Demystifying Health Insurance: Coverage, Costs and Investment Opportunities
Health insurance is more expensive (and complicated) than ever! So, let’s explore the pros and cons of different types of health insurance, how to make sure you’re not caught off-guard by the Medicare “gap” and how to profitably invest in insurance companies.
I remember when most people didn’t give too much thought to health insurance. And if they did, it was in a positive light. For example, my first memory of health insurance was when my sister Pat had her tonsils removed when she was 15. Right after that, my parents bought her a stereo! Of course, I asked why she got a stereo and my brother and I didn’t get anything—it wasn’t even her birthday!
Well, dad explained, that both he and mom carried health insurance on us (fully employer-paid, can you imagine?) and that both insurance companies paid for my sister’s surgery. My parents got to keep the extra payment. So, since she had to endure the operation and recovery, my parents took some of the extra money and bought her a gift.
Many of you reading this probably think I’m making this story up, but it’s absolutely true! But, sad to say, maybe that’s one of the reasons that the health insurance industry became so confusing and expensive—that early neglect of watching costs.
In those days, insurance was simple. Your employer paid for it, and it covered most of your medical costs. Today, the health insurance industry is extremely complex and difficult for most people to navigate. The options are seemingly endless:
- Health Maintenance Organization (HMO)
- Preferred Provider Organization (PPO)
- Exclusive Provider Organization (EPO)
- Point-of-Service Plan (POS)
- Exclusive Provider Organization (EPO) plans
- Indemnity Plans
- High Deductible Health Plans (HDHP)
- Health Savings Accounts (HSAs)
- Health Reimbursement Arrangements (HRAs)
- Qualified Small Employer HRA (QSEHRA)
- Individual Coverage Health Reimbursement Arrangement (ICHRA)
- Affordable Care Act
- Self-Funded Insurance
- Supplemental Insurance
And I know there are a few more types of plans out there (and more every day!). And because the costs and service options are as varied as the different plans, it’s essential that you know just what you are getting for your money.
Today, the average individual pays about $495 per month for health insurance. But that varies from the least expensive plan which can be purchased in Maryland for $344 monthly, to the highest premium of $712 per month in West Virginia. Here in Tennessee, where I live, the average premium is $495.
You can see how your state stacks up, in terms of premiums, right here:
If you are a couple, you can expect to shell out around $984 for your monthly premium, and a family of five will pay around $1,782.
According to balancingeverything.com, that’s more than the average mortgage payment of $1,275!
Consequently, it’s more important than ever to be an informed consumer. So, let’s get right to that and talk about the various policies available so that you can decide which is the best route for you and your family.
Health Maintenance Organizations (HMOs)
HMOs caught on in the early 1970s due to rising health costs. They hit their stride in the 1980s, growing to 480 HMOs and 21 million insured by 1986.
But HMOs were actually born as far back as 1910, when the Western Clinic in Tacoma, Washington, offered lumber mill owners and their employees a selection of medical services from its group of providers. Wait for it—the premium was $0.50 per member per month!
HMOs haven’t really changed all that much since then. An employee or member enrolls in an HMO that has secured a network of healthcare providers—doctors, hospitals, etc.—and pays a monthly fee, part of which goes to the healthcare provider. That provider fee is pre-set, which is supposed to keep healthcare costs down and generally keeps them less expensive than other plans like PPOs.
In an HMO, the insured selects a primary care provider, who then refers the patient to specialists, when needed. The insured cannot just make an appointment with a specialist.
Advantages of HMO plans:
- Lower monthly premiums (than PPOs).
- Lower out-of-pocket costs (than PPOs).
- Rarely have to file claims, since most of your providers will be in-network.
- A primary care physician will manage your care.
- They generally provide broader coverage for preventative care than other policies.
Disadvantages of HMO plans:
- There are typically fewer physicians participating in HMOs than in PPOs, so your favorite doctor may not be approved.
- Your primary doctor must refer you to a specialist.
- Unless you have an emergency, you are required to stay within the network, or you may have to pay 100% of the bill.
