Important Information About Your Individual Health Insurance Coverage for 2017

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IMPORTANT INFORMATION ABOUT YOUR INDIVIDUAL HEALTH INSURANCE COVERAGE FOR 2017

I wanted to provide you an update of the dramatic changes we anticipate in the individual health insurance market for the Jan. 1, 2017, open enrollment.

First - if you have a grandfathered health insurance policy (you have maintained your same plan since prior to March 23, 2010) - the below Changes Will Not Affect Your Policy. You may keep your grandfathered plan for 2017.

For anyone who made policy changes after March 2010, or purchased a metallic ACA plan in 2014, 2015 or 2016 the following applies:

The individual plan designs and rates for 2017 will be available November 1st, when the ACA individual open enrollment begins. In order to receive a January 1, 2016 effective date - you must enroll in a new plan by December 15th . If you enroll after December 15th, you will not have coverage until February 1. So it is VERY IMPORTANT THAT YOU ENROLL BY DEC. 15th. This is an ACA rule, and is true for all plans and carriers.

We are monitoring all the individual health insurance carriers offering coverage for the 2017 open enrollment, but will not have access to the rates or plan designs before November 1st.

BCBS announced they will continue to offer their HMO plans in Texas (HMO network much larger in 2017) for individual health insurance policies (again - does not apply if you are grandfathered with an older plan issued before March 2010.) We are expecting a 58% rate increase.

- BCBS HMO Network (Blue Advantage)

Must choose a Primary Care Physician and will need to obtain a referral to visit a specialist in-network.

No coverage outside of the network

- BCBS HMO Plus (Blue Advantage)

Must choose a Primary Care Physician and will need to obtain a referral to visit a specialist in-network.

There is coverage outside of the network, however you still must obtain a referral. Out-of-network claims will be subject to higher out-of-pocket costs. This plan is considered a POS (Point Of Service) plan.

AETNA - Will offer off exchange plans using a limited network. They will not be paying commissions or working with brokers, so if you currently have an Aetna plan you will need to contact them directly regarding any plan offerings for 2017. Expecting 15% rate increase.

CIGNA - Will offer off exchange plans using a limited network. They will not be paying commissions or working with brokers, so if you currently have a Cigna plan you will need to contact them directly regarding any plan offerings for 2017. Expecting 23% rate increase.

HUMANA - Will offer on and off exchange plans using a limited network. They will not be paying commissions or working with brokers, so if you currently have a Humana plan you will need to contact them directly regarding any plan offerings for 2017. Expecting 45% rate increase.

UnitedHealthcare One - Pulled out of Texas for 2017. If you had a plan with UHC, you will need to find a new carrier for Jan. 1.

SCOTT & WHITE Health Plans - They are offering one PPO and one HMO plan off the exchange both with very high deductibles. They have their own HMO Network, which utilizes Baylor facilities and doctors. Their HMO plan is a point of service (POS) plan that does not require a gatekeeper (Primary Care Physician) referral, and you can use any doctor (including specialist) in their network. They also have limited coverage if you go outside the network. If you are comfortable with limiting your provider options to the Baylor facilities, this may be an option. They are paying limited commissions, so we will not be selling new business with them in 2017. Expecting 30% rate increase.

Oscar Health - Will also be using the Baylor Scott & White network, but only for residents in Dallas, Tarrant and Collin counties. They will offer on and off exchange plans, but will not be paying commissions or working with brokers in North Texas, so if you currently have an Oscar plan you will need to contact them directly regarding any plan offerings for 2017. Expecting 18% rate increase.

Molina Health - Will be offering on exchange HMO plans in Collin and Dallas counties using the Baylor Scott & White network. Expecting 11% rate increase.

Other Options -

If you have a business entity, you may want to consider a small group health plan that will provide access to BCBS, Aetna and UHC national PPO networks. The ACA permits a company with two owners or one owner and one employee (fulltime or part-time) to purchase group health insurance if the individuals are employees, partners or officers of a business. This may be the best option for those who have a business entity. Contact us for more information.

Another option that is not health insurance but does exempt their customers from the ACA individual penalties for being uninsured, are the Claims Sharing Ministries, MediShare and Altrua(TX Based). Keep in mind that they do limit benefits for pre-existing conditions.

We recommend that you start checking with your physicians to determine which networks they accept, and if you are considering an HMO, be sure that you can get the Primary Physician of your choice and that they are accepting new patients.

The NEW REALITY is that there will be less choice and higher premiums in 2017 for individual health insurance policies. Individuals will have to choose a plan and choose to use the doctors covered in that plan. In other words, you may not be able to keep your current doctor. You should be pro-active NOW and determine if your doctors are in any of these networks, so you can narrow down which plans and networks will work for you. Remember, once you sign up you may only make a change at the next open enrollment, so if you choose the wrong plan, you may be locked-in until next year.

After November 1st, you may access the plans, rates and enroll from our website: www.insuranceisboring.com

An excellent add-on benefit to supplement the high deductible plans under the ACA is Healthiest You an affordable teledoc and discount Rx coupon service for individuals and families. Additional information can be found on our website.

Please feel free to contact us after November 7th, when we will be better equipped to answer your questions.

We appreciate your using us as your Agent in the past and, we regret that many of the insurance companies have decided to move forward without broker involvement.

Please contact us with any questions.

Thank you,

George Knox, CLU, ChFC

214.695.2904 (mobile) | 214.443.1400 (office) | [email protected]

Please Note: The information and materials herein are provided for general information purposes only and are not intended to constitute legal or other advice or opinions on any specific matters and are not intended to replace the advice of a qualified attorney, plan provider or other professional advisor. This information has been taken from sources which we believe to be reliable, but there is no guarantee as to its accuracy. In accordance with IRS Circular 230, this communication is not intended or written to be used, and cannot be used as or considered a 'covered opinion' or other written tax advice and should not be relied upon for any purpose other than its intended purpose.

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