We know that the future of the healthcare industry is uncertain. That’s why we have created four recommendations for the coming open enrollment period (OEP). Last week, we discussed our first recommendation, group health insurance plans (link when that one is published). This week, we examine Affordable Care Act (ACA)-Compliant insurance plans for individuals.
Individual health plans are for people who don’t get insurance coverage through their employer and are not eligible for Medicare or Medicaid. Unfortunately, there are fewer individual health insurance options for agents to offer their clients during the 2018 OEP. Carriers are pulling out of counties across the nation because of the uncertainty of the future of the ACA and the industry as a whole. With limited options and massive rate increases, clients and agents alike are concerned about the long-term stability of the individual market.
Pro’s and Con’s for ACA-Compliant Individual Health Plans
For health plans to be compliant, they must be qualified. The Health Insurance Market qualifies plans and these plans provide essential health benefits, follow established limits on deductibles, co-payments, and out-of-pocket maximum amounts while also meeting other requirements under the ACA. All qualified plans must meet the ACA requirement for having minimum essential health coverage.
Although the marketplace is experiencing instability, there are advantages for ACA-Compliant plans. As of 2014, all plans became guaranteed issue, which means that medical history will no longer keep someone from obtaining coverage. Other advantages of ACA-Compliant plans are that they cover all required benefits like maternity leave, mental health care services, and more.
Con’s of ACA-Compliant individual plans include higher premiums and co-payments, limited networks like Health Maintenance Organizations (HMO’s), and dealing with the individual insurance marketplace. For those with many medical expenses throughout the year, the silver lining of higher out-of-pocket costs is that all plans are subject to out-of-pocket maximums. The maximum for individuals in 2017 is $7,150. If a consumer reaches this amount, their health insurance carrier will begin to pay 100% of medical expenses.
Additionally, there are pro’s and con’s regarding HMO health insurance plans. These plans are the most popular plans to purchase as they offer a wide variety of care from the doctors and healthcare providers within the network. However, they can seem limiting since they usually require a primary care physician to coordinate care and refer patients to specialists.
Help Your Clients Pick The Right Plan
The OEP for 2018 coverage is a short 45 days beginning November 1st and ending on December 15th. You can get ahead of the game by dedicating more time to knowing everything you can regarding the options available in your market. By doing so, you will help your clients pick the right plan for their needs and will be able to spend more time enrolling. You should know the following policies regarding the plans available in your area:
- Deductible amounts
- Coinsurance agreements
- Pharmacy benefits
- Available subsidies
- Possible penalties
If you missed our recent blog on 6 ways you can prepare for a smooth OEP, catch up here. The goal is to sign up as many clients with the right plan for them during OEP. You can do so by knowing the in’s and out’s of the available plans and following the information on the blog linked above to have a successful enrollment.
If you are an individual seeking medical coverage, find out if you qualify for a subsidy, which is based on your income. If you do qualify, you must purchase insurance through the exchange as that is the only way subsidies are available. If you’re an insurance agent, take the next step in preparing for open enrollment by calling Myra Gifford at (800) 960-1371 ext. 1213 for more information on ACA-Compliant individual health plans.