- You may have a deductible and most likely will have a co-pay when you see your primary or specialist doctor.
Preferred Provider Organizations (PPOs)
Like HMOs, PPOs also have a provider network, but you don’t have to select a primary care provider. You can see any in-network doctor, and you don’t need a referral for a specialist.
And the doctors in the network receive an “agreed upon” rate, not a flat fee.
Advantages of PPO plans:
- They usually have a wider selection of doctors, so your favorites might make the list.
- There’s more flexibility in using providers, both in-network and out-of-network.
- There may be some coverage for out-of-network providers.
- You don’t need a referral to see a specialist.
Disadvantages of PPO plans:
- The monthly premium is usually higher than HMOs.
- Out-of-pocket costs may also be higher.
- You won’t have a primary who will be responsible for managing your care among several doctors. Instead, you will be in charge.
- You may also have a deductible.
- If you see an out-of-network provider, you’ll have to pay up front and then file a claim with the insurance company for reimbursement.
Point of Service (POS) Plans
A Point of Service (POS) Plan refers to where and from what provider you receive services. The plans are sort of a combination of HMOs and PPOs. They offer both lower costs and fewer provider choices. And both in-network and out-of-network options are available. Lastly, you are also required to choose a primary care provider.
With a POS plan, your coverage varies depending on whether you see a provider who’s in- or out-of-network and if you’ve received a referral, if required by your plan.
Advantages of a POS plan:
- Costs are lower when you use in-network providers.
- You can use out-of-network providers.
- In-network requires no filing of claims.
Disadvantages of a POS plan:
- You may need a referral from your primary care provider to see a specialist.
- Out-of-network providers will require an out-of-pocket payment and you may have to file your own paperwork.
Exclusive Provider Organization (EPO) Plans
An exclusive provider organization, or EPO, is a health insurance plan that provides coverage only from doctors, hospitals, and other care providers who are within your network. So, if you see a care provider outside of your network, you are on the hook for the full cost. The only exception is emergency care, and you will still need a pre-approval if you use an out-of-network hospital. Also, any out-of-pocket spending for an emergency may not count toward your deductible.
As a result of the Affordable Care Act, insurance companies cannot charge more for out-of-network emergency care. However, they will only cover costs if you meet their definition of an “emergency.” So, you need pre-approval.
You will probably need to select a primary care provider, but you don’t need a referral from him or her to see a specialist. And you will have a deductible before your insurance coverage kicks in.
If you travel a lot, an EPO may not be the plan for you, as you may become ill in an area whose providers are not covered by your EPO. But if you need mostly routine care that can be offered within your EPO network, you might save a few dollars using an EPO.
Hopefully, the following chart will help you differentiate between the four major types of healthcare plans.
An alternative to a managed care plan is indemnity health insurance, also known as fee-for-service plans. With indemnity plans, you can choose your provider and health facility (anywhere you live or travel to) and you don’t need any referrals. The plan then pays a predetermined percentage of the “usual, reasonable and customary” charges for the services—generally around 80%. You would then be responsible for the remaining 20%. And if the charges are more than the usual, reasonable, and customary amounts, you will have to pay the difference. Also, preventative care such as mammograms, annual physical exams, and immunizations will probably not be covered. And an indemnity plan may not cover preexisting conditions, and you may have to undergo a physical exam in order to qualify for coverage.
A deductible is also required before the insurance begins its coverage.
Indemnity plans are typically classified as either traditional or fixed. Traditional plans cover hospital and surgery, or major medical, or a combination of both. These plans generally are more expensive than an HMO or PPO.
Fixed indemnity plans are supplements to major medical insurance plans and help to cover out-of-pocket costs not covered by primary insurance. Fixed indemnity plans also feature several additional levels of coverage encompassing accident fixed indemnity, critical illness coverage and hospital sickness coverage.
You must first file a claim, and then benefits are paid to you after each covered expense has been submitted to your primary insurer and paid. You pay no deductible and can choose your own providers.
