How safe are health insurance companies in Pennsylvania? Perhaps the most respected and authoritative resource is A.M. Best Company, which has been rating the financial safety and strength of insurers since 1899. Not only do they provide an unbiased snapshot and opinion of large and small carriers, but they also report the latest changes in financial status and alert consumers if a company may be under distress.
The security of your coverage and benefits are critical, especially when large claims may be paid, or funds in an HSA are invested. If a bill needs to be paid, or funds need to be released to pay for treatment, justifiably, you want the transaction to be taken care of quickly. And you don’t want your doctor, specialist or OBGYN reminding you that your insurer hasn’t paid their bills yet, or that a reimbursement check bounced.
How Companies Are Rated
The three major ratings are financial strength, debt and credit. All three could possibly impact the current and future rates that may be charged to individuals or businesses in the Keystone State. A++ and A are considered “superior” and A and A- are considered “excellent.” B++ and B+ are considered “good” while B and B- are considered “fair.” Additional classifications are “marginal,” “weak” and “poor.”
Typically, any rating below “B” may be a cause for concern. Although a rating this low does not mean the carrier is on the verge of bankruptcy, it should be treated with caution. And if it is during Open Enrollment, a change of companies should be discussed. Once Open Enrollment has ended, it is more difficult to change companies unless you have a “qualified lifetime event,” which creates an SEP (Special Enrollment Period). Several examples include pregnancy, divorce, move to a different service area, loss of job, and reaching age 26 while covered under a parent’s plan.
Impact On Medigap Coverage In Pennsylvania
These classifications are especially important when considering a Medigap plan in Pennsylvania. Seniors often utilize (and they should) this type of information when deciding which Supplement or Advantage plan to purchase. There are many national and local carriers to consider, so choosing the safest company is very important. Although a lower-rated carrier is not necessarily going to delay claims payments or charge a higher premium, it’s still best to eliminate any risk you can.
There are more than 50 Pa Medigap options offered, and the vast majority of carriers have very good (or excellent) ratings. We provide free safety information for most companies and alert customers if there has been a major degrading of ratings. Medicare Supplement plans are usually only purchased during an Open Enrollment period (unless you have a qualified exception, such as reaching age 65) so the time you have to research safety may be limited. The OE period is from October 15th to December 7th.
When comparing Exchange (Affordable Care Act) plans, along with the subsidy, it’s important to consider the safety of the carrier you are going to select. This can be very important since a few new companies will not be familiar to many applicants. How quickly money is dispersed to pay bills will be an important factor to the doctor-patient relationship. Of course, the larger carriers, such as Highmark, UPMC, Aetna, Independence Blue Cross and Keystone all have very respectable track records.
Because tax-free subsidies are involved in Marketplace policies, and the federal government is involved in most of the mandates and regulations, an added layer of safety was added. This layer protects consumers from purchasing policies from any carrier that has a checkered or questionable background. Each year, carriers are reviewed and any rate increases must be justified, and then subsequently approved. Generally, insurers submit their requests in the Spring, and by October, the Pa Department of Insurance determines how much of these increases will be approved.
Pa Department Of Insurance (DOI) Resources
The State DOI protects policyholders with the help of the NAIC (National Association of Insurance Commissioners). Specific standards must be met, record keeping is monitored, and regulatory oversight helps maintain the safety of carriers conducting business. Consumers have access to many valuable resources that provide current data and research information. Some of these resources include:
Surplus And Capital Requirements
Regulatory Examination Details
Company Consumer Complaint Information
Guidelines For Record Retention
Trust Your Personal Observations
Your own personal experience with a company should always be taken into consideration. For example, if claims are often mishandled with delayed payments, or surprisingly denied, it may be time to find a different health insurer. This would especially be true if there are no local primary-care physicians or specialists, and you are forced to utilize a provider outside of your area. Since there is an annual Open Enrollment, you can change companies every year regardless of any pre-existung conditions you may have.
Another area of concern should be when you have difficulty obtaining assistance or answers to simple questions. If it appears that information provided is either misleading or inaccurate, it’s time to take your business to another company. Are your phone calls and emails promptly returned? If not, this should be addressed and corrected. If problems persist, once again, it may be time to change companies.
NOTE: Typically, the most efficient (and accurate) information is provided by experienced brokers, and reputable websites. We have helped consumers for more than 36 years understand their coverage, and properly shop for the most cost-effective plan.
Listed below are the most recent A.M. Best Company ratings for major Pa health insurance companies: (“NR” denotes not rated)
Capital Blue Cross NR
First Priority NR
HMO Of Northeastern Pennsylvania NR
Independence Blue Cross NR
Inter County NR
Keystone Health Plan East NR
Keystone Health Plan West A-
Sterling Life B++
So what does this mean? Is Aetna safer than Highmark? Is UPMC better than Sterling Life? Not necessarily. There are many other factors to consider when comparing two (or more) companies. For example, there are other financial rating instruments such as Standard and Poors and Moodys. You can also check the Pa DOI to research the history of complaints and how effectively they are handled. And our website will provide current prices and any trends that may be worrisome.
Also, ask an experienced broker (like us) what we think about a particular company. There’s a very realistic chance that we have worked with each company multiple times, and can provide a balanced opinion and analysis that will help you choose the best options. It’s free advice that will save you hours of research. We document customer complaints, and retain data regarding how each carrier handles them.
A.M. Best Co. is simply one of many available tools that allow you to research and analyze an insurer. But perhaps a simpler and easier way is to utilize our website and all of the in-depth information that is available, including current free online quotes. We will always consider a company’s safety and security when discussing plan choices. But affordability and reliability are also important.