth, we again used each carrier’s consumer facing provider directory.

As one of the carrier’s MRDs was noted as “Medicare” we excluded that carrier’s MRD from the analysis. Even after removing one of the four carriers, the overall results were as bad, if not worse, than the hospital websites.

In the aggregate, the three remaining MRDs were incorrect approximately 24% of the time, either including a hospital as in-network when it was not, or vice versa.  No MRD was perfect, with error rates ranging from 14% to 41%.

Just under 5% of the time, these MRDs incorrectly excluded in-network hospitals; a false negative that could result in an individual selecting an alternative plan with their hospital, at perhaps a higher premium.

More disconcerting was that nearly 20% of the time, the MRDs showed a hospital as accepting a plan when in fact they did not, creating a false positive. In this case someone shopping for a plan may enroll with the expectation that their local, or preferred, hospital will be in-network when in fact it is not.  Those anticipating a hospital stay, for the delivery of a baby for example, may not be able to use their chosen hospital despite doing their diligence.

The conclusion is the same as in my last analysis.  Before enrolling in a plan based on a particular provider choice, make sure you check with your prospective carrier.  And even then, there is no guarantee that your provider will remain in network throughout the year, so be sure to double-check again before going to the hospital.

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

Nearly 70% of Hospital Websites analyzed missed the mark.

A rule issued with much fanfare by the Department of Health and Human Services now requires that hospitals make their “chargemaster” public via the internet effective January 1^st, 2019. The chargemaster is a list detailing the official rate or list prices charged by a hospital for individual procedures, services, and goods.  There are no hospitals operating within the U.S. that are exempt under the new rule.

Much has been written about this new rule, with most experts correctly pointing out that very few people actually pay the chargemaster price because they have health insurance.  Instead, health insurance carriers and hospitals negotiate, seeking to reach agreement on lower costs for procedures for each carrier’s members.  In an ideal world, it would be the negotiated or contract reimbursement rates that would be made available online to patients.  If a carrier does not reach agreement with any given hospital, then charges incurred by that carrier’s members at that hospital are treated as out-of-network and/or billed at the chargemaster rate.

With this policy in place, prospective patients are being encouraged to look to hospital websites to understand the cost of services. However, if patients with health insurance will ultimately pay less, then it would be reasonable to also look to those same websites to determine whether the hospital accepts the patient’s health insurance plan.

You would think so… however, the Vericred team investigated further and revealed surprising results.

We took a look at the websites for 29 hospitals in the Columbus, Ohio area to analyze the accuracy of the insurance information they posted. Specifically, we zeroed in on the section of their websites that outlined “insurance(s) accepted,” with a focus on Individual Under 65 (ACA or “Obamacare”) plans, available from the four health insurance carriers offering coverage on Healthcare.gov.

We compared our findings to each health insurance carrier’s consumer-facing provider directory as the “source of truth.”

The results were stunning:

• Of the 29 hospitals analyzed, nine (31%) hospitals did not include information on which insurance they accept on their website.
• Of the remaining 20 hospitals, more than half provided incorrect information
• Only nine (or 45% of the hospital websites displaying such information) correctly conveyed whether or not they accepted one or more carrier’s ACA plans

Further, as a patient looking at these websites, there was a 9% chance that the hospital whose website they viewed actually accepted their plan, but showed otherwise — an avoidable false negative that could result in the patient going to different, less convenient, hospital.

Even more disconcerting, we found a 15% chance that the hospital will indicate that they take a plan when they do not — a false positive that has the potential to spiral into disastrous financial consequences to the patient. In this situation, the patient could select a hospital with the mistaken belief that their services will be covered by their insurance as in-network. Not only will that prove not to be the case, but the patient may well be billed at that chargemaster price which so few are.

The chargemaster ruling encourages us to look to hospital websites for the cost of services.  But the true cost of service depends on whether or not the hospitals accept the patient’s insurance and if so, the negotiated rates.  Hospital websites are not a reliable source for neither cost nor coverage.  Patients will still need to call their insurance companies to determine this information.

Moral of the story: Until hospitals update their website information with complete, accurate and timely information, patient beware — take a good look at the chargemaster; you may end up paying those rates!

**Ideon is the company formerly known as Vericred. Vericred began operating as Ideon on May 18, 2022.**

This is the third of three posts on this subject

In this blog series for Diabetes Awareness month, we are exploring how the medications used to treat diabetes are covered by ACA health insurance plans. In our last two posts, we showed that many plans exclude entire classes of diabetes medication and explored the prevalence of prior authorization requirements for insulins. In this post, we will walk through a real-life example of how much drug coverage costs for a common diabetes medication.

Lantus is a popular, long-acting insulin used to control blood sugar in people with diabetes. The data science team at Vericred reviewed several silver plans on the 2019 individual market in the state of New York to see what the yearly cost of Lantus would be assuming one carton of Lantus injection pens per month; GoodRx estimates the cost for one carton to be $281.

An individual in New York covered by one of these silver plans will pay anywhere from $480 to $3,372 out-of-pocket for a year of Lantus. That’s up to seven times as much for the same medication. Real life is more complicated than this—most diabetes patients will see multiple doctors and fill a variety of prescriptions—but this simplified example illustrates the importance of carefully researching your health insurance options.

The out of pocket cost for Lantus depends on more than the premiums, deductibles, out of pocket maximums, and cost sharing for prescriptions. The widespread in the cost of Lantus is due to differences that may be harder to notice. Plan 1 does not apply the deductible to drug costs, meaning that from the first dollar the individual pays only the copay for Lantus. Plan 2 has a separate (and much lower) deductible specifically for drugs. Plan 3 requires the full deductible to be met before the copay applies. There are also differences in the plans’ formularies. Plans 1 and 3 cover Lantus as a preferred brand drug. Plan 2 covers Lantus as a non-preferred brand drug, meaning the cost sharing is higher than it would be for a preferred brand—in this case, a percentage of the drug’s cost rather than a flat copayment). The formulary for Plan 4 does not cover Lantus at all, meaning the plan will not pay for any portion of the drug’s cost. It is worth noting, however, that the total cost of healthcare (including premiums) for Plan 4 is actually the second lowest of the four example plans. Somewhat counterintuitively, a plan that does not cover the drugs you need might be less expensive, depending on the premium and other plan characteristics.

Formulary coverage and to which benefits the deductible does and does not apply are two easily overlooked aspects of health insurance design that shoppers need to be aware of when evaluating plans, but they need to be considered in combination premiums and other plan features to determine which will best meet your needs.