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Individual Rates Are Less Than Group

URDRWHO

Guru
100+ Post Club
347
In my State of PA I've noticed that individual rates are less than group rates for the same plan. Example - Insurance company offering shared cost PPO 2000 - cost in group is $675.63 but the same insurance company offering the flex PPO 2100 on the individual market is $296. Deductible / doc co-pay / MOP is virtually the same. Both plans have the mandated EHB's. What am I missing?

Is it the networks? Is there a loop hole in the individual market that allows this to happen? We are talking the Blues here and I would guess that the networks would be the same. Is the individual market getting government subsidies? The devil is in the details and I feel I am missing some details.

IMHO I think the individual market is buying the business and next year --- well it won't be pretty.

I have a group that is stopping their group plan and sending everyone into the individual market. Now in my State there are minimal insurance companies on the exchange. The un-subsidized individual rates on healthcare.gov are the same rates that I can sell. I'll loose the group plan but I am hoping to get the individuals to sign up with me. All the employees make too much money to receive any government subsidies.
 
You need to really do a side by side comparison. In Texas, the Blues PPO network is the same for group and indy. The HMO networks are very different. Also, on the indy copay plans, there are copays for everything. Its $250 copay, THEN ded/coins for every inpatient stay. Same for outpatient surgery. Its $500 ER then ded/coins. Which is not how the group plans work. The last thing you want are the calls that start with "you didn't tell me...."

Good luck!
 
Some of the pull is coming from employees that have visited healthcare.gov saw individual rates and started asking the employer, "why is my share of the premium so high.? The one employee was complaining to the owner about $5 more out of his paycheck a month. After the complaint the employee states that he is buying a brand new car. I bet those payments are more than $5 .

You need to really do a side by side comparison. In Texas, the Blues PPO network is the same for group and indy. The HMO networks are very different. Also, on the indy copay plans, there are copays for everything. Its $250 copay, THEN ded/coins for every inpatient stay. Same for outpatient surgery. Its $500 ER then ded/coins. Which is not how the group plans work. The last thing you want are the calls that start with "you didn't tell me...."

Good luck!
 
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