Aetna Launches New Health Insurance Website with Online Enrollment Capability for Individuals and Their Families
Aetna Press Release
September 20, 2005
“Aetna is making it as simple as possible for individuals to choose the appropriate, affordable plans that match their health care coverage needs,” said Laurie Brubaker, Aetna’s national general manager for Individual Markets. “The website guides individuals to consider their current life stages – for example, graduating from college, getting married, raising a family, becoming a sole proprietor, being between jobs or retiring early. We know that people’s priorities change and life circumstances determine the type of health care coverage individuals need.”
“We believe we can make an impact on reducing this nation’s population of uninsured – and under-insured – people,” Brubaker added. “We have researched consumers’ needs and created a range of health plans that provide choice, simplicity and affordability. Our cost-effective plans are designed to fit a variety of personal situations.”
In addition, Aetna offers individuals and their families high-deductible health plans that are compatible with the Aetna HealthFund(R) HSA (health savings account) in (eleven states and D.C.). These plans offer members similar benefits to the Aetna Advantage PPO plans… paired with an HSA.
http://www.aetna.com/news/2005/pr_20050920.htm
And…
Health Products for Individuals
Aetna
Life Stages in California (as an example)
New graduate
Getting married
Raising a family
Self employed
Between jobs
Empty nest
Retiring early
Frequently Asked Questions
The Aetna Advantage plans are voluntary plans that are medically underwritten; they are not conversion plans.
http://www.aetna.com/members/individuals/
Brochure for California Aetna Advantage Plan options:
http://www.aetna.com/members/individuals/health/data/
memberbrochure_California.pdf
Comment: The trends represented by the Aetna Advantage plans portend disaster for the future of health care coverage. This discussion barely touches on some of the alarming aspects of their program.
These plans are being marketed as a mechanism of selecting out only the coverage that you believe you will need, thereby avoiding contributing to risk pools that include coverage that you believe you won’t need.
Individuals will be enticed by the lower premiums of the limited coverage they select. Since no healthy person can predict future major health care needs, those individuals who select the limited plans will find themselves financially vulnerable with a significant change in their health status.
This unpredictability is precisely why everyone needs to have comprehensive coverage through a common risk pool.
Since these plans are “voluntary plans that are medically underwritten,” they will be sold exclusively to healthy individuals. People with preexisting disorders will have to find their coverage elsewhere. In the individual market, those plans would have to charge very high premiums because they concentrate risk. In actuality, those plans have been priced out of the market, leaving these vulnerable individuals without coverage.
The state-sponsored high-risk pools have not been able to make a dent in this problem. Only nefarious insurers/policymakers would target those with the greatest needs for exclusion from coverage.
These plans for various life stages “are not conversion plans.” Simply stated, as you move from a low-risk life stage, to one with greater risks, you must again pass underwriting standards to be covered by a plan that better meets your needs. What a clever idea. Aetna has figured out a way to drop coverage of many of those individuals who do develop chronic problems.
A problem for traditional plans is that, through the years, many of their clients develop chronic problems, and that results in higher, less-competitive premiums. This life stage concept circumvents that problem. Wall Street should really like this.
One of the most serious defects is that these are being marketed as plans that provide catastrophic coverage. If you look at the brochure describing plan options, you will see that they all offer an “out-of-pocket maximum,” ranging from $5000 to $25000. So if you chose the most comprehensive coverage, your maximum out-of-pocket expense, as an individual, would be $5000 plus the premiums paid for the year, or so they would have you believe. But what is the “out-of-pocket maximum”? It is merely the deductible plus the coinsurance paid to in-network providers. It does not include deductible and coinsurance penalties for using out-of-network providers. It does not include the balance of fees and charges required by non-contracted providers, which can be in the thousands or tens of thousands of dollars. It does not include charges for services not covered by your individual plan, often the very coverage you declined because you wouldn’t need it. You would think that there would be regulations prohibiting insurers from using the term, “out-of-pocket maximum,” unless a full, clearly stated disclosure of the true risks were simultaneously provided.
Aetna also reveals the fallacy of the HSA plans. The high-deductible health plan that covers everything after the deductible is met is a fiction. The Aetna HealthFund(R) HSA plans “offer members similar benefits to the Aetna Advantage PPO plans.” Clearly, the HSA plans work only if you don’t get sick.
Under-insurance has become epidemic in America. Insured individuals are financially vulnerable in the face of significant medical need. The Aetna Advantage program represents a perverse expansion of this epidemic of under-insurance.
Aetna’s press release on the Aetna Advantage program, states that “we can make an impact on reducing this nation’s population of… under-insured people.” They could, but apparently they have no intention of doing so.
