There will be limited options for individuals seeking compliant healthcare coverage during this year’s open enrollment period (OEP). Many insurance companies have opted out of the individual marketplace because of the uncertain future of the Affordable Care Act (ACA) and the healthcare industry as a whole. Kentucky will have two carriers for 2018, but there are a few other options your clients may be interested in, which we will highlight over the coming weeks.
The companies that haven’t already opted out due to the ACA’s instability are worried cost-sharing reductions will be reduced or cut out altogether. If this is the case, premiums will greatly increase and new rates will have to be filed. As an agent, it is your job to know the options that are available as best as you can. Then you can focus on enrolling as many of your clients as possible throughout the OEP. We have created a recommendation list for the 2018 OEP, which we will be writing about over the next few weeks to help you have a successful enrollment period. To start us off, below is an overview of the marketplace and what makes up qualified plans.
Kentucky’s Individual Health Insurance Options for 2018 Open Enrollment
This year is the first year open enrollment will end before the new year begins. Come January 1st, 2018, the client’s chosen plan will kick into effect and there will no longer be an option to switch to a new plan after the start of the year.
The health insurance marketplace is where individuals who do not have employer-provided coverage can get compliant health care coverage through private insurers. Kentucky will only have two available carriers in the marketplace for coverage in 2018 and half the counties will only have one option for coverage.
While two options at max seems low, Kentucky is lucky to have every county covered. There are some counties across the nation with no options for healthcare and the number will likely rise before OEP begins.
Anthem will offer coverage in all 120 counties and CareSource will offer coverage in about 60 counties in the Eastern part of the state. Although there are only two options, they both provide qualifying coverage meaning they offer the minimum essential coverage that is required by the ACA.
Both Anthem and CareSource have increased their rates under the assumption that cost-sharing reductions will continue to be funded. Anthem will have a 34.1% rate increase and CareSource will have a 20.8% rate increase.
What Are Minimum Essential Benefits?
President Obama signed legislation in 2010 that requires all health insurance plans from 2014 and on to cover ten essential benefits in order to be compliant with the ACA. Since Congress has been unable to replace the ACA, this legislation is still in effect. All plans for 2018 coverage must include the following:
- Emergency Services
- Ambulatory Services (to doctors, other healthcare professionals, and outpatient hospital care)
- Maternity and newborn care
- Mental health care and substance abuse services
- Prescription drugs
- Lab tests
- Chronic disease management, which includes preventive services like screenings for blood pressure, breast and colorectal cancer, breast-feeding counseling and more
- Pediatric services including dental and vision care
- Rehabilitative services, which include helping a person keep, learn, or improve daily life functionality
States have the flexibility to create their own benchmark plan, which is a plan that serves as a minimum standard on which all new plans are modeled. Although there is some flexibility, all plans must include the minimum essential benefits. Catch up on of our latest posts where we discuss the latest healthcare industry news for more information.
We exist to support insurance agents through superior service, trusted carriers, and innovative processes. We understand that the uncertain future of the healthcare industry can seem daunting, but our team members are here for you, especially our Benefits Department who can help run quotes quickly, customize plans, maintain compliance, and educate the workforce. Contact us to see how we can help and keep an eye on our blog as we introduce four options for this year’s open enrollment.