On October 12th, President Trump signed an Executive Order, forcing changes to be made toward some of the rules of small business health insurance plans, short-term health insurance policies, and cost-sharing reduction payments (aka subsidies).
What does the Executive Order mean
- Broader rules for AHP’s (Association Health Plans), allowing small businesses to purchase plans across state lines. By joining an AHP, small employers within the same line of business could purchase plans collectively.
- Increase the policy period on short-term plans from 3 months to 12 months with the option to renew. These plans are not required to follow the rules of the ACA mandate (i.e. they do NOT provide coverage for pre-existing conditions)
- Cost-sharing reduction payments (aka subsidies) will no longer be funded by the government. Insurers are required by law to offer assistance to low-income individuals. Customers who are currently receiving assistance through the Marketplace will likely see little change.
- Rates have not been released and likely will not be released until November 1st. This means renewals will not be available until November 1st.
How to Avoid Rate Increases:
- Be prepared to discuss your household, estimated adjusted gross income for 2018. This will be used to determine if you qualify for assistance.
- Those without pre-existing conditions should consider temporary insurance. The premium is much lower and all plans offer a PPO network. Wellness visits are not included with these plans.
- If you are going to opt to self-insure, protect yourself with an accident or critical illness plan. The plan works separate from health insurance and pays you based on a diagnosis of a critical illness (cancer, heart attack, or stroke) and in the event of an accident (slip, fall, and break an ankle) the plan will pay you a certain dollar amount. The purpose is to use the funds to pay towards the unexpected hospital or urgent care visit.
- Review ALL of your insurance policies. As a broker I have access to multiple carriers which allows me the opportunity to find the best plan based on your needs. I’ve saved people thousands by reviewing rates with multiple carriers. Personal lines insurance (auto, home, life, and health) is my area of expertise!
Open Enrollment started November 1st and will last until January 31st, and only affects those that are required to purchase their own insurance.
Here is what you can expect…
- If you need a policy with a 1/1/17 effective date, you must enroll by December 15th. This includes anyone with a plan with Aetna/Coventry, Harken Health, United Healthcare, and Land of Lincoln.
- The remaining carriers offering plans are Blue Cross Blue Shield, Health Alliance, Ambetter, and Cigna. Carriers and plan options vary by county.
- If you are happy with your plan it will automatically renew. I will warn that rates have increased and it may be worth it to review your options. Please Note: Subsidies (assistance provided by the government) have also increased in an attempt to offset the premium difference.
- Blue Cross has announced that doctors in the NorthShore University Health System NorthShore Medical Group and Northwestern Medicine are accepting the Blue Cross Blue Precision HMO plan. Call 847.570.4202 to find out if your Northshore doctor accepts the Blue Precision HMO and 312.926.8400 to find out if your Northwestern doctor accepts the Blue Precision HMO.
- Group insurance is competitive again. This may be an option to consider for small employers. The larger PPO network is still available for group insurance.
- Out of Pocket Maximums have increased from $6850 to $7150 (the out of pocket max varies per plan. The maximum allowed on ANY plan is $7150).
- Blue Cross Blue Shield has introduced a new plan with a smaller network to help offset the increase to premiums.
- As a reminder, assistance is provided by the government to those who qualify. The assistance is based on household size (number of people reported on your tax return) and the household’s adjusted gross income for 2017. Your adjusted gross income is located on line 37 of your 1040. If you are self-employed, this is the number AFTER your write-offs.
Please contact me at 708.444.0050 or firstname.lastname@example.org to schedule a time to review your plan options.
Open Enrollment this year will be November 1st-January 31st. During this time, Blue Cross Blue Shield has already announced major network changes. The biggest being the elimination of their broad PPO network. Those with a plan in this network will receive a letter and or phone call from BCBS stating that their policy will expire 12/31. You will need to pick a new plan by 12/15 to ensure there is no gap in coverage.
Those with the Blue Choice, the HMO network, or on an employer plan will NOT be affected by this change.
BCBS has also announced that there will not be a cap on out of network charges, making it extremely important to stay in your plans network. What this means is that a service that costs $10,000 at an out of network facility will cost you $10,000. Nothing will be applied towards your deductible.
Assurant Health just announced they will exit the Individual Medical and Short Term Medical markets effective JUNE 15th. If you have a policy with Assurant Health, contact me to discuss your options.
The tax filing special enrollment period is now open available for plans on and off the Marketplace. In order to qualify for the special election period
*You had to pay a penalty for 2014
*Are not currently enrolled in a plan
Application submitted March 15th-April 15th will take effect May 1st and April 16th-30th will take effect June 1st