Losing BlueCross coverage? Here’s what to do
If you are one of the more than 50,000 Nashvillians not on Medicare who has non-group BlueCross BlueShield of Tennessee health coverage, you have probably received a termination letter indicating your coverage will lapse at the end of this year.
That letter should have told you that BlueCross’ individual plan members have had more health needs than anticipated, leading to financial losses. Based on this and other uncertainties, the company has decided to pull out of the Nashville, Memphis and Knoxville regions.
While those with BlueCross employer plans or Medicare are not affected, about 130,000 individual consumers across the state will lose their existing coverage.
At Bernard Health, we have had many worried people call us now that they have to reevaluate their health insurance plan for 2017. If you are in that situation, too, here are the steps to take if you want to navigate the waters on your own.
Familiarize yourself with your current plan
Before you compare new options for coverage, you should familiarize yourself with your current BlueCross plan. That way you know exactly what is and isn’t covered, and you will be better prepared to make any necessary changes.
For example, be sure to evaluate the new provider network of any coverage you consider. Your new plan might not include all the same providers in-network as your last plan. Specifically, patients with Saint Thomas providers should pay particular attention. Last year, Saint Thomas exclusively partnered with BlueCross, and initially was not included in any exchange plans for 2017 once BlueCross pulled out of the Nashville marketplace.
Saint Thomas is now included in some Cigna networks, but patients choosing a Humana plan may need to find a new in-network doctor. When comparing health plans, always check the plan’s network, deductible and cost-sharing structure to see how it will compare with your BlueCross plan.
Evaluate your new off- and on-exchange options
Now that you have a good understanding of your current coverage, you can start taking steps to evaluate what is out there. Remember, even if you bought your individual BlueCross plan off of the marketplace, you are still affected by this news. BlueCross isn’t just pulling out of the exchanges, it’s pulling out of the individual market altogether. Unless you have group coverage, you will not be able to get BlueCross coverage in 2017.
But consumers in Nashville have other options for coverage, both on and off the exchanges. Cigna and Humana will be selling plans through the marketplace, with a total of 11 options. Farm Bureau and Aetna will also be selling plans off of the marketplaces. There are also cost-sharing ministry options such as Medi-Share.
If you don’t already have one, create an account on Healthcare.gov to evaluate the 2017 marketplace options. For off-exchange plans, you can visit the carriers’ websites to find out what they are offering. For the first time ever, one can even sign up for a Farm Bureau plan through its dedicated website, www.fbhealthplans.com.
To avoid a coverage gap, be sure to enroll by Dec. 15 for coverage beginning Jan. 1. You can enroll or change your plan until open enrollment ends on Jan. 31. After that, you will need a qualifying event, like having a baby or getting married, to choose new coverage for 2017.
Consider group coverage if you can
If you are a small business owner, you and your employees may have previously purchased individual coverage. In the wake of this announcement, many such employers who want to keep BlueCross insurance are reconsidering a group coverage strategy with the carrier.
Another group option for cost-sensitive employers would be to offer a minimum essential coverage plan (MEC). These bare-bones plans do not cover a lot, but protect employers and employees from the federal essential coverage penalties.
They do not protect employers from the value penalty, however, which in this scenario would be $3,000 for every employee who receives an exchange subsidy. But if employees choose off-exchange coverage — which doesn’t have subsidies — in addition to their employer’s MEC, neither the employer nor employee will be subject to fines.
Farm Bureau still offers plans off of the exchange that have underwriting, which allows their premiums to be much, much lower than ACA qualified plans. That said, you can only get them if you are healthy enough to qualify and they don’t protect the individual from fines.
The combination of an employer-provided MEC (which does protect the individual from fines) with this sort of individual plan, however, could produce a lot of savings as well as protection from fines for small employers who have mostly healthy employees. Another advantage to have in mind is that Farm Bureau’s plans have all Nashville area hospitals in-network, including Saint Thomas Health.
While BlueCross leaving has wide-ranging implications, many consumers will still be able to find coverage that meets their needs. Healthcare.gov is a helpful tool, and consumers and employers alike can enlist the help of a broker or navigator for assistance in finding a coverage strategy for 2017.
This article was originally published in The Tennessean. If you enjoyed this post, you may like "Three things to know about BlueCross leaving the exchanges."
Do you need help finding new coverage for 2017?
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