Individual Health Insurance Update: 2017

Many people have been disappointed and angry about the direction individual health insurance coverage has gone.  Promises of being able to keep what we had if we liked our plans and indications that premiums would go down have not been kept. Rather, plans have become more restrictive in networks and approved drug lists.  Rates have risen so high that any plans we can afford in no way resemble the plans we had before the Affordable Care Act changes were implemented.

So how did we get here and how is CDA, Inc. planning to cope with current circumstances?

The health insurance industry was struggling to control rate increases before the Affordable Care Act which then burdened our industry with additional mandatory benefits and restrictions.  Additionally many individuals “gamed” the system by enrolling in coverage only when services were needed after open enrollment.  Carriers have had to file rates in the spring of each year before any claims history was available for the prior year.  Rate filings became best guesses and most carriers anticipated their expenses and claims payouts far too conservatively.  Obviously, those who guessed the lowest took the biggest hits with the largest market share of a non-profitable and sickly book of business.

Each year carriers have reviewed their experience and made decisions about how to manage costs while still remaining in the market.  For 2017 Georgia is about to experience what has already happened in many other states: a significant reduction in the number of carriers who have insured us in the past and a diminishing number of plans that we as consumers consider palatable.  Nothing has been made public yet as carriers have historically waited until the last minute before the Open Enrollment begins on November 1 to produce plan outlines and rates.  We have attended agent-only events hosted by several insurance carriers over the past couple of months, so we do have a pretty good hint of what to expect for 2017.

Our conclusion is that shopping this year will be even more critical than in prior years as our discussions of premiums vs. benefits will become ever more important.  We have written several posts (article one, article two, article three) about how to select a style of plan (high deductible vs. copay, etc.) and we encourage you to review these previously released notices before November 1.

Our agency faces the daunting task of moving over 600 contracts from carriers who will not provide the plans in which our clients have been enrolled.   And this needs to be accomplished between November 1 and December 15 for a January 1 effective date.  Worse yet, carriers are paying little to no commissions which restricts the time we can allot to helping our clients. 

  1. You will receive an email notification providing a suggested plan option for 2017 based on your current coverage through our office.  We will suggest a new policy for next year that is most similar to your current policy based on the plan structure and benefit model.  Please check your email regularly for anything that could possibly come from our office.  Included in the email will be a link to review and enroll in the plan suggested or evaluate other policies from that carrier.  We will remain your enrolling broker, but since we are no longer being compensated for servicing accounts we will bill a servicing fee of $150 per hour (broken into 15 minute segments) when additional assistance is requested.  Many of our clients may not need much assistance or advocacy through the course of the year so we wanted to accommodate these policyholders with a low cost option.
  2. For those who would prefer the full consultation that we have provided in prior years, we are offering an all-inclusive service package which will consist of plan comparison, research regarding your providers and prescriptions, enrollment and ongoing advocacy for the year as you are accustomed to.  The fee will be $400 per policy for the year and is only for Off-Exchange programs.
  3. Those who need help for on-exchange services, please contact us early so that we can determine how best to help you.

Please look for electronic communication from us and head to our website to keep up with all that is going on.  If you know that you would like to go the route of the annual service, please contact us at your earliest opportunity so that we can send out the form to update your information.

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