Tuesday, January 7, 2020

Special Enrollment Period

Open Enrollment for 2020 ended December 17, 2019.

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.


Sunday, November 10, 2019

BCBSNC adds Telehealth with MDLive


Telehealth with MDLive is being added as a covered benefit at the Primary Care Provider cost share.  MDLIVE connects Blue Cross and Blue Shield of North Carolina® members to a national network of U.S. board-certified doctors who average 15 years' experience.  Their specialties include primary care, pediatrics, emergency medicine, family medicine and behavioral health.

Telehealth represents a convenient, cost-effective alternative to in-person doctor visits.  Virtual visits ease the burden by being available quickly and easily.  This is available for all plans except Blue Local Atrium Health because that network already offers their own telehealth benefit.

Treatment includes non-emergency conditions such as acne, allergies, cold and flu, constipation, cough, diarrhea, ear problems, fever, headache, insect bites, nausea/vomiting, pink eye, rash, urinary tract infection, respiratory problems, sinus problems, sore throat, depression, stress, grief and loss, anxiety and more.

If appropriate, a prescription can be sent to a pharmacy of your choice.

Members will have standard access to MDLive 24 hours a day, seven days a week (including holidays).

Members are required to setup an MDLive account before using their services.  MDLive Care Coordinators are available to walk them through the registration process.

Options to access MDLive:
  • Download the MDLive app on a smartphone or tablet
  • Go to MDLIVE.bcbsnc.com and click “Activate Now”
  • Call 888-910-9722
Take advantage of this great added benefit for our members in 2020!







Thursday, October 31, 2019

Blue Home with UNC Health Alliance


Blue Cross and Blue Shield of North Carolina® is changing Blue Value with UNC Health Alliance to Blue Home in 2020.  Why is this important?  Blue Home is not a statewide network.  It is now a LOCAL network.  Blue Home limits in-network to UNC Health providers and affiliates.  The rest of the state will now be out-of-network.

Current Blue Value with UNC Health Alliance members will be mapped to Blue Home with UNC Health Alliance.  Your subscriber ID and Blue Connect account will remain the same.  However the Alpha prefix will change for 2020.  Notices of the change were sent to members in October.

The counties impacted by this change are:

Alamance, Caswell, Chatham, Durham, Franklin, Johnston, Lee, Orange, Person and Wake.





Friday, October 25, 2019

New Network: Blue Local with Wake Forest Baptist Health


Blue Cross and Blue Shield of North Carolina® is offering a new low cost narrow network product for Wake Forest Baptist Health.  

Blue Local with Wake Forest Baptist Health is 40% less than Blue Advantage and 23% less than Blue Value.  However, members who choose this network will only be able to see Wake Forest Baptist Health providers and their affiliates.  Be sure you complete a doctor search before choosing this network.  I can help.

Here is a list of counties where this new product is available.

Davidson, Davie, Forsyth, Guilford, Randolph, Stokes, Wilkes and Yadkin.

As subsidies decrease in 2020 due to lower premiums, having this new network option may keep your monthly costs down.






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.