Report: Fewer get HMO from employers

Missourians’ enrollment in the health programs is continuing to decrease.
Friday, September 24, 2004 | 12:00 a.m. CDT; updated 4:19 a.m. CDT, Tuesday, July 1, 2008

JEFFERSON CITY — Missourians’ enrollment in employer-sponsored HMOs dropped more than 20 percent last year, continuing a five-year downward trend, according to a report released Thursday by the state Insurance Department.

At the same time, however, the percentage of Missourians who lacked insurance fell slightly. Eleven percent of Missourians were uninsured in 2003, compared to 15.6 percent nationally, and 11.6 percent in Missouri during 2002.

The department said its data shows that more employers are moving workers from HMOs into regular group health insurance or self-insured plans. Enrollment in regular group insurance plans increased last year by 17 percent to 1.1 million, the Insurance Department said.

“The type of coverage is changing with less protection available for Missourians who become ill,” state Insurance Director Scott Lakin said in a statement. “Employers are switching to plans that usually have lower company contributions, reduced benefits and higher out-of-pocket expenses for workers.”

Last year, 754,642 Missourians were enrolled in employer-sponsored health-maintenance organizations, down from 948,956 the previous year and nearly 1.3 million at the 1998 high point.

By law, HMOs are required to cover various services and cannot have deductibles although other plans don’t have such restrictions, the report said.

The report said the average monthly premium in health maintenance organizations was $208.83 last year, an increase of 3.2 percent. But the department said that for most people, the increase was 8.7 percent. Rates through United Healthcare of the Midwest fell 22 percent, affecting the overall average.

United had been the state’s largest HMO but dropped many customers last year, and Healthcare USA, which is Medicaid-only, became the state’s largest HMO, with 188,815 people. United ranked third, but had the highest Medicare enrollment in the state, the report said.

State and federal government-run health care plans — Medicare and Medicaid — also now make up a larger percentage of HMO enrollment in Missouri. They accounted for 42 percent of HMO enrollment last year, compared to 25 percent in 1999.

When government-offered HMOs are included with employer-offered plans, Missouri’s overall HMO enrollment fell 12 percent last year to 1.3 million, down from a peak of 1.6 million in 2000.

Although serving fewer people, health-maintenance organizations doubled their profits to $307 million in 2003, compared to about $150 million in 2002.

Calvin Call, executive director of the Missouri Insurance Coalition, did not immediately return a call seeking comment.

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