Author Anthony Nefouse

chi-blue-cross-blue-shield-health-plans-renew--001Welcome to the new world of health insurance plans under the Affordable Care Act.

Some people have experienced premium joy. This has come from the Federally Facilitated Health Insurance Marketplace in Indianapolis. Hoosiers have been eligible for subsidized premiums in the marketplace.  The average subsidy we are seeing is about $2,800 a year.  On the high end, we have help many Hoosier in their early 60’s pick up subsidies for over $11,000 a year. The biggest subsidy I have seen so far is $15,900.  This has created a lot of premium joy for Indianapolis residents. They have had to make some difficult decisions on doctors though; the networks on the exchange plans are 40% smaller than what they use to be. In some areas there is no access to primary care doctors. There has been a lot of frustration getting these policies but now the process is getting a lot better.

Guaranteed Issue in the individual market has helped a lot people. When we look at policies off of the exchange, there is no more underwriting. This has increased premiums!  If you don’t qualify for a subsidized plan you may have premium shock.  Many young families in the area have been content with a $700 per month premium. That is no longer the case; these young families now are looking at $1,200 a month for a similar policy. On the plus side, the new policies have more coverage and cover maternity.

One of the key benefits to these new off-the-exchange policies is the traditional PPO network. Not all of the off the exchange policies have it but a few still do. So if you do not want to have to decide between doctors at medical facilities and would rather have the ability to go to almost any doctor, you still have this option.  The interesting thing is these traditional PPO plans cost about the same as narrow network plans.

Remember: there is an open enrollment season right now that ends on March 31 for both on and off the exchange plans. Get signed up now!

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If you to took out an individual policy from Anthem with a 1-1-14 start date, I would recommend making your payment online if you have not.

 

On Anthem On the Exchange Payment Portal  If you mailed in you check you will be better off submitted an online payment. Anthem is having a hard time processing the Paper Checks because they may not have the Anthem Control number on it. Without that control number they don’t know who you are.

 

Anthem Off the Exchange Payment Portal  Same issue with off the exchange business.

 

If you elected a January 1st effective date you have until Jan. 31st to get your payment made.

 

 

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narrownetworksIf you’ve been searching for a new healthy policy, you’ve probably heard by now about the narrow networks that are available. Since the insurance industry is trying to reduce costs, they have formed narrow networks to lower the cost of care. This applies to plans both on and off of the exchange.

In the beginning, this transition will be tough since many people will be forced to find a new doctor or health care provider. But it’s not an evil plan to keep you away from your family doctor. Narrow networks might be the solution that will help keep the cost of health care and health insurance down. Insurers say that limiting the size of the network allows them to steer patients to high-quality facilities and doctors, while the providers might consider price cuts since they will be getting new volumes of clients.

Fortunately, we still have the option for true PPO plans off the exchange. These plans have large national networks with access to health care. These policies are more expensive, but some people will find it worth the extra money to have this option. We still have a free market for health policies. There are not a ton of options, but we have a couple available. If you have the means and you do not want to change doctors, we can help you with that.

The plans designs are traditional co-pay and HSA plans.  There are also really rich plans in the Gold and Platinum categories. Please contact me if you want the rates for these plans; there are no more quotes, only rates!

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healthcare_reform_banner2_rdax_100We are starting to see the impact of Obamacare, both the positive and negative initial outcomes. It depends on every Hoosier’s individual situation to say if they feel joy or if they feel pain.

There is a lot of joy for Hoosiers that suffer from ongoing health conditions. This segment of our community is now able to get access to health insurance, which will lead them to receiving health care, sometimes for the first time in years. If you have ever been denied coverage then you know how frustrating this can be.  Those days are now over. Everyone is guaranteed issue and can not be carry the title of pre-existing condition.

If you have been priced out of the health insurance market, you may experience a lot of joy. With the Federal Facilitated Marketplace, you may be eligible for a subsidy which is going to reduce your monthly premium. We are seeing some estimates that the policy holder may not have a premium at all because the subsidy is more than the monthly premium. To go from not being able to afford a policy to getting a policy for free is extraordinary.

If you are healthy and do not qualify for a subsidy  you might be feeling pain right now. You have gotten a notice from the insurance company on how much your premium is going up in 2014, and these are very ugly increases. If you are a family of four, the new budget for health premiums is around a $1,000 a month.  This is creating a lot of pain for Hoosiers.

Small group health insurance premiums are going to feel a lot of pain also. There have been projections of 30%-60% increases. Most small companies can not absorb that kind of increase. Neither the employer or employee will be able to pay their portion of the premium. This could turn out to be a significant blow to small business. Small business owners are going to have to get really creative on keeping key employees. It’s difficult right now competing with large companies on employees. In 2014, it may be impossible.

One thing is for sure: we are a part of the biggest transformation in health care history. Everything is going to change.

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federal_exchanges_onpageThe new Indianapolis Health Insurance Exchange will go live in only one week!  Here at Nefouse & Associates, we are authorized to sell and service the exchange plans.

There will be four options of coverage: Bronze, Silver, Gold and Platinum. Under the Affordable Care Act, often referred as Obamacare, no one can be denied coverage due to pre-existing conditions.  The other huge benefit is the access to subsidies to lower your monthly premium. These subsidies will only be available through the Indianapolis Health Insurance Exchange.

We are predicting that you will enter an authorized quote engine (which we will provide) and that platform will guide you to the subsidy portal. Once at that portal, you will have the option to apply for subsidies. When your eligibility is determined, then you should be assigned some type of identification number and you would place this number on the health insurance policy. The federal government will then send money to the insurance company, bringing your monthly premium down.

