Tuesday, August 23, 2016

Options Limited for Health Insurance in 2017

If you buy individual health insurance (especially via healthcare.gov), your options WILL be limited this upcoming year.

Right now DuPage County (IL) has 4 options. Aetna, BCBS of IL, Coventry, and United Healthcare. BCBS and Coventry have PPO networks. In 2017, you will have BCBS and Cigna only as Aetna, Coventry, and United Healthcare pull out. Cigna will be an HMO. This means the ONLY PPO network available will be the Blue Choice PPO network via BCBS of IL (assuming they continue this plan, which I think they will). If you need a variety of specialists who are not in the same medical group, you will either have to pay out of pocket or change doctors.

Cook County won't be much better. You have 7 options, but 3 will be going away (see above). Harken Health (who currently has the best PPO network) will be changing the network to either a smaller PPO network or HMO (they haven't told me yet). In 2017, you will probably have Ambetter, BCBS of IL, Harken Health, Humana, and newcomer Cigna. The only two that would possibly have a PPO is BCBS of IL and Harken Health (see above).

Downstate will at least have Health Alliance (as of my writing this article) who offers a POS plan (less restrictive than an HMO, but not quite as flexible as a PPO) in addition to BCBS of IL.

BTW, I didn’t mention the premiums. Go to https://ratereview.healthcare.gov/ if you want to see how bad it is going to be.

To help people who can’t afford the cost, I have a new plan that is NOT insurance but is a cost sharing ministry that will be available to those who just can’t afford the new premiums. It avoids the penalty and has some holes, but something is better than going with nothing. If you want more information on this, contact me. The good news is that you can sign up at any time, but it does NOT cover any pre-existing conditions or medications other than generics. View this as a “last resort” plan.


1 comment:

  1. This is a follow up to this post. Note that this insurance company is focusing on limited network plans (e.g. HMOs and very narrow networks) and pulling out of unprofitable areas. Realize that the government charges insurance companies 3.5% of the total premium for the privilege of offering them on the exchange (they do receive some benefits, like customer service reps from the government for this 3.5%). If they stay out of the exchange, they just boosted their profit by 3.5%. Also this 3.5% is taken off of the 20% maximum profit they can make (they have to give 80 cents of every dollar back in the form of a patient benefit - e.g. paying claims, customer education, etc.). That 20% is all they have to pay their bills, government taxes, this 3.5%, etc.

    This company (Oscar) is also going into the small group market. This is a healthier market in general.