If you try to use Medicare Advantage, understanding which doctors are available and where they’re located is becoming more and more difficult, if not outright impossible.
Medicare Advantage is the government-subsidized, private option to the traditional public Medicare program that is quickly growing in popularity over the last few years.
The Trump administration has significantly contributed to this recent growth by sending emails to people using Medicare to promote how much more coverage they could get for less money from private plans, but with one glaring omission:
Missing from those emails, is any mention of the one big limitation of those plans: They cover far fewer doctors than the traditional Medicare program.
If you can find a doctor you prefer or covered doctors in close convenient locations, this likely won’t be a problem for you but often, that is not the case. Government audits of Medicare Advantage plan directories show that the Centers for Medicare and Medicaid Services, which oversees the program, found that nearly half of entries had one of three problems: address errors, incorrect phone numbers, or doctors who were not accepting new patients. In 2017, the Department of Justice reached a settlement with two Medicare Advantage plans over charges of unscrupulous misrepresentation of their networks to regulators.
Despite being a multi-billion dollar industry dominated by some of the largest insurers in the world, basic research revealed that Medicare Advantage provider directories are notorious for not being accurate. For example, a study published in the American Journal of Managed Care found that Google was more correct.
“Directory accuracy is hard,” said the study’s lead author, Michael Adelberg, a former senior Health and Human Services regulator in Washington and now a leader of health care strategy for the Faegre Baker Daniels law firm. “But when a consumer joins a plan to get to a doc in the directory and then cannot, that consumer has a very legitimate beef.”
Working with plan directories — flawed though they may be — a Kaiser Family Foundation analysis examined the physician networks of almost 400 Medicare Advantage plans offered by 55 insurers in 20 counties in 2015. It found that networks of these plans included 46 percent of physicians in a county, on average.
Basically, if you selected a plan at random in these counties, you could expect that a bit less than half of doctors would be covered, at least according to its directory. (This does not necessarily mean those who are covered are taking patients or practicing in locations convenient for you.)
The study found considerable variation by specialty. Psychiatrists are least likely to be included in plan networks; a typical plan covered fewer than one-quarter of them. Ophthalmologist are most likely to be included; a typical plan covered nearly 60 percent of them. Depending on what kind of care you need, the extent to which plans cover specific specialists would be important to know. But there is no single source that meaningfully compares Medicare Advantage plans’ networks in the aggregate, much less by specialty.
This could change. A recent draft regulation would require Medicare Advantage, as well as other kinds of plans, to provide their directories in an electronic format that third parties could use to compare them, for example through apps or online.
Why do plans’ networks vary anyway? One possibility is that plans may strategically narrow or broaden their networks of certain specialties to try to attract more of the kind of enrollees they want (healthier, cheaper) and fewer of those they don’t (sicker, more expensive). Studies have shown that sicker beneficiaries are less attracted to Medicare Advantage, perhaps for these reasons. Another possibility, suggested by an Urban Institute study, is that plans narrow networks to control productivity and quality — for instance, covering only doctors who meet quality standards and tend to provide more efficient and valuable care.
A study of Medicare Advantage plans offered in California in 2017 found that the quality of obstetricians-gynecologists, cardiologists and endocrinologists covered by those plans tended to be comparable to those available through traditional Medicare. But some plan enrollees, particularly those in more rural areas, would need to travel far — in some cases exceeding 100 miles — to see those covered physicians.
The Kaiser Family Foundation study found that broader-network plans tended to charge higher premiums than “narrow network” plans (narrow network means covering less than 30 percent of doctors in a county).
One limitation of analyzing plan directories is that even if physicians are listed as in-network, they may not really be accessible because they’re too busy to accept new patients. So another way to assess the influence of Medicare Advantage networks on people’s access to care is to observe which doctors people in a specific plan actually see.
Looking at it this way, which colleagues and I did on a recent study published in Health Affairs, reveals that 80 percent or more of Medicare Advantage plans provide access to at least 70 percent of primary care physicians in their markets. Our study also suggests that narrow network plans are not growing over time in Medicare Advantage, which runs counter to the narrative that they’re taking over health care.
