Did you get a call from the Marketplace telling you your plan has gone away for 2023? I did too. If you had Bright Healthcare, that statement was on point. But if you had a Blue Cross plan, it was a little misleading.
Here's what you need to know. If you had a Blue Cross NC Blue Local or Blue Cross NC Blue Home plan in 2022, your plan had a Point of Service (POS) network. This means, that even though it would cost A LOT more to go out of network, there was still a small benefit.
An Exclusive Provider Organization (EPO) is a small step up from a Health Maintenance Organization (HMO) that typically requires you to declare your Primary Care Physician who is then responsible for referring you to a specialist. With an EPO, referrals aren't required, but there is no out of network coverage except for emergencies. This is a significant change.
Here are the Networks Impacted - they are now EPO's.
- Blue Local with Atrium
- Blue Local with Wake Forest Baptist Health
- Blue Home with Novant
- Blue Home with UNC Health Alliance
Because of the change from a POS to an EPO, all Blue Local and Blue Home members will have an additional Special Enrollment Period (SEP). This means you have 60 days from December 31st to enroll in a new plan. This SEP extends beyond the Annual Enrollment Period deadline of January 15, 2023.
Note: There are HMO health insurers in the individual ACA market that do not require referrals to see a specialist.
This year, the only Point of Service (POS) option is Blue Value, which is not available in every county, i.e. Mecklenburg or Wake. The Blue Advantage Preferred Provider Organization (PPO) is even scarcer across the state and is not available with a subsidy in most counties. PPO's are more expensive but give you the most freedom with the largest network that crosses state lines. This is of interest for people who want to get second opinions or treatment from facilities outside of North Carolina.
Need help this open enrollment? My expertise is free.
Stay well,
❤
Tara
