Healthcare costs have been rising dramatically in recent times, far outpacing the rate of inflation. Medical bills have recently become the biggest cause of bankruptcy in the United States, with a simple visit to the doctor's office setting us back over $200 and medical emergencies leaving us in severe debt. Nobody knows better than the insurance agent just how important health insurance is in the current financial climate.
The top individual health insurance companies are trying to strike the fine balance between cost and coverage, providing the most affordable plans with the most benefits. Here we focus on the four major players: Assurant, Aetna, UHC Golden Rule and Humana, considering their history, ratings, benfits and pitfalls. They are listed in alphabetical order:
Company Overview: Aetna
Aetna has long been one of the leading health insurance providers, having been in operation for over 160 years. Based in Connecticut, Aetna provides insurance for 13 million dental members, 15.8 million medical members and 10.6 million pharmacy members as of 2013. They are known for being the first company to provide consumer directed health plans and offering a diverse range of products. Aetna is an A.M. Best “A” (Excellent) rated company.
Company Overview: Assurant
Founded in 1969, Assurant branched out into the health industry in the early 1980's. It is based in New York, with offices in four states, as well as in several countries abroad. Assurant covers over a million citizens in the US and is represented by over 200,000 agents nationwide. They are known for pioneering the Health Savings Account in the late 20th century. Assurant is an A.M. Best “A” (Excellent) rated insurer.
Company Overview: UHC Golden Rule
Golden Rule Insurance Company has provided insurance policies for over 65 years and is notable for being instrumental in providing the first Health Savings Account (HSA) plans in recent years. Based in Indiana, the company was bought by UnitedHealthcare in 2003 who provide their policies but are noted for their high quality customer service and care. A.M. Best also offered them an “A” (Excellent) rating.
Company Overview: Humana
Everybody recognizes Humana as one of the leading providers of insurance in the United States. It was established in Kentucky in 1961 and went on to become the largest health benefit businesses with approximately 6.5 million members. Humana is predominantly centered around the eastern states with a predicted expansion to dominate the entire United States by 2020. They carry a comprehensive variety of plans and were awarded an “A-” (Excellent) rating by A.M. Best.
Different Rules, Different Rates
It is difficult to compare four major, influential individual health insurance carriers which essentially do the same job. As to who comes out on top will usually depend on the individual consumer and their own unique requirements and personal circumstances, particularly those involving health.
For instance, a lot of people like the fact that Aetna doesn't specifically factor tobacco into the equation when underwriting for individual health insurance. On the other hand, an applicant's body mass index (BMI) does factor heavily (no pun intended). Therefore an average-weight smoker would be wise to choose Aetna as their plan provider, yet an otherwise healthy non-smoker who is overweight could be looking at paying between 25% and 50% more on the same plan.
Why do we tend to favor the major providers? Agents and clients alike rely on the larger institutions for the same reasons. Experience, reputation, affordability (or saleability), financial strength ratings, size of provider network and service are all important considerations when choosing who we want to do business with, no matter whether we're buying or selling a policy.
As an example, large companies such as Humana and Aetna can negotiate lower rates on their health insurance plans as compared to smaller local companies who would find difficulty getting even close to providing the same rates.
Nearly every POS, HMO and PPO plan sees the insurance company in a contractual arrangement with clinics, physicians and hospitals in order to agree on the lower negotiated rates on medical services for members. Large companies have more 'clout' when negotiating cheaper rates due to the volume of membership which in the case of these four companies runs into the millions.
Often people who are on plans provided by major insurers such as UnitedHealthcare or Assurant can make savings of 50% or more on services such as prescriptions, medical procedures and visits to their doctor. These plans are far more attractive to consumers and as such, agents find them easier to sell.
As an independent agent, it is important that you understand the benefits of each of these major carriers in your business state. All four companies can benefit somebody, but no one company will benefit everybody and this is why it is important to have a comprehensive understanding of each provider's uses, drawbacks and costs.
We all scratch our heads from time to time over individual health insurance pricing. With most providers, similar plans shouldn't come with more than a 10% - 20% difference, however sometimes we will see a carrier that charges double the rate that everyone else does! Rate structures are complex and varying and it is down to us to decipher them and draw conclusions that will best benefit our clientele.
* The information provided is intended for licensed insurance agents only. It is not intended for the purpose of advertising the insurance products to the general public. Certain exclusions may apply. Plans offered by insurer. All products not available in all areas. Not affiliated with the United States Government or the Federal Medicare Program.