Pharmacy Changes for limited networks in 2017 - WALMART no longer in network

Beginning 2017, if you have a Blue Value, Blue Select, Blue Local- Carolinas Healthcare System or Blue Local - Duke Medicine and WakeMed network plan, you will see several participating pharmacy changes.

• Walgreens will now be in-network.
• CVS will continue to be in-network.  However not if you go to a CVS outside of NC.
• Walmart will be out-of-network.
• Rite-Aid will be out-of-network.
• Harris Teeter will be out-of-network.

Affected existing members will receive a letter in early November advising of the changes.  
And as always, networks are subject to change due to new mergers and other negotiations.

CaroMont Health - Approved Networks in Gaston, Cleveland and Lincoln

BCBSNC_® offers three networks in Gaston, Cleveland and Lincoln Counties. 

• Blue Advantage
• Blue Select
• Blue Local - Carolinas Healthcare System.  (not in network with CaroMont)

If you are in one of these counties and want to go to CaroMont Health and CaroMont Regional Medical Center,  you must be in in the Blue Advantage or Blue Select network.  
While the hospital can't turn you away, if you have Blue Local, you will be out of network with higher out of pocket maximums.

CLICK HERE TO CHECK YOUR NETWORK.

IMPORTANT:  Anyone who had an Aetna or United Healthcare plan through the marketplace (healthcare.gov) will be automatically mapped to Blue Local in 2017.

If you need to make a change or have questions about your options, call me or make an appointment by clicking on the link below.

Schedule a call with Tara O’Neill

WakeMed to exit Blue Value network in 2017

In 2016, we experienced a major disruption when BCBSNC_® forced members in the Raleigh/Durham area into one of two networks - Blue Local DKWM (Duke Medicine and WakeMed) and Blue Value which included UNC, Rex and WakeMed.

WakeMed will no longer be in the Blue Value network beginning January 1, 2017.  

If you have a Blue Value plan, it's time to do a doctor search to see if your doctor(s) is still in network.  If they are affiliated with WakeMed, you'll need to switch to Blue Local DKWM.

CLICK HERE TO CHECK YOUR NETWORK.

If you need to make a change, or have questions about all your options, call me or make an appointment by clicking the link below and I'll help you enroll.

Schedule a call with Tara O’Neill

Open Enrollment Ended January 31, 2016

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
• Moving to a new residence
• 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 care physicians.

SHORT TERM QUOTE

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.

Open Enrollment Nov 1st through Jan 31st

The annual open enrollment for 2016 coverage begins November 1^st and ends January 31^st.  During this window, you can enroll in a new plan, renew an existing plan, and apply for a premium tax credit to subsidize your plan if you qualify for one.  After January 31^st, you will not be able to enroll in individual medical coverage unless you have a qualifying life event.  (See May 11, 2015 Blog.)

New Enrollments

If you didn’t have a Blue Cross and Blue Shield of North Carolina_® plan in 2015 but are interested in enrolling in a Blue Cross and Blue Shield of North Carolina_® plan for 2016, now is the time to request a quote.  I will walk you through the entire enrollment process including applying for the premium tax credit if you’re eligible for one.

Premium Tax Credit

Based on your household size and income, you could be eligible for the premium tax credit to subsidize your plan.  If you or your spouse have access to affordable insurance through an employer, then you won’t be eligible for the premium tax credit.  If you’re not offered health insurance through work, and you fall between 100% and 400% of the federal poverty levels, then you could be eligible and should definitely apply for it.  Even if you choose not to use the credit to subsidize your plan, by applying for it, you will be able to get the credit when you file your 2016 tax return.

Renewals

If you had a Blue Cross and Blue Shield of North Carolina_® plan in 2015, you will receive a renewal notice.  In that notice, you’ll be provided the steps to take to either keep your existing plan or enroll in a new plan.  If you had a subsidy in 2015, it is recommended that you make sure your income information is up to date to insure you’re getting the most out of your premium tax credit for 2016.  I can assist you with this process.

Tax Penalty

Every year, the tax penalty (shared responsibility payment) increases for those who choose not to enroll in a qualified health plan that provides minimum essential benefits.  For 2016, It will be the greater of

• 2.5% of the taxpayer’s household income that is above the tax filing threshold for the taxpayer’s filing status, or
• The taxpayer’s flat dollar amount, which is $695 per adult and $347.50 per child.  The maximum penalty per family is $2085.

Take a look at the 2016 plan brochure here.

http://healthplansofnorthcarolina.com/agent_docs/Docs/ba_brochure_2016.pdf

If you have questions about our plans or need help with the process, please feel free to call me.  I’m happy to help!

Blue Value vs. Blue Local - Big Changes in Metro Areas

Many of my clients choose Blue Advantage because it provides the largest network statewide. Blue Cross and Blue Shield of North Carolina_® has announced that they will no longer offer Blue Advantage or Blue Select in the Charlotte Metro area and the Raleigh Durham area in 2016.  My clients will have to choose between two limited networks for the coming year.  In the next month, you will receive a renewal notice explaining that if you had Blue Advantage or Blue Select, you will automatically be routed to a similar deductible Blue Value plan in 2016.  But you still have choices. 

Charlotte Metro Area:

If you are in the Charlotte Metro Area and make no change, you will no longer be able to go to Carolina’s Healthcare System.  You will be limited to the Novant network once you're routed to Blue Value.  If you want to go to Carolina's Healthcare System providers, you must switch to Blue Local with Carolina’s Healthcare System.

• Blue Value = Novant
• Blue Local = Carolina’s Healthcare System

Raleigh Durham Area:

The limited Blue Local network is new to the Raleigh Durham area.  Previously, if you wanted the Duke Medicine network, you had to choose Blue Advantage.  In the coming year, if you want to stay with Duke, you must switch to Blue Local with Duke Medicine & WakeMed network.

• Blue Value = UNC, REX and WakeMed
• Blue Local = Duke Medicine and WakeMed

Important Points to Remember

• If you are comfortable with the Blue Value network, then no action is necessary. *
• If you choose Blue Local instead of Blue Value, a binder premium payment will be required.  What that means is, if you’re mapped to Blue Value, but want Blue Local beginning January 1^st, you must make the change via Blue Connect and your binder payment must be received by December 31^st.
• Walgreens is not included in either of these networks at this time.  If you currently use Walgreens, you will need to find a new pharmacy that is in network.
• Counties impacted:  Anson, Cabarrus, Mecklenburg, Rowan, Stanly, Union, Alamance, Caswell, Chatham, Durham, Lee, Orange, Person, Franklin, Johnston and Wake.

Open enrollment begins November 1^st.  I am here to help you navigate through your choices.  Don’t hesitate to call me with questions.

*If you are currently receiving a subsidy, you will need to update your income estimates at healthcare.gov to make sure you are getting the proper premium tax credit for 2016.

Take a look at the 2016 plan brochure here.    http://healthplansofnorthcarolina.com/agent_docs/Docs/ba_brochure_2016.pdf

Still need Individual Health Insurance Coverage?

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 *
• Moving to a new residence
• Gaining citizenship or lawful presence in the US

If you have any questions or concerns, I can help you determine if you qualify.  If you don’t qualify, the next open enrollment begins November 1, 2015. 

*Examples of losing other health coverage.

• Losing job-based coverage for any reason
• Losing coverage through divorce
• COBRA coverage expiring
• Aging off a parent’s plan when you turn 26
• Losing eligibility for Medicaid or CHIP

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.

Reminder:  Without an ACA plan, you may have to pay a shared responsibility payment (penalty) when you file your tax returns next year.