Open Enrollment - New Consumer Protections

Open Enrollment begins November 1st

Now is the time to look at plan options for 2024 and update your household information if you are eligible for the premium tax credit through Healthcare.gov.

The Centers for Medicare and Medicaid have added new protections when working with agents.  Agents must provide a consent form for customers to sign before assisting with enrolling in a marketplace plan.  I will use an E sign option that will be available at the time of our call.  There will also be a confirmation step that what is on the application is correct.  That will need to be verified by you as well. Your agent must store these forms for 10 years and make them available for audit when requested.  This new requirement will help ensure greater transparency when working with health insurance agents and brokers.

If you speak with an agent who does not require this, then they are not in compliance with these new protections.  If you have questions about this or your plan options for 2024, please don't hesitate to reach out to me.

Stay well,

❤

Tara

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Blue Cross NC EPO Networks

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

Bright Healthcare Leaves NC

Open Enrollment for 2023 began 11/1/2022.  

Bright Healthcare, a strong player with the Health Insurance Marketplace has left the market.  Bright Healthcare members in NC are being "mapped" to other carriers for 2023.  Now is the time to talk to an agent to review your options.  In Mecklenburg, Union, and Gaston counties, members have been mapped to Aetna which is part of the Atrium Health system.  Bright Healthcare is the Novant system.  This is important.  If you've been visiting Novant providers, you will need to switch to a plan that includes the Novant Health system.  This is just one example of the disruption.

I am appointed with all the major carriers in NC.  If you have a Bright Healthcare plan, please feel free to reach out to me.  I am happy to go over your options for 2023.

Schedule a call with me.

Take care,

❤

Tara

ARPA Subsidies Expiring- Action Needed!

The COVID-19 Relief Bill signed into law is expiring December 31, 2022.  The primary result of the American Rescue Plan Act on health insurance was larger ACA subsidies for individuals between 100-400% of the federal poverty level (FPL.)  It also removed the "subsidy cliff" expanding subsidy eligibility to those above 400% FPL. 

Due to the enhanced ARPA subsidies, more people are covered now through the Marketplace than any year since it began in 2014.

If Congress does not pass additional legislation, we will return to the pre-ARPA subsidies for health plans that will be available for this upcoming Open Enrollment Period beginning November 1, 2022.

It is estimated that over 3 million people will lose coverage next year if ARPA subsidies are allowed to expire.

Please consider contacting your representatives & senators: https://www.congress.gov/members/find-your-member

Here is a sample script - personalize it if you or someone you know will be impacted:  

Hello, my name is [Name].  I am concerned about the upcoming expiration of the American Rescue Plan Act health insurance subsidies.  If Congress does not act to continue these additional subsidies before Open Enrollment this fall, Americans will be facing higher premiums and some may no longer be able to afford coverage at all.

Stay well,

❤

Tara

Source:  https://www.hhs.gov/about/news/2022/06/22/fact-sheet-what-happens-premiums-if-extra-help-american-rescue-plan-expires.html

Allergies in NC - Achoo!

It is definitely allergy season in North Carolina!  I've been waking up with itchy eyes more than I care to.  Often they are almost glued shut before washing my face.  It seems worse this year for some reason.

Here is an excerpt from our Health Plans of NC blog.

Let’s look at some of the most common sources of allergies in North Carolina and tips for reducing allergies. 

Pollen

You may not realize it, but in North Carolina, we actually have three pollen seasons, including an overlap in seasons. Many people think that pollen is caused by flowers, but it’s more likely to come from trees, grass, and weeds. Unlike flowers, which rely on insect pollination, wind-pollination plants can cause significant allergies in people. The different pollen seasons in North Carolina are determined by the different types of plants that produce pollen. 

Between March and June, trees typically release pollen into the air, and in North Carolina, this can peak around April. Trees that can cause significant allergies in North Carolina include oak, hickory, American beech, and river birch. 

Grass pollen season typically lasts from mid-spring until fall, with the peak hitting in April and May. The most common grass types that cause allergies in NC include Bermuda grass, centipede, ryegrass, tall fescue, Kentucky bluegrass, and zoysia grasses. If you’re laying grass in your yard, consider buying tall fescue, which doesn’t usually cause allergies.

The last pollen season is caused by weeds and lasts from August until winter, usually peaking around September. While a few different weeds in NC can cause allergies, ragweed is usually the worst. People living in rural areas in Charlotte particularly tend to suffer from ragweed allergies. 

Mold

Mold can thrive in humid weather, making North Carolina prone to mold in the summer months. In addition, mold spores can cause seasonal allergy symptoms for many people. Using a dehumidifier can help discourage mold growth inside your home. Mold spore counts can be higher at night, so it’s also a good idea to keep windows closed overnight.

Like a pollen allergy, some common symptoms include a runny or stuffy nose, cough, itchy eyes, watery eyes, sneezing, and dry or scaly skin. Some people also suffer from headaches, migraines, and rashes.

Dust Mites

Dust mites are small insects that live indoors. They’re common throughout America and aren’t just prevalent in North Carolina. Allergies can be common in young children and result in a runny nose, nasal congestion, cough, facial pressure, itchy nose, and red or watery eyes. Washing bedding weekly at a hot temperature can help kill bugs and allergy-proofing your bed covers, pillows, and mattresses is also worthwhile.

Top tips for reducing allergies in North Carolina

Here are some common tips to help reduce your exposure to allergies:

Avoid cutting the grass if you can. Instead, try to get a family member to help during pollen season or hire a lawn company to cut your grass to help protect you from allergies. 

Avoid going outside in the morning where possible. Between 5 am to 10am is prime pollen time, and 10 am to 3 pm is actually the worst time to be outside if you suffer from ragweed allergies. So head out in the late afternoon or early evening if you can. 