Health Savings Accounts (HSAs)
An HSA is a tax-advantaged account that you can use to pay for qualified medical expenses that your insurance plans don’t cover. It also allows you to save for expected medical expenses on a pre-tax basis. You put the money into an HSA, pre-tax, and the balance grows tax-free. You can use the funds to pay for qualified medical expenses, including your copays, coinsurance, and deductible.
You can accumulate the funds in your HSA as cash savings or you may invest all or some of them, depending on your plan rules. You can continue contributing until you are 65 and eligible for Medicare. The funds can remain in your HSA for the rest of your life, even if you change jobs, switch plans, or retire.
In addition to your contributions, your employer—if it wants to—can also contribute funds to your account. Contributions are subject to annual limits set by the IRS. For 2022, those limits are $3,650 for an individual and $7,300 for families. And like IRAs, HSAs allow catch-up contributions of $1,000 (for 2022), if you are 55 or older.
It’s important to note that you may withdraw money from your HSA for items other than qualified medical expenses, but those funds will be subject to income tax and, if you are not yet 65 years old, you’ll pay an additional 20% penalty tax on the amount withdrawn.
Advantages of HSAs:
|You can contribute to the account pre-tax, up to the annual limit; the interest or other earnings in the account are tax deferred; and the withdrawals are tax free, if you use them to pay for qualified medical expenses.
Because the funds in your HSA belong to you and your balance rolls over at the end of every year, you can save money for qualified medical expenses over a long period of time.
At age 65, you can use the HSA funds for qualified medical and nonqualified expenses (including nonmedical expenses). If you spend HSA funds on nonqualified expenses, you’ll be taxed, but you won’t have to pay the 20% penalty that’s incurred on nonqualified expenses before age 65.
|Contributions remain in your account until you use them. Your employer may also contribute to your account as an added and valuable benefit.
|Accessible and portable
|You can access the funds in an HSA using a debit card or checks. Funds roll over from year to year and are yours to keep, even if you switch jobs or retire.
Disadvantages of HSAs:
|Even with the benefit of saving in an HSA, it may be difficult to meet the high deductible required in an HDHP, especially if you have high medical expenses.
|Unplanned expenses and penalties
|Nonmedical emergencies come up from time to time. If you withdraw funds from your HSA for nonqualified expenses before you turn 65, you’ll owe taxes on the money you take out, plus a 20% penalty.
|HSA providers often charge monthly maintenance and/or per-transaction fees.
Who Is Eligible for an HSA?
You are eligible for an HSA if you are:
- Enrolled in a High Deductible Health Plan (HDHP) and not covered by another health plan (including a spouse’s health plan, but not including specific injury insurance and accident, disability, dental care, vision care, or long-term care coverage).
- Not enrolled in Medicare.
- Not in receipt of VA or Indian Health Service (IHS) medical benefits within the last three months.
- Not covered by your own or your spouse’s flexible spending account (FSA), and are not claimed as a dependent on someone else’s tax return.
High Deductible Health Plans (HDHP) combine a lower premium with a higher deductible, with a set maximum out-of-pocket medical expense. You can enroll in these individually or with your employer, if your company offers it.
This is more of a catastrophic health insurance plan. With a HDHP, once your annual out-of-pocket expenses—deductibles, copayments, prescriptions, and coinsurance—for covered services from in-network providers reaches the pre-determined catastrophic limit, the plan pays 100% of the allowable amount for the remainder of the calendar year.
The plan can also be combined with a Health Savings Account (HSA) to pay for preventive care (through the HDHP) and can be reimbursed for non-preventive care through your HSA.
An HDPD may also be combined with a Health Reimbursement Arrangement (HRA). An HRA is an employer-funded, tax-sheltered account to reimburse allowable medical expenses, such as certain medical, prescription, dental or vision costs. Your employer—not you—determines how much to contribute to the account and which expenses will qualify for reimbursement. Usually, the reimbursement funds you receive from your HRA are not taxed. The funds may roll over, year to year, but that is up to your employer. And similar to an HSA, your HDPD will pay for preventive care, and you can then be reimbursed for non-preventive care through your HRA.
