Most of us have health insurance through one of three major channels: employer based coverage, Medicare or individually contracted coverage. Today we will focus on the last group: those who must seek out and enroll in coverage directly with an insurance carrier.
Since the onset of the Affordable Care Act there have been significant changes in benefits and premiums which have impacted on the willingness of carriers to offer rich networks and comprehensive drug lists. The latest impact is that many carriers are limiting their participation into market areas where there is an opportunity for profit.
For 2017 those insured in the Metro Atlanta market will see a significant change in options. Carriers are not required to publicize their intentions, but this is what we have heard so far and what we suspect:
- United Healthcare will not provide individual coverage in the state of Georgia either on or off-exchange.
- Aetna / Coventry will provide one policy only and those who are already enrolled in either product line will not be transitioned into the new policy. It will be the responsibility of insureds to find rates, plan designs and paper applications.
- Humana will no longer offer its National Point of Service plan in the state of Georgia. It will also no longer offer any plans off exchange rather offering only the HMO X network for Marketplace insureds.
- Kaiser Permanente and BlueCross have filed rates for 2017, but no rumors have yet emerged about plan designs or networks (although the Kaiser HMO network is currently its only offer and can be easily viewed at kp.org.)
- Ambetter will likely remain in the market although there are no rumors either good or bad about what they may offer.
So what’s the plan?
It looks like there will be major upheaval in the health insurance market since a large segment of Atlanta based insureds are covered with some combination of Aetna, Coventry or Humana.
This situation is worsened by the fact that no specific information will become available until November 1 which is the opening day of the 2017 Open Enrollment Period. Carriers reserve the right to offer whatever product lines were filed and not all that were approved.
Worse still, enrollment for January 1 effective dates will likely end on December 15 if we look back to prior open enrollment periods plus web-based systems have historically over-loaded the first few days of the Open Enrollment Period. All of this shortens the time we have to make well-informed decisions. We will all need to keep our ears to the ground and antennas up to stay as well informed as possible leading up to the start of the annual enrollment period. Prepare to move quickly when the time comes by considering carefully how we have used healthcare in the past.
We will have to determine whether a low deductible copay plan or a high deductible health plan or something between might suit us best for 2017. Look for future posts as well as reference back to articles already posted to help with these decisions. We at CDA Inc. are committed to providing resources to help with the decisions that will need to be made.