Thursday, April 28, 2016

For UHC, what's the matter with Iowa?

This week, health insurance Centene announced that it is meeting its profit targets in the ACA marketplace. That's in marked contrast to United Healthcare, which expects to have lost a billion dollars in the marketplace by year's end -- and is withdrawing most of its offerings there in 2017.

I've previously noted that Centene is primarily a managed Medicaid company and has acted like one in the marketplace, fielding plans with low premiums, high deductibles and narrow networks. UHC, the nation's largest provider of employer-sponsored plans, put up more robust networks at higher prices in large markets.

While the contrast seems clean, there's more to the story. UHC is also a major managed Medicaid provider, and in many smaller markets its plans are price competitive.  That's the case in most of Iowa, from whence it is nonetheless withdrawing. In a post on, I examine why that might be -- and wonder why, more broadly, UHC is withdrawing most of its marketplace offerings, instead of replicating the low-cost narrow network model.

1 comment:

  1. Your "blogroll" is really an invaluable service. You deserve a lot of credit for aggregating all those sources and grabbing their latest offerings.
    Your article on UHC and Iowa had good data, however I think it spent too much time on pricing, at least for me.
    What interests me is why UHC lost so much money on the exchanges, apparently over $1,000 a person per year.
    I realize that claims data is proprietary, so I sure do not have the answer,
    Did United get stuck with more premature babies, hep C cases, transplants, et al.??
    Or did United just attract less healthy people because it was almost always a PPO and not an HMO?
    United is considered a slow payer and even a deceitful payer by many providers, so I think we can say that generosity did not cause their losses.

    I help people choose insurance plans, and when I see Ambetter as the low price entity, I tell people that it is a very narrow HMO. Healthy people say "fine with me," but older people want to explore further.
    Let me know your views on this.