Open enrollment for individual/family medical plans is November 1st through December 15th 2017. New enrollments and renewals must be completed during this time for a January 1st start date. In the past, open enrollment was extended, allowing for start dates in February and March. That is no longer allowed unless you are eligible for a special enrollment period.
If you have a grandfathered plan ending at the end of 2017, you may be eligible for an SEP.
BCBSNC has consolidated their ACA offerings for 2018. While they are still offering different networks depending on your county of residence, the metallic levels have changed to four options.
- Bronze 6650
- Silver 7000
- Silver 4000
- Gold 2500
The number in the name is your deductible. Deductibles go into play when you have diagnostic services like MRIs, X Rays, special blood panels, or a hospital stay.
The out of pocket maximum, which is established by the government and the Centers for Medicare and Medicaid, has increased from $7150 in 2017 to $7350 in 2018 for in network charges. Your out of pocket maximum includes your co-payments, prescription costs, and deductible. In other words, if you have an in network hospital stay for a week, the most you'll pay, according to the law, is $7350 for 2018. Once you reach that, as long as you make your premium payment, your carrier will pay the rest of your in network covered medical expenses for the rest of 2018. [*Covered medical expenses must be considered a medical necessity and prior approval may be required.]
However, your deductible and your out of pocket maximum may be lowered considerably based on your income. I can help you find out if you're eligible for these additional cost share reductions.
If you have an HSA (Health Savings Account) eligible plan, your out of pocket is capped at $6650 hence the name "Bronze 6650" above.
Please feel free to reach out to me with questions. I'm happy to help you navigate your options.
Customers in Western North Carolina may be impacted by Mission Health's decision to terminate their contract with BCBSNC®.
There are other provider options available, including Park Ridge Health. Customers may qualify for a continuity of care program but must contact customer service by November 19, 2017. And as always, in an emergency, members should always go to the nearest hospital.
Members in Cleveland, Gaston and Lincoln counties were limited to three networks in 2017: Blue Advantage, Blue Select and Blue Local. Blue Advantage and Blue Select are larger networks which require higher premiums. And Blue Local, with the lowest premium, is limited to Carolina's Healthcare System only.
Members could only see providers in the CaroMont Health network if they paid the higher premiums for the larger networks.
Beginning in 2018, CaroMont Health will be added to the Blue Value network which means members have more choices and may pay a lower premium if they are willing to go with a limited network. If all of your providers are in the Blue Value network, it may be worth making a change in 2018.
This is great news!
BCBSNC will no longer offer its grandfathered health plans as of January 1, 2018. If you have kept your grandfathered plan, you will need to transition to an Affordable Care Act (ACA) plan during open enrollment beginning November 1, 2017.
BCBSNC will attempt to match you to a plan with similar benefits. Depending on your area, you may find yourself with a limited network moving forward. In the Charlotte Metro area, there are two networks - Blue Local with Carolina's Healthcare System and Blue Value which includes Novant and other participating providers. In the Raleigh-Durham area, there are two networks - Blue Local with Duke Health and WakeMed and Blue Value which includes UNC Health Care, REX Healthcare and other participating providers.
You can also expect rate increases which you'll be notified about in writing. You may be eligible for a subsidy depending on your household size and income.
If you'd like assistance navigating your options, feel free to reach out to me if there is no agent listed on the notices you receive from BCBSNC.