There are a few differences between an HRA and an HSA, including:
- An HRA does not earn interest.
- An HRA is not portable. If you switch health plans or employers, the balance in your HRA is forfeited. Whereas you can move your HSA around if you change employers or retire.
- You cannot make additional contributions to an HRA.
Qualified Small Employer HRA (QSEHRA)
A Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) allows small employers with less than 50 employees and no health insurance plan to designate a fixed amount of money each month that employees can use to purchase individual health insurance or use on medical expenses, tax-free.
With health costs rising significantly, the number of small employers providing health insurance to their workers have generally been on a decline for the past 20 or so years.
The following are the maximum contributions allowed for QSERA’s:
The way it works is that the employer sets the amount of reimbursement allowances; the employees pay their own health insurance and medical bills; they send the claim to the employer; and then the employer reimburses the employee, tax-free, up to the set limit.
If the employee doesn’t use all of the allowable reimbursement, too bad—the employer gets to keep the money!
Individual Coverage HRA (ICHRA)
Similar to the QSEHRA, but all businesses—regardless of size—can create an ICHRA. And the ICHRA has no allowance caps. Additionally, the ICHRA allows employers to set up different guidelines for employee classes in order to customize health benefits.
To participate in an ICHRA, you must be covered by an individual health insurance policy before you can collect reimbursements.
The Affordable Care Act (ACA)
This act was passed by the legislature in March of 2010 to provide individuals and families greater access to affordable health insurance options including medical, dental, vision, and other types of health insurance that may not otherwise be available. The law is targeted toward households with incomes between 100% and 400% of the federal poverty level (FPL). And it also expands the Medicaid program to cover all adults with income below 138% of the FPL.
It works by providing consumers with subsidies (“premium tax credits”) that lower the costs of insurance
The ACA provides:
- The purchase of health care coverage through a state or federal marketplace that offers a choice of plans.
- Insurers can’t refuse coverage based on gender or a pre-existing condition.
- There are no lifetime or annual limits on coverage.
- Young adults can stay on their family’s insurance plan until age 26.
- Seniors who hit the Medicare Prescription Drug Plan coverage gap or “donut hole” can get a discount on medications.
For additional information regarding the ACA, please visit https://www.hhs.gov/healthcare/about-the-aca/index.html.
The insurance that we are most familiar with is fully funded, with a premium paid by individuals or a combination of individuals and employers. The insurance company then bears the risk of claims.
Self-funded plans are “pay-as-you-go” plans. With self-funded plans, the organization (an employer or trade association or even a Christian organization) assumes full liability for financial risk.
There are both advantages and disadvantages to self-funded health plans:
Advantages of a Self-Funded Health Plan:
- Flexibility in customizing the plan to the goals and the member population.
- The organization has greater control of all plan vendors.
- If all the reserved funds are not used for claims, the organization keeps them.
- Self-funding a health plan is often less costly as there are no profit or risk margins to pay to an insurer, there are no state-levied premium taxes, the plan does not need to satisfy certain ACA mandates and is not subject to state insurance laws and mandates and it is easier to access data on health care usage to identify trends and opportunities for cost savings.
Disadvantages of a Self-Funded Health Plan:
- Risk of high losses due to extraordinary claims.
- Unpredictable claim flows.
- If the managers are not conversant with insurance regulations, the organization can be subject to penalties and lawsuits.
- Greater risk of in-house fraud or abuse.
- Member demographics could expose the organization to higher claims.
The rising costs of insurance have created a growing marketplace for self-funded health insurance. According to the 2020 Employee Benefits Survey, 62% of corporations, 72% of public employers and 85% of multiemployer plans now have self-funded plans.
Many of the plans incorporate nationwide PPO networks and provide state-of-the-art billing systems. They may also offer no annual caps, no lifetime limits, no re-qualification for membership, and 100% of bill amounts are eligible for sharing (Maternity & Co-Share exception).
If you are a member of a large organization, there may be a self-funded insurance plan available for you to join. Heck, your current employer’s insurance plan may even be self-funded! Ask them and see.
