You like your health insurance plan. You want to keep it in 2017.
The potential problem?
As we experience each year, there will be shifts in the health insurance market for 2017 open enrollment, and those shifts will include the cancellation of some health plans. As such, your health insurance options may look a little different when 2017 open enrollment begins.
One big change that made headlines in recent months was UnitedHealthcare’s announcement that it will pull out of about 34 state-based and federally facilitated exchanges next year.1 The company cited increasing losses on Obamacare plans as the reason. More co-ops created as a result of the Affordable Care Act have also announced their dissolution. Of the 23 health insurance co-ops launched in 2014, at most seven will remain for 2017 open enrollment; as of July 2016, four additional co-ops have failed in 2016: Ohio, Connecticut, Oregon and Illinois.2 There will surely be other companies and plans entering and exiting the individual market as well.
You may be among the individuals and families who can’t re-enroll in the same coverage.
Here are three common reasons some individual and family health insurance plans could be cancelled for 2017—and three ways you can handle such situations.
1. Your health insurance carrier stopped selling exchange-based plans or exited the individual market completely.
Each year, health insurance companies enter and leave the state-based and federally facilitated health insurance exchanges. Some continue to sell individual policies in the private market, while others leave the individual market completely—either nationwide, statewide or regionally.
If you currently have an individual health insurance plan through UHC or one of the failed co-ops that had announced their closure as of mid-July, you already know this is our situation and your insurer will send notification. Others may not yet know if their plans will or will not be available. When a plan will be cancelled because will no longer be available, insurance companies must provide at least 90 days notice in writing to each covered individual.3
We do not yet know all of the changes in store for 2017 open enrollment. However, 50 health insurance carriers left the ACA’s state-based and federally facilitated health insurance exchanges for 2016 open enrollment.4 Perhaps one of the biggest hits to consumers came with Assurant Health’s departure. In June 2015, Assurant Health announced that it would no longer sell individual major medical insurance, small group fully insured, and short term health insurance policies as of June 15, 2015, and that it would not participate in 2016 open enrollment.5 The company insured nearly 1 million people.6
2. Your state’s health insurance co-op is closing.
As mentioned above, by mid-July 2016, more Obamacare health insurance co-ops had announced their closure and seven remained for 2017 open enrollment. That means 16 of the original 23 co-ops formed under the Affordable Care Act will be closed by year-end 2016. When you consider that Colorado HealthOP, Colorado’s co-op covered 40 percent of the state’s exchange population—more than 80,000 people7—and Health Republic Insurance of New York, New York’s co-op, covered more than 200,000 individuals on and away from the state’s Obamacare exchange, it becomes clear these closures have impacted hundreds of thousands nationwide.
3. Your carrier stopped offering PPO plans.
A PPO, which stands for preferred provider organization, is a type of health insurance plan that typically gives consumers the option to select in- or out-of-network healthcare providers.8 In what seems to be a market-wide trend, many insurance companies reduced or eliminated their PPO plan offerings for 2016.
While we do not yet know the statistics for 2017 open enrollment, as plan offerings have yet to be finalized, here is what happened in 2016:
A Robert Wood Johnson Foundation analysis of Marketplace plans (i.e., plans offered through state-based and federally facilitated health insurance exchanges) found that 33 percent of 2015 silver plan PPOs remained available in 2016, and in 22 states, all 2015 PPO offerings were dropped or reduced.9 According to the analysis, the PPO plans were dropped either because the carriers exited the market or because the carriers discontinued their PPO plans.
Blue Cross Blue Shield of Texas discontinued all its PPO plans for individuals and families starting Jan. 1, 2016, which impacted about 367,000 Texans, and Humana is no longer offering PPOs on HealthCare.gov.10 In Arizona, Aetna, Blue Cross Blue Shield, Cigna and Meritus stopped offering PPO plans through the state’s federally facilitated exchange.11 In 2016, there were no PPO plans available in Miami and most Florida counties, much of Texas, New Mexico, New York, and many counties in Mississippi and South Carolina.12 Alaska, Arkansas and Wyoming, however, only offered PPO plans in 2016.
The other types of health insurance plans available to consumers who no longer have access to PPO plans may include HMO (health maintenance organization) plans, PPO (point-of-service) plans, and EPO (exclusive provider organization) plans.13 These plans have various restrictions regarding in- and out-of-network care—click here for a basic overview. If you have questions about the differences between the health insurance plan types offered in your area, consult with a health insurance producer or contact the insurance company whose plan you are considering.
There are other reasons your health insurance plan may be cancelled, including the discontinuation of grandfathered plans. No matter why your coverage might cease to exist at year-end, your health insurance company will notify you in advance. If you have questions or concerns about your 2016 coverage not being available in 2017, contact your health insurance company.
What to do if your 2017 health plan has been cancelled
Here at HealtheDeals.com, we often remind consumers the importance of shopping around and comparing plans rather than automatically renewing one’s health insurance coverage from year to year. Sometimes you find a plan more suitable to your needs and financial situation. Sometimes you decide your current coverage remains the right option.
But when your current coverage is no longer an option for the next year, it can often feel like starting from square one. Here are three key things you can do if you find yourself in this situation.
1. Shop and compare plan options. Then, enroll by Dec. 15, 2016, to begin coverage Jan. 1, 2017.
Start exploring your 2017 health insurance options as soon as possible—click here for tips to help you begin.
If you plan to apply for financial assistance in the form of premium tax credits and/or cost-sharing reductions, you must enroll in a health plan offered through a state-based or federally facilitated health insurance exchange.
If you don’t qualify for a subsidy or don’t want to apply for one, you can still shop the Obamacare exchanges as well as the private market—keep in mind subsidies are not available in the private market.
Get help from a licensed health insurance producer or exchange-based helper if you have questions or need assistance.
2. Get a short term health insurance plan if you need more time.
Open enrollment coincides with the holiday season, which can be a busy and stressful time of year for many. If you don’t think you can make the Dec. 15, 2016, enrollment deadline for Jan. 1, 2017, coverage and need more time to find the right ACA-compliant major medical plan, you might consider a short term health insurance plan in the meantime.
These temporary plans offer some financial protection from the unexpected when you are in between Obamacare plans. They last as few as 30 days and provide benefits for covered healthcare expenses you may incur from an injury or illness. It is important to note that short term plans are not considered minimum essential coverage under the ACA, and they are not ACA compliant, which means you may be denied coverage based on health history.
3. Consider medical gap insurance.
If you find yourself with a high deductible health insurance plan—for instance, maybe you move from silver to bronze coverage—you may want to consider medical gap insurance. Medical gap plans such as Metal Gap and Metal Gap 2, which are available through healthedeals.com, provide lump-sum benefits that help you pay for out-of-pocket healthcare expenses when an accident or critical illness occurs.
Metal Gap and Metal Gap 2 plans are guaranteed issue, which means your health history won’t impact eligibility. Metal Gap plans cost about $1 per day, and Metal Gap 2 plan premiums vary. Plan availability varies by state. Click here to learn more about how medical gap plans work.
You can get quotes for Metal Gap and Metal Gap 2, short term health insurance, and off-exchange Obamacare plans at healthedeals.com.
Need help? Call the number at the top of your screen to speak with a licensed health insurance producer who can answer your questions, assist you with plan options, and provide a quote.