Still, because there is no way for Medicare beneficiaries to compare plan networks, people could easily stumble into a narrow network plan without knowing it. As with many things in health care, it’s hard to make an informed decision.
Health Insurance Innovations Inc. (NASDAQ: HIIQ) of Tampa has acquired a Coral Springs-based health care network in a cash and stock transaction.
TogetherHealth, a direct-to-consumer platform that connects individuals with insurance carriers through consumer acquisition and engagement was acquired for $50 million in cash and 630,000 shares of Health Insurance Innovations’ common stock.
A five-year earn-out provision based on the future performance of the acquired businesses is also included in the transaction, according to a release.
Health Insurance Innovations expects the acquisition to contribute at least $10 million of adjusted earnings before interest, taxes, depreciation and amortization for the remainder of fiscal 2019, which assumes any incremental increase in earnings will be reinvested back into building a market-leading position in more than 65 health insurance and supplemental insurance markets.
“This transformative acquisition offers immediate scale for us in the large and growing over-65 insurance market. This segment of the market continues to benefit from the strong, multidimensional tailwinds of changing demographics, as over 10,000 Americans a day turn 65 and age into Medicare,” said Gavin Southwell, Health Insurance Innovations CEO and president, said in a statement.
Health Insurance Innovations is cloud-based technology platform and distributor of affordable health insurance, life insurance and supplemental plans.
The acquisition, according to Southwell, will further leverage the company’s tech platform.
“We believe we can quickly leverage their resources to capitalize on this opportunity and continue to build our presence in this market,” said Robert Gregg, CEO of TogetherHealth, in a statement.
The acquisition is allowing Health Insurance Innovations to raise its 2019 revenue outlook to $450 million to $460 million, with an adjusted guidance of $82 million to $87 million, according to a release
Health Insurance Innovations has been in the news lately because one of the businesses it has done business with was taken over by the FTC after allegations of fraud. HIIQ has disavowed all activities by this rogue distributor and are not of any interest by regulatory agencies.
In fact, Health Innovations recently concluded a 42 state investigation where its business practices were thoroughly examined.
An anonymous stock analyst has recently released one of the most authoritative looks at the Health Insurance Innovations business model in a hard to find post on Scutify.
A number of other research firms have also recently commented on HIIQ.
B. Riley boosted their target price on shares of Health Insurance Innovations from $56.00 to $60.00 and gave the stock a buy rating in a research note on Thursday, September 27th. TheStreet raised shares of Health Insurance Innovations from a c rating to a b- rating in a research note on recently as well.
Lake Street Capital upped their price objective on shares of Health Insurance Innovations from $51.00 to $75.00 and gave the company a buy rating in a research note on Tuesday, October 30th. Craig Hallum raised their price target on shares of Health Insurance Innovations from $58.00 to $65.00 and gave the company a buy rating in a research note on Tuesday, October 30th.
And lastly, ValuEngine lowered shares of Health Insurance Innovations from a strong-buy rating to a buy rating in a report on Tuesday, October 16th.
Three analysts have rated the stock with a hold rating, seven have issued a buy rating and one has assigned a strong buy rating to the stock. The company currently has a consensus rating of Buy and a consensus price target of $56.78.
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But if you are healthy and want to prevent against an unexpected accident, these plans are great. Most of them will cover your hospital visit.
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Fortune Magazine has released it’s latest list of 100 fastest growing companies for 2018. Health Insurance Innovations has topped the list.
Not just out of health insurance companies, ALL companies.
Hiiquote has a unique model of Internet insurance sales, posted expectations-breaking earnings for its second quarter ended in June, up 16% year over year to $71.7 million. It wasn’t long before the company’s stock hit a 52-week high of $51.60. The Tampa company raised its 2018 guidance to revenues of $303 million—a figure that marks a 21% increase from the previous year. On tap? The next generation of the company’s cloud-based technology platform, according to CEO Gavin Southwell.
See the entire list of companies who made it to Fortune Magazines 100 fastest growing companies here
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