I’m writing this post in late August 2016. By now, most people are aware of the big news – that Aetna decided to pull out of 11 states in 2017. Some experts are saying this is the unraveling of Obamacare. Regardless of the what the future holds, we now have a much different and more challenging health insurance landscape.
Aetna currently offers plans off the Exchange in Georgia. They also offer plans through their subsidiary – CoventryOne – on the Exchange. In 2017, both Aetna and Coventry plans will no longer be available in Georgia – either on or off the Exchange. If you’re confused about “On Exchange” versus “Off Exchange”, I’ll address that below.
United Healthcare already decided to pull out of the Exchange too, so they will no longer offer personal plans in Georgia. UHC has a wholly-owned subsidiary – Harken Health – that will still offer plans on and off the Exchange. Harken Health is a little different than other carriers and they are only offered in two metro areas: Atlanta and Chicago. You can read a Harken Health review I wrote. In the review, I cover the pros and cons of this new carrier.
The Personal Plans Market (aka, non-group plans)
Keep in mind, all this news pertains only to the personal plans market – also known as individual plans (or non-group plans). This market makes up about 6% to 8% of the US population. Close to 50% of the population has their coverage through an employer. The rest of the population has their coverage through Medicaid, Medicare, and other public sources. Depending on who you ask, the uninsured rate is somewhere between 6% and 10% of the population.
In Georgia, only 6% (approximately) of the population have personal plans.
I mention these stats because whenever people see headline news about carriers like United Healthcare, Aetna, and Blue Cross Blue Shield, they think it will affect their Medicare Supplement or Medicare Advantage plan. Sometimes, people think it affects all plans, including their employer-based plan. Not so…the big news of late is with personal plans.
Again, personal plans, including on-Exchange plans and off-Exchange plans, only represent a small, but significant percentage of the US population.
Okay, so we got that cleared up. Now, for those of you who have a personal plan, keep reading…
On-Exchange vs Off-Exchange Plans
- On-Exchange plans refer to plans sold on the Marketplace. The reason people go to the Marketplace is due to the financial subsidies (Advanced Premium Tax Credits) available based on income. To get an on-Exchange plan you must go through the Marketplace. You can start the process through a web broker, but the application and subsidy determination has to be approved at the Marketplace. A good web broker is Health Sherpa. You can see plans, rates and apply for coverage using Health Sherpa.
- Off-Exchange plans. Some carriers offer plans off the Exchange too. If you don’t qualify for a subsidy based on income, it’s usually better to get Off-Exchange plans. I go into detail on this subject in my 57-page eBook on purchasing health insurance. You can still get a policy through the Exchange, via healthcare.gov or (a better, easier method is Health Sherpa) even if you don’t qualify based on income. I cover all the pros and cons of the Marketplace versus off Exchange in my eBook. I will send it to you upon your request. The eBook will be updated for 2017 Open Enrollment.
Individual Health Insurance in Georgia 2017 – Blue Cross Blue Shield and Other Carriers
One of the lowest-cost carriers for the past few years – Humana – filed for huge rate increases for 2017. They were approved for a 67.5% rate increase. That is unprecedented for Humana! If you’re with Humana now, then you’ll probably want to make a change for 2017. If you have an off-Exchange plan, you will not have a choice. They will no longer offer plans off-Exchange in 2017. I have my coverage through Humana, so I am in the same boat as you.
Harken Health was also a low-cost carrier in 2016. Since they were so new and unproven, most people stayed away. They also were approved for an enormous rate increase – 51%
Kaiser Permanente hasn’t been very competitive in recent years, but they only filed for a 17.6 rate increase, so they could be a decent option in 2017. Keep in mind, they only offer HMO plans. However, Kaiser Permanente has consistently been rated a top carrier. People who have KP seem to really like them.
Blue Cross Blue Shield – A Review of their Plans and Rate Increase
Blue Cross Blue Shield dominates in Georgia and they have for a long time. Even when their rates were higher than most, people would flock to them because of their name recognition. They will (as of today) only offer HMO plans in 2017. Their HMO network is anemic, so you will need to check it out carefully. Blue Cross Blue Shield has been fairly competitive in 2016. Most of my clients opted for either Aetna, Coventry or Humana because their plans were similar or better than BCBS and had lower premiums. Also, many people preferred a national PPO or POS network. This could change in 2017.
Blue Cross Blue Shield originally filed for a 15.1% premium increase. Then, they filed for a rate increase of 21.4% AFTER they learned that Aetna was pulling out of Georgia. This was recently approved by the state.
Fewer carriers = Less competition = Higher Premiums
Lack of competition hurts the consumer, as we all know. Blue Cross Blue Shield did pretty well with their very small HMO networks over the past couple of years. They figured out how to attract customers, but not the sickest ones (who prefer better provider networks). Unfortunately, this seems to be the trend and the formula for carriers to be profitable (or at least to hang in there until things improve).
The annoying part of all this is that carriers don’t release their rates until just a week or so prior to Open Enrollment on November 1. I’ll do my best to inform people as to the best options. Even though most carriers don’t pay commissions, I’ll hang in there and continue to help my clients. Sometimes, I feel like the musicians on the Titanic, who kept playing their instruments as chaos, panic and disaster surrounded them.
Don’t worry though – I’m not fatalistic. I enjoy what I do and I like to help people. I am very practical and will inform you of the strategies I use to make the best of a bad situation.
I do a lot in the Medicare market (where they still compensate agents), so if you are close to age 65 or know someone else who is, please let me know. I also sell all the best life and disability insurance plans. Don’t hesitate to call me for advice.
Greg Sanders 678-236-1600
