What makes an individual major medical carrier good or bad for brokers to work with?

[soardove]

Thanks @yorkriver1 . Agreed on the importance of reliable reinsurance here. We're competing more directly with the individual major medical carriers without medical underwriting (particularly BCBS and Oscar in Austin). All plans include unlimited primary care with no copays or coinsurance, as keeping more care in the primary care setting helps people stay healthier and drives plan costs down too.

 

[yorkriver1]

Thanks @yorkriver1 . Agreed on the importance of reliable reinsurance here. We're competing more directly with the individual major medical carriers without medical underwriting (particularly BCBS and Oscar in Austin). All plans include unlimited primary care with no copays or coinsurance, as keeping more care in the primary care setting helps people stay healthier and drives plan costs down too.

Some would be willing to give up ACA required plan benefits for lower pricing. I am always concerned about the client's understanding of coverage differences that are the reason for lower prices.

 

[soardove]

Right on. Our plans cover all essential health benefits, but I absolutely agree with what you're saying. A fair number of people we talk to don't know the difference between major medical, short term, and even ministries.

 

[somarco]

All plans include unlimited primary care with no copays or coinsurance, as keeping more care in the primary care setting helps people stay healthier and drives plan costs down too.

That has been the legend for some time but, unless things have changed, are not reflected in actuarial studies.

Again, Lee may have more current and accurate information.

When managed (mangled) care was a grass roots movement (late 70's) carriers offered heavy premium rate discounts for networks with steerage. Not unusual to see 15% discounts and more for implementing the full complement of managed care.

Follow up studies a few years later revealed no negligible savings.

Sure, you can find the guy who never smoked but a random test indicated he had lung cancer. But broad studies involving large numbers indicated a lot of folks won't go to the doctor even when it is "free".

Employer plans have lately had to offer cash incentives to participate in healthy living assessments, smoking cessation, alcohol counseling, etc.

Even then many just have no interest in lifestyle changes.

Not trying to be a Debbie Downer but a lot of $$$ has been tossed around running up to 2014 and later in an effort to build a better mousetrap. The ACO experiment pissed away millions of taxpayer $$$ to Obama cronies for start ups that mostly failed. Of the 30 or so ACO's I believe 3 are still in existence.

 

[soardove]

Super hard to change patient behavior. Some promising research is coming out of the direct primary care movement. That said, I suspect we're on the same side in wanting to see more affordable healthcare options for people that don't compromise on value. We'll see what happens! I wish you luck.

 

[somarco]

Behavior changes following crisis.

 

[DS4]

I yearn for the old days of a quality product, good provider network, good pricing, good agent commissions, and, agent incentive vacation trips. Is that too much to ask?

 

[rousemark]

Behavior changes following crisis.

Sometimes not even then... After my heart attacks and open heart surgery crisis, the change in behavior (my watching my diet) did not last very long..

 

[soardove]

I yearn for the old days of a quality product, good provider network, good pricing, good agent commissions, and, agent incentive vacation trips. Is that too much to ask?

This is useful. We're building out the network and our commissions (5% up front and ongoing) aren't STM level but are better than market in Texas. Did the agent incentive vacation trip make a real difference? If so we can consider.

 

[DS4]

Did the agent incentive vacation trip make a real difference? If so we can consider.

Nick, cash is king.