Open Enrollment for 2016 has begun. Individuals and families can select a health insurance plan for next year from November 1, 2015 through January 31, 2016. An enrollment must be completed by December 15th to receive a January 1st effective date.
There have been changes in the companies that are available in the Nebraska market.
• BlueCross BlueShield will continue to offer products both on and off the Marketplace. Network Blue is the provider network that BCBS policyholders will use.
• Coventry will also offer products on and off the Marketplace, but the products are different from those offered in 2015. Those who lived in Lancaster County in 2015 and were enrolled in a Coventry individual health insurance plan were required to use the St Elizabeth Regional Medical Center network of providers. This is an HMO network that does not offer any out-of-network benefits. This means that if you used a doctor or hospital that was not a part of the St Elizabeth’s network, no benefits were provided by the Coventry policy. Coventry offered other HMO networks in the Omaha metro.
The St Elizabeth network will not be available in 2016. All areas of Nebraska, except Dodge and Sarpy county, will use the Coventry POS network. (Coventry does not offer plans in Knox and Thurston counties in Nebraska.)
• Medica is the new insurance carrier coming to Nebraska. The company is based in Minneapolis and has been in the health insurance business for 40 years; offering coverage in Minnesota, Wisconsin, North and South Dakota. Their products will be available both on and off the Marketplace and will feature the Midlands Choice network for all plans.
• United Healthcare has offered health insurance coverage in Nebraska for many years but has not participated “on” the Marketplace. In 2016, UHC will have plans both on and off the Marketplace. Plans offered on the Marketplace will use the Compass network of providers and will be an HMO. Policyholders are required to select a Primary Care Physician (PCP) and must have a referral to see a specialist. No benefits are available outside of the Compass network. The network for health insurance products that are available off the Marketplace will be Choice Plus, which is the network that has been used by UHC in Nebraska for several years.
Insurance companies are required to adjust the benefits offered on a policy to comply with the Actuarial Value guidelines of the Affordable Care Act. This means that deductibles, maximum out-of-pocket expenses, and copay benefits may change in 2016. An example would be that the 2015 Gold plan had a deductible of $1200, but the 2016 Gold plan deductible will be $1500. Copays for doctor visits and prescriptions may increase. Some plans that were offered in 2015 are being discontinued. Your insurance company will offer to renew your coverage with the 2016 plan that is closest to your 2015 benefits.
You may be eligible for financial assistance through the Health Insurance Marketplace if your income for 2016 will be 100% to 400% of the Federal Poverty Level. A single person’s income can range from $11,770 to $47,080. The income range for a family of 4 is $24,250 to $97,000. http://familiesusa.org/product/federal-poverty-guidelines
Our best advice is to review all your options for next year. The medical needs from year to year will vary. If you expect to have more medical expenses next year because you plan to have a baby or have your knee replaced, you will need a different insurance plan. If your income will be different next year, it may impact your choices for health insurance. Those who enroll through the Marketplace should update their application to be certain that your Premium Tax Credit is calculated using correct information. If you allow the Marketplace to do it for you, it will be based on financial data from your 2014 or earlier tax return; which may not be in your best interest. Health insurance is complicated. Contact your agent or ComPro for expert advice.
by Chris McPike, Vice President
ComPro Insurance
402-488-5100 |www.comproins.com