The Christian plans, such as Medi-Share, have really caught on. Medi-Share has been operating for 25 years and claims 98% customer satisfaction due to aligned values. Its tagline says, “Our members share medical expenses that support and honor biblical values.”
The costs of a self-funded health insurance plan will vary with the requirements of the employer or organization behind the plan.
For example, with Medi-share, there’s a $50 application fee, a one-time $120 membership fee, and an Annual Household Portion (AHP) that ranges between $1,000 and $10,500, depending on your household. This is the annual amount a household will contribute to its medical bills before participating in bill-sharing with other members.
The plan says that “if you visit a Medi-Share covered provider, it would cost about $35 for doctor visits and hospitalizations and $200 for emergency room visits. Telemedicine visits do not cost anything. The rest of the bills would be submitted to the Private Health Care System (PHCS) for additional payment consideration.”
Continuation of Health Coverage (COBRA)
If you leave your job (and your insurance coverage), the Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to remain in your employee’s group health insurance plan for a limited time after a change in eligibility.
In order to become eligible for COBRA, your group health plan must be covered by COBRA, a qualifying event must occur (voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, or divorce), and you must be a qualified beneficiary for that event.
You have 60 days following the qualifying event to decide if you want to continue your insurance coverage through COBRA, and the plan covers you up to 18 months after the event that made you eligible for COBRA.
Once you turn 65 years of age, you become eligible for Medicare, the government’s health insurance program for seniors. At last—something useful for our golden years.
Medicare comes in two parts:
Part A covers inpatient hospital stays (up to 60 days, then insured folks are responsible for a “coinsurance” payment, as outlined below:
|Part A Deductible and Coinsurance Amounts for Calendar Years 2021 and 2022
by Type of Cost Sharing
|Inpatient hospital deductible
|Daily coinsurance for 61st-90th Day
|Daily coinsurance for lifetime reserve days
|Skilled Nursing Facility coinsurance
Part B covers outpatient or medical care.
Together, they cover about 80% of the typical healthcare costs for seniors, leaving a “gap” of 20% to be borne by the insured.
Consequently, the insurance marketplace has come up with a couple of options to reduce your out-of-pocket costs.
The first is a Medicare Supplement Plan, also called “Medigap.” These plans are designed to help you pay some of the healthcare costs like coinsurance, copayments, deductibles, dental and vision care, and prescriptions that are unpaid by Medicare Parts A and B. There are many of these supplement plans (A through N) available, as you can see below.
According to retireguide.com, the average cost of a Medicare Supplement plan is $150 per month.
Medicare Supplement (Medigap) plans are offered through private insurance companies and must include the same coverage regardless of carrier. Medicare Supplement plans pay the 20% (gap) that Medicare doesn’t cover. With a supplemental plan, you will always know your out-of-pocket limits and you can go to any doctor or hospital that accepts Medicare across all U.S. states and territories.
The other option is a Medicare Advantage Plan. Sometimes called “Part C,” these plans are also offered by private insurers, subject to rules set by Medicare. Most include Part A, Part B, and drug coverage (Part D). They require that you use providers within your network (most also offer the ability to use out-of-network providers, at a higher cost), and set a limit on out-of-pocket expenses (except prescriptions). Many also include vision and dental plans.
Advantage plans also offer low premiums
To help you make a decision, here’s a comparison table of Medicare Supplements and Medicare Advantage Plans:
|Medicare Advantage Plans
|Medicare Supplement Plans
|The plans are ideal for those who want a low monthly premium and do not mind paying more out-of-pocket when they visit doctors and hospitals.
|These plans are ideal for those who want low out-of-pocket costs, coverage to travel with them, predictable costs, and the freedom to choose their own doctors.
It really comes down to which plan works best for you. I have a friend with a Supplement and one with Medicare Advantage. Both had to have dental crowns last year. My Supplement friend paid $3,000 out-of-pocket, but my Advantage friend paid zero for hers!