Dust, wash and vacuum regularly. Regular cleaning can help remove allergens from your home, particularly dust mites.

Check pollen counts. Monitoring pollen counts online can help you plan your time outside and reduce exposure to pollen. 

Understand your allergies. Consider taking an allergy test to determine what’s causing your allergies to better protect yourself.

Private health coverage

Allergy testing and allergy treatment are typically covered by most insurance plans. If you’ve met your deductible for the year, your out-of-pocket costs could be minimal, so it can be an excellent opportunity to get an allergy test to determine what’s causing your allergies.

If you decide to receive immunotherapy, it can also be worth considering starting these if your deductible has been met to keep your costs low. For most insurance plans, your deductible resets to the full amount on January 1, so timing your allergy requirements can save you money. 

To check your eligibility, get in touch with your health insurance provider, or contact one of our specialized local health insurance agents to find out more.

Learn more about common allergies and ways to treat them.

As always, feel free to reach out to me with questions or assistance with your health insurance.

Stay well,

❤

Tara

704-436-4136

150% Federal Poverty Level SEP

North Carolina’s low-income earners that do not exceed 150% of Federal Poverty Line can qualify for ACA health insurance for $0

It may not be not too late if you missed out on signing up for the Affordable Care Act coverage for 2022. If you do not exceed 150% of the FPL you can now enroll in plans with $0 premiums for the rest of the year. Want to learn more? I am happy to answer all your questions.

Take care,

❤

Tara

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Considering Early Retirement?

I have had a significant increase in clients reaching out to me to discuss their options and healthcare costs if they retire early. The person I spoke to today said it's because her employer is requiring her to go back into the office. Instead, she's retiring early and taking 4 months to travel cross country in her camper. 😀

Here is an excerpt from my agency Health Plans of NC's blogpost.

Securing health insurance with early retirement.

If you are like many people, you have an insurance plan associated with your work. These employer-sponsored health insurance plans are one of the most sought-after benefits associated with work these days. Typically, your employer will shoulder a portion, and in some cases the full burden, of the cost for your health care coverage. Since most people lose their health insurance coverage when their employment ends, you need to consider how you will provide for your health care needs going forward. To secure insurance coverage at a price you can afford, you are going to want to consider your options for obtaining health insurance coverage once you retire.

Coverage options may include:

• COBRA: Just as when you leave one job to move to another, you may be eligible for COBRA, or continuation coverage, if you find yourself facing early retirement. If you choose to continue your insurance through COBRA, you will be required to pick up the full cost of your health insurance plan costs, but you can continue for a period of time (usually 18 to 36 months) to obtain your health care coverage under the plan your past employer set in place.
• Your spouse’s health insurance: Assuming you’re married to a partner with an employer-sponsored health insurance plan, the simplest and often most cost-efficient choice will be to have them add you to their existing health insurance plan.
• Retiree health insurance benefits: If you have worked in a union or in a highly valued occupation, you may have access to what is referred to as retiree health insurance through your past employer, your union, or, in some instances, an established trust. This plan is generally a group health insurance plan established specifically to support employees and their spouses in retirement.
• Health Insurance Marketplace coverage with a subsidy: If you fall between 100 and 400% of the federal poverty limit, you can find some health insurance plans through the Marketplace that will give you a governmental subsidy regardless of which state you reside within. If you choose to go this route, you should make sure you understand which plans allow you to use a subsidy. Even if you qualify for a government subsidy, they are only available on some of the plans available to you.
• Private insurance without a subsidy: Obviously, you can always buy your health insurance plan from a private agency. However, you should be clear that there are no governmental subsidies available to you if you choose this option. If your pandemic stock strategy has placed you outside of the federal subsidies, there are plenty of options available to you from private insurance agencies.

 

• Short-term insurance plans: If you are looking for an insurance plan to get you over a short stint, you may wish to consider a short-term plan. You are going to want to make sure, however, that you understand that these plans often fail to cover preexisting medical conditions. Also, if you have a history of complex medical issues, you can be turned down for these types of plans.

Knowing which option is best for you

The best health insurance plan for you is going to depend upon your specific needs. Some people are going to be most concerned about controlling their monthly budget. If this is your concern, you may wish to seriously consider buying your insurance plan through the Health Insurance Marketplace. Even if you have failed to meet criteria for subsidies here in the past, you may meet criteria this year. As part of the American Rescue Plan Act of 2021, tax credit subsidies were increased and extended to cover individuals with higher income levels than were covered in the past.

If you qualify for insurance coverage through your spouse’s company, you will likely fail to qualify for a government subsidy through the Marketplace. However, you will still want to compare the options you do have. If you find yourself choosing between having your spouse add you to their plan or using a COBRA plan, you are likely to find it less expensive to have your spouse place you on their plan. This option may be more cost effective than either a COBRA plan or plans you can acquire through private insurance companies. Remember, when you are making your choice, to compare all costs of the individual plans and not just the cost of your monthly premiums. Make sure you are clear of all copayments, deductibles, and the out of pocket maximums associated with each of the plans you are considering.

If you find you don’t qualify for a subsidy through the Health Insurance Marketplace, and the other options available to you are more expensive than you can comfortably afford, you may want to consider a short-term insurance plan. This is more likely to be a good option for you if you are in general good health and are only waiting a short time to become eligible for Medicare coverage. However, you will want to be aware that these plans aren’t required to provide the minimum essential benefits that are required by the Affordable Care Act (ACA). This means that not only are your pre-existing conditions unlikely to be covered, but some of the medical concerns covered under the plans offered to you in the Health Insurance Marketplace may not be covered in your short-term plan.

Considering Early Retirement?

❤

Take care,

Tara