What are they covering up?
All we get to know about Ambetter’s 2017 rate review filings is NOTHING!
It doesn’t much matter that CMS gave Ohio millions of dollars to set up
EFFECTIVE RATE REVIEW
THEY THINK OHIOANS DON’T COUNT
AND CAN’T READ!
Buckeye Ambetter is owned by Centene, one of the biggest managed care companies for Medicaid and Medicare. Centene has 5.1 million members. The CEO is one of the highest paid of all health insurance CEOs, reeling in 44 million dollars worth of compensation last year.
Ambetter is the benchmark SLCSP (second lowest cost silver plan) in Lucas County. Ambetter’s plan controls the amount of the tax credit that the 80-90% people receive on healthcare.gov.
In 2014, the Toledo area had only 61 Ambetter enrollees, which was 10% of the entire state membership of 616. In 2015, the first year as the SLCSP, it had 345 local enrollees in the SLCSP plan, called Ambetter Balance Care 1, and 600 local enrollees in Ambetter Balance Care 2, the first lowest cost silver plan. For 2016, it estimated 1,784 local members in total for all their plans, including the SLCSP in the Toledo area. I hope I got it right, because it’s difficult to decipher anything from their extremely redacted rate filings.
Ohioans have the highest average premium after tax credit than any other state on the Marketplace. (This, according to the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation, ASPE ISSUE BRIEF, HEALTH INSURANCE MARKETPLACE PREMIUMS AFTER SHOPPING, SWITCHING, AND PREMIUM TAX CREDITS, 2015–2016, April 12, 2016, page 9, Table 4, second column to the right, Average Monthly Premium after APTC [Advance Premium Tax Credits. ])
Amidst competing plans on the Marketplace that are going up double digits next year, Ambetter’s rates for 2017 are actually going down by an average of 1% in 2017. Is that because their provider network directory for their primary care physicians is 90% inaccurate, and people die first before they can find a doctor? Or do they just attract younger, healthier Toledoans — ones who never see a doctor? Or is it both?
Below is a chart representing the breadth of inaccuracies I discovered contained in Ambetter’s online provider directory from my survey, linked here: Ohio Citizen Rate Review Provider Network Survey, Summer, 2016. 90% inaccurate. Wow.
It makes you wonder, how can anything be so inaccurate! It makes you wonder if it could be an Orwellian scheme to keep the government subsidies down while controlling utilization! Whatever it is, Ambetter has been the second lowest cost silver plan (SLCSP) sold in Toledo for the past two years, and it has more weirdness to it than simply the weirdness of its grossly inaccurate provider network.
Complicated, complicated stuff.
Because Ambetter’s rates are going down next year, the tax credit for Toledoans will go down as well. That will make a much larger rate increase for the other plans Toledoans can buy, contrary to what the U.S. Health and Human Services department is telling reporters.
The Toledo Blade reported in August in a typical article that tows the line, Fewer choices, higher prices in Lucas County for Obamacare:
The federal officials stressed that the tax credits, which many consumers are eligible for, are designed to protect against rate increases. If rates go up, so do the tax credits.
Not so! Do the math! I wonder, does Ambetter by Centene get a government bonus for reducing their rates, thereby reducing the tax credit? Or are they just racking up brownie points for the inevitable end result? Not only does Ambetter’s rate reduction lower the tax credit, but something else is going on with Ambetter that makes the tax credit even smaller, that I describe below. Our tax credit this year is actually equal to the first lowest cost silver plan, not the second lowest cost silver plan! And why is that?
So so very complicated. I’ve been searching for an answer since November, 2013, and no one knows.
Ohioans have the highest average premium after tax credit than any other state on the Marketplace, and the SLCSP discrepancy must be one big piece of the puzzle as to why.
It’s just so complicated, that if you make it so very complicated, we won’t ever be able to understand! But please tell us anyway because it’s really very simple — Why aren’t Ohioans getting an honest second lowest cost silver plan tax credit that is equal to the second lowest cost silver plan that we can actually buy?
And back to that 90% inaccurate provider network.
This from the horse’s mouth:
"Our approach to developing and managing the provider network begins with a thorough analysis and evaluation of the state Department of Health and Human Services (HHS) network adequacy requirements for the managed care organization networks. We will develop and maintain a network of qualified providers in sufficient numbers and locations. Providers will be adequate and reasonable in number, in specialty type and in geographic distribution to meet the medical needs of members, both adults and children, without excessive travel requirements, and will be in compliance with HHS access and availability requirements."
Promises, promises, promises. All they sell are broken promises.