Long-Term Care Insurance
Like life insurance, or pre-planned funerals, no one really enjoys talking about long-term care. But as a people, we are living longer, and many of us will run out of money before we run out of time.
In the U.S., men average a lifespan of 76.1 years, and women, 81.1 years. And with age, come challenges. But age isn’t the only factor. The biggest risks for entering long-term care are:
Gender. Since women generally live longer than men, we are at higher risk of needing aging care.
Marital status. Single people are more likely than married people to need care from a paid provider.
Lifestyle. Poor diet and exercise habits can increase the likelihood for needing long-term care.
Health and family history. Both can increase the risk of needing help as we age.
And the cost of long-term care is pretty steep, as you can see below:
Monthly National Median Long-Term Care Costs (2021)
|Community & Assisted Living
|Home Health Services
|Adult Day Health Care
|Assisted Living Facility
And those costs are growing faster than inflation, says Genworth. The company reports that the average cost of home-care services rose $980 annually from 2004-2020, while the cost of a private room in a nursing home jumped by $2,542 each year during the same period.
Consequently, purchasing long-term care insurance may be a smart idea. It covers aging costs that private insurers and Medicare don’t. But like with life insurance, the younger you are, the less your monthly premiums will be. The American Association for Long-Term Care Insurance estimates that the premium for a 55-year-old man can average $2,220 per year. For a 55-year-old female, the premium rises to $3,700.
The coverage amounts to $165,000 in benefits at the time the policy is issued, and increases to $400,500 at age 85, assuming a 3% annual increase.
According to the Urban Institute and the U.S. Department of Health and Human Services, “the average 65-year-old today has a 70% chance of needing some kind of long-term care eventually, Of those who need it, most would use it for about two years, but around 20% would require it for more than five years.”
Lastly, there are lots of other insurance plans—supplemental health insurance—that offer coverage beyond your normal policies.
There are many different types of supplemental health insurance plans, including vision, dental, hospital, accident, disability, as well as insurance for specific conditions such as cancer, stroke, or kidney failure. And still other types of supplemental health insurance may also be used to help pay for food, medicine, lost wages, transportation, lodging, childcare, and other expenses related to an illness or injury.
In her later years, my mother had an AARP Hospital Plan that paid her a certain amount of money for every day she was in the hospital. I can’t remember exactly how much it was, but I think it was more than $50/day but less than $100.
There are scores of supplemental insurance companies. If you are an AARP member, you will have heard of their policies. And you can’t miss the commercials for AFLAC, which offers accident, cancer, critical illness, dental, hospital, life, short-term disability, and vision supplemental insurance.
As you can see, you have many choices for health insurance. Of course, if you are employed, your options will be somewhat limited. But I think it’s good to know what’s available. After all, as you change employers, become self-employed, and/or retire, you will undoubtedly also have an opportunity to select new insurance options.
My Favorite Health Insurance Stocks
Now as much as I like giving you ideas on how to save money by choosing the right health insurance plan for you and your family, I love offering you recommendations for making money by buying shares of well-run companies with excellent growth prospects even more.
Finding health insurance stocks is a little more challenging than it was last month when I delved into the life insurance industry.
There are more than 1,000 health insurance companies in the U.S., but most are private. Here are the top 25, by market share:
Top 25 U.S. Health Insurance Companies Listed in Order of Market Share (publicly traded companies include the stock symbol)
United Health (UNH)
Centene Corporation (CNC)
Health Care Service Corporation (HCSC)
Molina Healthcare (MOH)
Independence Health Group
Guidewell Mutual Holding
California Physicians Service
Blue Cross Blue Shield of Michigan
Blue Cross of California
Blue Cross Blue Shield of New Jersey
UPMC Health System
Health Net of California
Blue Cross Blue Shield of North Carolina
Local Initiative Health Authority
Blue Cross Blue Shield of Massachusetts
Blue Cross Blue Shield of Tennessee
Source: National Association of Insurance Commissioners (NAIC)
I took a look at each of the publicly traded stocks, put them through my testing parameters, and eventually found three that look interesting.
