As we wind down 2013, I’d like to say thank you to all those who read my blog. I’ve had many people, especially in the past few months, tell me they called because of information they found here. I am glad this information is useful for so many folks.
These past few months have been the busiest in my 14 year career as an insurance agent. Numerous people had questions about how the Affordable Care Act would impact them…which leads me to the subject of this post: Lots of Changes in 2014!
Most people now have a handle on the major changes in health insurance due to Obamacare, but there are plenty of changes that aren’t so major, yet are important to know.
There have been some changes in where carriers are now doing business. Many carriers have pulled out of areas where they are not very profitable. United Healthcare is not offering Qualified Health Plans in the personal plans market in Georgia. This means they no longer offer insurance On or Off the exchange (Marketplace). Expect to see more of these changes in the future. As claims start rolling in during 2014, carriers will be forced to make more changes.
Rate Increases: Many group health insurance plans will experience higher than average renewal increases in 2014. Although many large groups renew on January 1, small and mid-sized groups renew throughout the year. Due to the fees and taxes resulting from the Affordable Care Act, these group plans will see some hefty rate increases. Of course, some groups opted for early renewals (to keep their lower-cost, non compliant plans until 2015). In our industry, this strategy has been labeled “delaying the pain”.
Narrower Networks: Many carriers have narrowed their provider networks. Several carriers now have HMO networks as a low cost alternative to PPO or POS networks. As I have noted in prior posts, it is very important to make sure your doctors and hospitals are “in network”. Most proposals /quoting services will show a provider search link next to the plan. Our quote engine (here) includes all the carriers in Georgia and shows the provider search links
Changes in Drug Formularies. Carriers have also changed pharmacy benefits. It is very important to find out whether your medications are covered and what tier they fall under. Don’t assume this will stay the same. Below are some tips on checking drugs with Humana:
Conduct a drug list search on www.humana.com (Pharmacy Services/Rx Tools/Drug List Search) to make sure your prescriptions are included in those lists. If not on the list, the drug is not covered in the plan. However, the list includes drugs within every therapeutic class, so there will be a suitable drug to treat the condition listed under the alternatives.
Other carriers: Aetna, Cigna, CoventryOne, Blue Cross Blue Shield, and Assurant Health have similar tools for finding both prescriptions and providers on their web sites. For more info on these carriers, just shoot me an email at greg@insuranceadv.com
Maximum Out-of-Pocket (MOOP) Costs: One of the positive changes with the new health plans pertains to the way the plans work in terms of deductibles and out-of-pocket maximums. In the past, doctor visit copays were separate from the deductible and didn’t apply towards the MOOP costs. The same was true of prescription (Rx) copays. New regulations mandate that the plan’s deductible, office visit copays, coinsurance, Rx deductible, and Rx copays ALL count toward satisfaction of the MOOP.
So, these are just some of the “not so major” changes in 2014. There are many more changes to come. I am here to answer questions about these changes and what pitfalls to avoid as you navigate the new health insurance landscape in 2014.
I hope everyone has a happy and prosperous new year!
Greg Sanders Peachtree Insurance Advisors 678-236-1600
