Indiana Health Insurance Company 03a56050

We are now three weeks in the Affordable Care Act’s 4th open enrollment. It is fair to say this will be the last open enrollment under “Obamacare”. A new system of health insurance for the individual market will be developed for 2018 and beyond.

For 2017, it’s important to realize that the health insurance decision you make, is only for one year.

Indiana Health Insurance Company Individual Rates

2017 individual rates are very confusing. There are some carriers that took a rate reduction, others took a 35% rate increase and there are others that left the market completely. From the outside looking in, it makes no sense, even from the inside it’s hard to understand.

The carriers that have low premiums, built their networks based off their Medicaid business models. This does not mean medical providers are providing a lower level of care! It is about the insurance contracts and the amount of money being reimbursed to the doctors.

We have had a chance to go through some of these insurance contracts. There are a couple areas of “shadiness’” that appeared. Most if not all procedures, have a prior authorization. This is not that unusual, but when the contract states, “even if authorization is approved, that does not guarantee payment”, this is shady! The insurance company approves the procedure, but then can decide not to cover it. The entire point of a prior authorization is confirming the services are going to be covered.

Under the current law, all emergency rooms must be covered as in network. The contract language is stating that coverage will only be paid at the Medicare reimbursement rates and you could get balanced billed.  Again, shady contract language.

The premiums are low vs an Anthem, that pays claims.

Indiana Health Insurance Company Exchanges

On exchange, some of the carriers have specific built plans to receive cost sharing reductions (CSR). CSR is when the out of pocket is reduced based on income. If you are eligible for the CSR, these plans look great. They have $1 co pays for office visits and no deductible plans.

In full disclosure, we are an agency that makes commission paid by the insurance companies.

The reason I bring this up is because, there looks to be a direct correlation with level of complaints insurance companies and if they use a broker distribution channel.

Indiana Department of Insurance Complaint Index for 2015

Individual health insurance companies with no broker distribution

  • CareSource                         11.21%
  • Coordinated Care Corp   18.53%
  • MD Wise Marketplace    10.86%

Individual health insurance companies with broker distribution

  • IU Health Plans        3.39%
  • All savers Ins Co       9.4%
  • Anthem                      0.78%
  • Golden Rule             0.80%
  • Humana                   1.33%
  • UHC                         1.90%

The companies that do not use brokers to educate Hoosiers on what they are buying, has double digit complaint ratio! Why is that?

Allsavers, has a high complaint ratio, this could be contributed by the fact this was their first year on the marketplace and they were not prepared to service the block of business they picked up. They made a mistake on which platforms to administer this individual block, they used a small group platform that was not integrated with the customer service.

Indiana Health Insurance Company Options

Bottom line for 2017, there are no good options. You must pick the best of the bad options based on your situation.

If you are healthy, you could go with one of the low-cost plans on the exchange. Another option is to go with a plan that does not have your current doctors in network.

If you have health conditions that are needing a high level of care, look at the carrier contract before enrolling. Look up your current drugs to see if they are covered and if they are doing what they require prior authorization? Look at network access, because plans no longer have out of network benefits.

Remember this is only for one year.