Evaluating health insurance companies requires a few more ratios than a typical stock. Sure, you want to make sure they are growing—both on the top and bottom lines. But with insurance companies, you also have to look at criteria such as revenue mix, dependence on Medicare and Medicaid, the medical loss ratio (the lower, the better), as well as diversification into businesses that may be related but do not write health insurance. Also, it’s important to figure out how regulatory changes—such as a reduction in Medicare benefits or reimbursements—may affect the health insurance companies.
And could anyone have imagined how the COVID pandemic would ultimately put untold pressure on insurers? It’s true that much of the pandemic expenses will be borne by the federal government (that’s us!), but insurance companies are not going to get off scot-free; you know the government never pays full cost for anything!
But with the current administration looking at expanding healthcare and instituting reforms, this may be a good time to be a health insurance company.
With all that in mind, I winnowed down the list and here are the three companies that I like best:
|United Health Group (UNH)
|Cigna Corporation (CI)
|Centene Corporation (CNC)
Let’s take them one by one:
United Health Group (UNH), headquartered in Minnesota, operates through four segments: UnitedHealthcare, Optum Health, Optum Insight, and Optum Rx, offering a variety of consumer-oriented health benefit plans and services, including insurance plans, well-being services, Medicaid plans, health and dental plans and children’s health care programs. The company also provides software and information products, advisory consulting arrangements and managed services outsourcing contracts to hospital systems, physicians, health plans, governments, life sciences companies, and other organizations, as well as pharmacy care services and programs, including retail network contracting, home delivery, specialty and compounding pharmacy, and purchasing and clinical capabilities. Additionally, UNH develops programs in the areas of step therapy, formulary management, drug adherence, and disease/drug therapy management.
Recently 13 Wall Street analysts boosted the earnings estimates for UNH, and the company beat its last quarter’s EPS estimate, posting earnings of $5.57 per share, compared to the $5.20 forecast.
Cigna Corporation (CI) is headquartered in Connecticut and provides coordinated and point solution health services, including pharmacy, benefits management, care delivery and management and intelligence solutions to health plans, employers, government organizations, and healthcare providers. The company also offers medical, pharmacy, behavioral health, dental, vision, health advocacy programs, and other products and services for insured and self-insured customers; Medicare Advantage, Medicare Supplement, and Medicare Part D plans for seniors, as well as individual health insurance plans, both on and off the public exchanges; and health care coverage in its international markets, as well as health care benefits for mobile individuals and employees of multinational organizations.
Cigna reported EPS of $6.22 in its most recent quarter, handily beating the analysts’ estimates of $5.48. Going forward, 20 analysts have recently increased their earnings forecasts for the company.
Centene Corporation (CNC) is headquartered in Missouri. It is a multinational healthcare enterprise that offers managed care health plan coverage to individuals through government subsidized programs, including Medicaid, the State children’s health insurance program, long-term services and support, foster care, and Medicare/Medicaid plans. Its health plans include primary and specialty physician care, inpatient and outpatient hospital care, emergency and urgent care, prenatal care, laboratory and X-ray, home-based primary care, transportation assistance, vision care, dental care, telehealth, immunization, specialty pharmacy, therapy, social work, nurse advisory and care coordination services, as well as prescriptions and limited over-the-counter drugs, medical equipment and behavioral health and abuse services. The company also provides pharmacy benefits management services; nurse advice line and after-hours support services; vision and dental services, as well as staffing services to correctional systems and other government agencies; and services to Military Health System eligible beneficiaries.
Wall Street is also increasing earnings forecasts for Centene, with 19 analysts upping their estimates in the past month. And Centene also beat quarterly estimates, bringing home EPS of
$1.77, topping the $1.59 analysts had expected.
The shares of all three of these companies have done quite well recently, after suffering along with the rest of the market during the early-2022 market downturn and the beginning-of-summer doldrums. Time will tell if they continue to excel, but both the fundamentals and technical indicators look promising at this time. Perhaps it’s a good opportunity to make insurance pay for itself, hmm?