Written By: Kyle Zajdel, Health Insurance Specialist, VanVleet Insurance
One year ago healthcare reform was introduced to Wayne County residents and it started off with a stumble. The website was slow, when it worked, Wayne County residents had two on-exchange options and neither of them included Reid Hospital. We had insurance companies dropping their policies and pulling out of the state instead of dealing with the uncertainty of a new system. Business owners struggled in their own right trying to navigate through the maze of new regulation. All of these hiccups caused consumer confidence in the ACA to plummet, but just when we were about to sink into deep despair the exchange began to operate with more efficiency and the enrollment numbers showed a glimmer of hope. After extending open enrollment an extra 45 days, enrollment picked up and the target was met.
INDIVIDUAL
After such a rocky start, I’m frequently asked what to expect for this year’s open enrollment period. My answer is increased options. As I mentioned before, we only had two on-exchange choices last year and neither had Reid Hospital in-network. The good news is it appears we have two more companies joining the mix. United Healthcare (aka Goldenrule) and Assurant Health have both filed to offer policies both on and off the exchange. What is the difference between “on-exchange” and “off-exchange” policies? Well for Wayne County residents who qualify financially, an on-exchange policy will allow them to utilize their subsidy thus lowering and in some cases eliminating their premium. An off-exchange policy, although still ACA qualified, is not sold through the exchange, but instead through a private web site. It’s been our experience that many citizens will qualify for some level of subsidy. My concern still lies with the network. Although United Healthcare and Assurant have filed to offer plans through the exchange, it’s yet to be determined what kind of network will be offered. Will it be their current robust network, which includes Reid Hospital or will they decide to follow Anthem’s lead and offer a more restricted network that is not accepted by Reid? Only time will tell. For those individuals who do not qualify for a subsidy, they should still be able to choose from a list of companies with a solid network in the area.
GROUP
Many employers, especially those with less than 100 employees, will also have new options available. Employers who have a healthy work force have begun to notice that their traditional “fully-funded” policies have taken a significant rate increase this year. This is because insurance companies are no longer able to take into account the health of employees when factoring the premium rate. The insurance companies have responded to this by offering new plans that fall into the “self-funded” category but look and act much like a “fully-funded” plan. Because the plans are self-funded, insurance companies are allowed to utilize employee health as a factor, thus helping to control cost for some employers.
In conclusion, deciding which new option is right for you or your business is a difficult one. Unfortunately, there is no one right answer for every situation, which is why it’s important to speak with a licensed insurance agent. VanVleet insurance will help you understand your options and help you choose which option makes the most sense for your unique situation. During the last open enrollment period, VanVleet Insurance enrolled hundreds of local individuals both in and out of the exchange. We have also helped many of our local businesses find solutions that not only fit their budget but help keep their workforce healthy and happy.