So we are looking to major factors that are going to change the way we purchase health insurance. The first one is guaranteed issue, meaning that no one can ever be declined for coverage. The second factor is the access to subsidized premiums, making health insurance affordable to you and your family.

Currently in Indianapolis we have about 800,000 people without health insurance. It is being projected that about 300,000 take advantage of the new health care law.

 

 

 

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autismFor families that are faced with Autism, there is great concern about how the new health care laws will impact them.

All of the insurance companies that will be participating have filed their plans with the Indianapolis Department of Insurance. From what we can tell, it looks like all of the plans will cover the Autism Mandate. It doesn’t matter if the plan is on the exchange or off of the exchange, the mandate will be covered.

When we look a the Federal Exchange plans, these plans are all HMO plans (Health Maintenance Organization) and operating on narrow networks. These plans state they are covering Autism under the mandate. The question is this: how difficult will it be to go out of network for the treatment of Autism? Unfortunately, we cannot answer this until we have actual claims. On an HMO plan, your doctor is the gate keeper to all of your care, so every medical procedure would have to be approved by your attending physician. This would add one more layer to the process of getting a treatment covered.

Outside of the exchange, we should see the same level of coverage that we have today. If you purchase a policy on a PPO plan (Preferred Provider Organization), then you will have one less obstacle to getting care covered. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician. One issue that we are waiting on is if stand-alone child policies will be available, which would help families a great deal if they only have to pay premium on the child.

From a carrier standpoint, our options are going to be limited.  We predict there will only be a handful of carriers selling PPO plans off the exchange. Right now, it looks like Humana and Anthem will be the main carriers.  UnitedHealthOne and Medical Mutual will not be offering individual health plans next year. Autism treatment facilities will want to build relationships with Humana and Anthem as they may be the only carriers left in the PPO market.

If the exchange plans work out, we could end up adding three more carriers to the equation, which would give us a total of five carrier options. The question then becomes this: do you want to be the first person to file claims for the treatment of Autism with a carrier that does not have experience in that field?

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http://www.dreamstime.com/-image13756165For the 7,200 policy holders who currently have a health insurance policy through Indianapolis Comprehensive Health, I have some good news.

Most of you have never had good news when it comes to health insurance. Under the new health insurance laws, your luck might change!

The first and most important point is that you can not be declined or rated up for any ongoing condition. If you are on the ICHIA plan, then you know what it’s like to get declined for coverage. Well those days are over and  you could possibly see a rate decrease! We are still going to have age-based premiums, but you could end up getting a rich plan design for less of a monthly premium.

Don’t think that you’re stuck with only one choice for health insurance; there will be health insurance policies offered both inside and outside the exchange.  Should you want to really reduce your premium, you will have the option of buying an exchange policy with a subsidized premium. These policies will look like HMOs and have very narrow networks.

If you decide that you are not comfortable with the narrow network, then you can purchase a policy outside the exchange. We should have the option of open access PPO plans. PPO plans allow you to visit whatever in-network physician or healthcare provider you wish without first requiring a referral from a primary care physician. The premiums for these plans could, in fact, be cheaper than what you are paying right now.

It’s rare in the health insurance industry to be able to deliver good news, so we’re excited to be able to give you this! Stick with us for information about Health Care Reform, and once October 1 comes around, you can sign up for your insurance plan right from our website!

 

 

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rising-resize-380x300-resize-380x300By now, you might have heard that the Indianapolis Department Of Insurance projected a 72% increase in individual health insurance market for Indianapolis. The IDOI has also released the Individual Insurance Market Report, which goes on to explain this projected increase.

This is a legitimate explanation for the increase, and the only thing that is not included into the 72% is the eligibility for subsidized premiums in the exchange. In the report, it does show that about 500,000 Hoosiers will be eligible for subsidies.

First, you must understand the way the IDOI determined the rate increase. They compared current medically underwritten health plans (in which they use  medical or health information in the evaluation of an applicant for coverage), Indianapolis Comprehensive Health plans (ICHP) (guaranteed issue, a policy that is offered to any eligible applicant without regard to health status) with Silver Plans.

According to the report, if you take a healthy 25-year old male and compare health insurance now versus on a Silver Plan, the current rates are $108 compared to $266 on the Silver Plan, which is a 145% rate increase. Now let’s use the same example, but this time we add pre-existing conditions. On the ICHP, the cost is $304 verus $266 on the Silver plan.  This is a 12.5% decrease.

In this example of healthy versus non-healthy, the non-healthy individual would benefit from the law with a rate decrease. Then, we add in subsidies and there may be real premium joy. For the healthy person that does not qualify for subsidies, now they have premium shock.

The report also looks at a 55-year old couple with excellent health and then with poor health. They may be paying $673 a month currently versus $1,188 on the new silver plan. This is a 76% rate increase…premium shock! If the same couple is unhealthy, they may be paying $1,673 a month on ICHP versus $942 on the Silver plan, which is is a 43% decrease. Premium joy!

I have two categories for post-Health Care Reform: Premium Joy and Premium Shock.

To get to Premium Joy, you will have to qualify for subsidies. To be really happy with the premium, one will need to be under the 250% Federal Poverty Level. Premium Shock is going to hit  Hoosiers that have household incomes over the 400% FPL.  These people could see 100% increases or more in premiums

Under the new law, everyone will have the same access to health insurance, which will help many Hoosiers. For instance, take the 7,200 people on the ICHP. The policy holders went to this high risk pool because they were turned down by a private insurance company. Each of those policy holders could see 25%-35% reduction in premiums in 2014.

So while the report states there will be a 72% increase in health insurance, that statement is only accurate if you don’t include federal subsidies.

 

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