Aetna perfects cream skimming for Medicare Advantage
Aetna Launches Employer Health Insurance Plans for Early Retirees
AISHealth.com
From Managed Care Week, Feb. 19, 2007
One objective of Aetna, Inc.’s launch of four new plans for early retirees targeting the 55-to-65 age group Feb. 8 is to create long-term relationships with pre-retirees that can continue as the members age in to Medicare.
Aetna’s new products will enable employers to reduce the benefits they pay for, while ensuring that retired employees have a level of coverage equal to, or slightly less than, what they had before.
The new plans will also enable Aetna to keep members after Medicare becomes their primary payer. Enrollees in an Aetna pre-65 product will be informed about 90 days before becoming eligible for Medicare that they need to convert to some form of post-65 coverage, and one option will be Aetna. Employers may assign beneficiaries to a post-65 Aetna plan, but they must give them notice, information about the plan and opportunity to opt out, (Aetna vice president Jay) Putterman says. The value of staying with Aetna is that “if we’re helping them pre-65 clinically, as they age, we think we’re in the most favorable position to continue to help them after 65.”
Aetna will guarantee issue of policies for people in the employer group, but employers’ rates will be subject to group underwriting.
http://www.aishealth.com/Bnow/022107a.html
Comment:
By Don McCanne, MD
Cream skimming? Well, let’s see.
Aetna has designed these plans to resemble their Medicare Advantage plans. By enrolling individuals in the decade before Medicare eligibility, presumably the patients will become comfortable with their Aetna physicians and want to continue with them under the Medicare Advantage version. Aetna makes the transition very easy by making enrollment essentially automatic unless the beneficiary specifically elects to opt out.
There is an element of cream skimming here since this over 55 group is still employed and comparatively healthy since those no longer employed because of their diasbilities have been removed from this risk pool. Targeting a healthier sector is cream skimming.
But this program is more nefarious than that. The over 55 population has a higher incidence of significant chronic disorders, though many may still be able to continue their employment. Aetna does not want those individuals to enroll in their Medicare Advantage program. So Aetna has established a separate risk pool for these employees over 55 that is subject to group underwriting. If they are healthy, great. But if that pool has an unacceptable level of chronic disorders, Aetna merely sets the premium at a level that is unaffordable so that the employer will decline this program. This is about as close as you can get to a program that is almost 100 percent effective in excluding those with health care needs from their Medicare Advantage plans.
Why do the policymakers continue to insist that the private insurers must be a part of our models of reform? How much more evidence do they need? Have the policymakers no decency?