The First Stage of Open Enrollment has Been Completed for Both Individual Health Insurance on and off the Exchange.

costsThere is not a lot of good to mention for policies off the exchange. With Humana and Assurant leaving this Indiana market, this has left just one insurance company offering a PPO plan. That company is United healthcare.

United Healthcare has publicly stated they want to limit the amount of policies they sell in both Indiana and the rest of the country.

They have removed all online quotes and online applications from their broker distribution channels. This has created a lot of issues because the only way to get rates is for the broker to call in and retrieve them. This step should not be a problem, but the carrier has repeatable given out the wrong rates. I don’t believe this is intentional but it comes from a lack of training.

Narrow networks will be the only option in 2017. It is my view, that United Healthcare will pull the current PPO plan move to more of a gatekeeper. This will be for both on and off the exchange. This will have a dramatic impact on Hoosiers. The options in the individual market will become options of networks.

For the many micro companies with less than 10 employees, many have dropped group benefits and moved to the individual markets. With tax credits and employees being able to decide on health options, this was is a very attractive option. With narrow networks on the horizon for all individual plans, small group employer will look at group health plans again. This will happen.

There has been one new carrier to the Indiana market that has lowered premiums, that is the IU health plan. This is a traditional HMO and I think will become the norm in the individual market. If you are wiling to move to this type plan, this is the only low costing health plan on the market. If they are successful and they might be, this will become a trend with all carriers in Indiana.

The Affordable Care Act, is not working the way the authors had intended. The Insurance companies have implemented many cost controls that most people have not experienced. Now plans have step procedures in place before covering higher costing services.

To get an MRI for back pain, you may have to go 6 weeks of treatment before that diagnostic service is covered. Brand name drugs are going to go towards the deductible 9 times out of 10. Pre authorization is going to be needed on almost every procedure, the attending physician is going to have to prove the procedure is needed. With some companies they will only pay 65% above the Medicare reimbursement rate. This is serious because the doctors are not aware of these restrictions or reimbursement rates when they agree to the network contracts.

These type of cost controls are just the beginning in the individual market.They will continue to get more restrictive.

2016 may be the beginning of the end of the ACA as we know it. The changes that are on the horizon do not look good for the insured.

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