Friday, October 18, 2019

Initial Rate Notices - Use the Subsidy Tool

Initial Renewal Rate Notices for members who receive a subsidy through the marketplace are just estimates.  The Centers for Medicare and Medicaid require providers send renewal notices in time to be received by November 1st.  The problem is, the new subsidy amounts aren’t reflected in that initial rate notice.  Subsidies are based on premiums.  Back in July, BCBSNC® filed to reduce 2020 rates by -5.2% with the NC Department of Insurance.

Premiums are going down next year which means the subsidy is also going down.  The initial notices reflect 2020 reduced premiums with subsidies based on 2019 higher premiums.  So don’t get too excited about your estimate.

According to the IRS, the premium tax credit is generally equal to the premium for the second lowest cost silver plan available through the Marketplace that applies to the members of your coverage family, minus a certain percentage of your household income.  When premiums go down, the premium tax credit (subsidy) goes down as well.  

If you want to get a better estimate for 2020, the subsidy tool is available again this year.

As always, if you have questions, don't hesitate to reach out to me.  You can call me directly or choose a time on my calendar.  Open enrollment begins November 1st.

Tuesday, October 1, 2019

Open Enrollment November 1st - December 15th

Open Enrollment for individual and family medical coverage begins November 1st and ends December 15th.  During this time, you can review plan options, make changes and update your income estimate for 2020.  Outside of open enrollment, you can enroll in a plan if you qualify for a Special Enrollment Period.  For example, if you or someone in your household lost qualifying coverage in the past 60 days.  If you have questions about whether you're eligible to enroll before the next Open Enrollment, give me a call and I'll help you.

  • Stay tuned for updates on plan changes and new offerings in the coming weeks.  I look forward to working with you!

Thursday, October 25, 2018

Blue Local with Duke Health and WakeMed Discontinued in 2019

Blue Value with UNC Health Alliance will be the sole network in the Raleigh Durham regions.  This new agreement is in effect through 2021.  

UNC Health Alliance will offer deeper hospital and professional provider discounts.  Members in the Raleigh and Durham regions will have an average pre-subsidy rate decrease of ~22%.  Blue Local with Duke Health and WakeMed will be discontinued in 2019.

Raleigh and Durham regions will be mapped to Blue Value.  Members can expect a decrease in premium.  This impacts ~45,264 members. 
[Raleigh Region = Wake Johnston and Franklin Counties.]
[Durham Region = Durham, Orange Alamance, Chatham, Lee Caswell and Person Counties]

The Henderson region will be mapped to Blue Advantage.  Blue Value is not offered in that area.  These members can expect a slight increase in premium since a limited network is no longer available.  This impacts ~ 2,018 members.
[Henderson Region = Granville, Vance and Warren]

The good news:
~ UNC Health Alliance is offering deep discounts and they continue to expand their network of providers.

The bad news:
~ If  you're in the Raleigh Durham area, your doctor will not be in network if he or she does not accept Blue Value.
~ If you're in the Henderson area, you no longer have access to the additional discount provided in a limited network.  However, overall premiums have gone down from 2018.

Wednesday, October 24, 2018

Gastonia Region Impacted by Network Reduction 2019

Blue Advantage and Blue Select networks will be eliminated in 2019 for Cleveland, Gaston and Lincoln Counties.  Many of my clients had already opted into the lower priced Blue Value or Blue Local networks.  But some opted to pay the higher premium for the larger network of providers that Blue Advantage and Blue Select included.

Migrating to limited networks has been a trend for some time in the larger metropolitan areas.  Both health systems have agreed to deep discounts which directly impact member's monthly premium payments.  BCBSNC ® estimates an average premium decrease of 17% before the subsidy is applied, if you're eligible for one through the health insurance marketplace.

Members who are currently enrolled in a Blue Advantage or Blue Select plan will be mapped to Blue Value for 2019.

In 2019, the Blue Local network will be Blue Local Atrium.  If you want to see providers affiliated with CaroMont Health and Hospital, then stay with Blue Value.  But if your provider is affiliated with Carolina's Healthcare System - now Atrium, then you will need to actively switch to the Blue Local Atrium network.  I can help you make the change and apply for a subsidy if you're eligible for one.

We can go over your options together.  Working with an agent does not add any cost to you.  I'm happy to help!

Tuesday, October 16, 2018

NEW Subsidy Tool

Every year, BCBSNC® and other carriers participating in the marketplace are required to send out renewal notices by a certain date.  Due to the time constraint, these notices go out before the new subsidy estimates are available.  Every October, I get a lot of panicked calls because of the confusion this causes many of my clients.

This year, BCBSNC® has provided a new tool so you can get your subsidy estimate before open enrollment which begins November 1st.  Input the premium information from your renewal notice, include your family size and household income and the tool will give you a better picture of what to expect when open enrollment begins.  I've been using it as well because our "quoting tool" isn't live until November 1st.  It's easy to use and it takes the guess work out of 2019 monthly premium estimates.

I hope you find this as helpful as I have.  And as always, I am available by appointment to discuss your enrollment and renewal for 2019.

Sunday, October 7, 2018

Tryon Medical Partners - Charlotte Metro Area

Roughly 90 physicians formerly with Mecklenburg Medical Group created a new practice called Tryon Medical Partners after leaving Charlotte-based Atrium Health.  In the Charlotte-Metro area, there are two BCBSNC® networks for the individual market: Blue Local with Atrium Health and Blue Value which is primarily the Novant network plus additional providers. 

Until recently, it was unknown how this exit would impact the many current Blue Local members whose doctors left Mecklenburg Medical Group.  With open enrollment coming up, I’ve received a lot of calls about what your options will be for 2019.

I am relieved to report that BCBSNC® recently advised its agent network that Tryon Medical Partners will participate in both networks.  I was able to confirm it on Tryon Medical Partners website.

When deciding on networks for 2019, if your doctor is now with Tryon Medical Partners, what you need to consider is which hospital and urgent care network you prefer if needed.  If you want to visit Atrium, you will need to stay with the Blue Local network.  If you are interested in Novant and other providers, then you will have to choose Blue Value.  Feel free to reach out to me with questions.

Saturday, January 6, 2018

Open Enrollment for 2018 ended 12/15/17

Open Enrollment Ended December 15, 2017.

You can still enroll in an ACA plan as long as you qualify for a Special Enrollment Period due to a Qualifying Life Event (QLE).  Here are a few examples:

  • Getting married
  • Having a baby, adopting a child or placing a child for adoption or foster care
  • Losing other health coverage
  • Gaining citizenship or lawful presence in the US

If you’re not eligible for the special enrollment period, consider enrolling in a short term plan.  Short term plans do not provide minimum essential benefits required by the Affordable Care Act, but many of my clients use this option if they missed open enrollment or if they only need it as a stop gap before their employer coverage begins.  Coverage can begin within 48 hours and there are a number of plans to choose from including ones with copayments to see primary physicians.

Reminder:  Without an ACA plan, you may have to pay a shared responsibility payment (penalty) when you file your tax returns next year. Please speak with your accountant for further details.