Many of us have received our pink slips from BlueCross notifying us that our individual/family medical coverage will not be renewed for January 1, 2018. Others of us have not yet been mailed notification from our health insurance carriers, but we know the handwriting is on the wall until the federal government takes action to stabilize the market.
With the ongoing uncertainty in the health insurance market no one expects any carriers to jump into the gaps being left by the exiting insurance companies. So where does that leave us as non-group health insurance consumers (who do not qualify for Medicare coverage) in the Georgia markets?
There are nine obvious options right now, some are better than others: First, if we have at least 2 people in our company a primary option will be to review a group insurance medical plan. There are certain circumstances where we can enroll as a 1-person group, but that 1 person cannot be the owner of the company. Fortunately, there is now one carrier who is willing to enroll husband/wife only groups as long as the company is either a C or an S-Corporation. The jury is still out on husband/wife companies who are other legal entities and we will update everyone as soon as we get final notification on this. If you believe this may be a possibility, contact our office at your earliest opportunity to begin the discussion.
As a second option, we can enroll in one of the Affordable Care Act (ACA) compliant Kaiser Permanente programs. We must access care through the facility system that exists across the greater Atlanta area, but with several hundred thousand BlueCross clients looking for coverage many worry how prepared Kaiser is to absorb so many extra patients and still maintain their current members’ care at a high level of quality. There has been discussion of Kaiser reactivating their “Community Providers” programs meaning that providers may be located outside of the main treatment facilities.
Our third option is to enroll in Ambetter, also known as Peach State, whose primary focus seems to be On-Exchange Marketplace policies. Recent warnings from federal sources state that the Marketplace website will be forcibly shut down periodically during the already shortened enrollment period of November 1 through December 15, supposedly for maintenance. Although the claim that regular monitoring and updating should help keep systems flowing smoothly like last year may be somewhat believable, the timing of those modifications could put a big crimp in our ability to get enrolled efficiently.
The fourth option we have been able to come up with is to move outside of the metro Atlanta area or purchase a second residence outside of the surrounding counties outside of city limits. BlueCross and Alliant will be providing coverage in counties that are not part of their definition of metro Atlanta. If we enroll with these providers, we will still be able to access doctors within their participating networks in the Metro Atlanta area. This may sound extreme, but we must consider all options.
Our fifth possibility, for those who own a business, is to enroll in a PEO that offers medical coverage (not all PEOs offer medical). We will be medically underwritten, so we will have to exhibit good health, but this is proving to be an opportunity for expanded health plan designs and competitive premiums. This proposal will require a thorough conversation to determine suitability.
For those who do not own a business a new executive order has sparked the creation of association based medical plans that revolve around a specific career such as being an attorney or nurse. These programs have historically not been stable over time, but may be a viable option with new plans being developed for next year with revived interest from those with limited coverage options.
A growing group of religion-based programs is offering a low cost alternative to medical insurance. Those who choose to enroll must share the faith, lifestyle, and health requirements of the group. Few are contracted with large provider networks and it is entirely up to the consumer to negotiate payment with providers or dispute claims. The claims processing/paying procedure is also different from what the majority of us are accustomed to, so please conduct some research before opting into one of these plans. There is no insurance or re-insurance built into these programs, so our office does not participate with this coverage options.
An eighth option is to enroll in a series of short-term policies. Although the previous administration reduced term limits for these plans in an attempt to stabilize the individual market, some insurance carriers have altered their contracts and now already have the ability to enroll clients for up to 12 months of coverage. Individuals may need to qualify through medical underwriting at the time of application and then the plan auto-renews every quarter. Not only do we have to pass through underwriting at the time of application, but we also must account for pre-existing conditions limitations, exclusions and the possibility of being declined outright. Although the premiums are dramatically less expensive than Affordable Care Act compliant policies, we will face a new deductible and out of pocket limit each 3-month period as these are not annual contracts.
The last opportunity is to cobble together a series of supplemental benefits indemnity policies. Taking a hospital/surgical policy and pairing it with an accident policy and critical illness contract may provide less expensive, although not as comprehensive, coverage as a short-term plan and undoubtedly less comprehensive than an Affordable Care Act contract. These additional products are intended to be used to supplement either a high deductible ACA plan or a short-term medical plan, but can be utilized as a minimum coverage/lowest premium option for those willing to take the risk of having no out-of-pocket-limits for their care.
In all, options are limited, and we will continue to try to find additional creative solutions to what looks like a very difficult benefit year. Do not forget that if we are not enrolled in Affordable Care Act compliant policies the law of the land is still the Affordable Care Act and the accompanying IRS penalties.
As in prior open enrollment periods, our office has been forced to bill for our services on an individual basis due to limited/no compensation from the carriers. For further explanation of our fee schedule, please visit our website: www.cdainc.net. Please let us know how we can help you navigate through these difficult decisions and to make the best selection for your situation.