Significant Changes Occurring in Insurance, Warns Agent in Letter to the Editor
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A Southern Humboldt insurance agent, Clover Willison, offers her take on changes to insurance this year.
Open enrollment for individual health insurance coverage is well underway and this year, more than prior years there are significant changes occurring in the marketplace that may greatly affect many insured members. Anyone wishing to enroll in individual coverage privately or through Covered CA to receive premium assistance must do so during open enrollment. You cannot purchase coverage at any other time of the year unless you meet special enrollment requirements (i.e. birth, death, adoption, marriage, divorce, us citizenship or loss of other credible coverage). In California we have an extended open enrollment period that those residing in other states do not have. The deadline to enroll in new coverage or make changes to existing coverage and secure a January 1st effective date is December 15th. If you enroll or make changes between December 15th and January 15th you will have a February 1st effective date. Those completing enrollments or making changes between January 15th and January 31st will have a March 1st effective date. Open enrollment will close for the 2018 plan year on January 31st, 2018.
The 2018 open enrollment season brings with it many changes, perhaps the largest being the announcement that Anthem Blue Cross is withdrawing as a carrier from 16 of the 19 rating regions in California. This holds significant impact for Anthem members throughout the state. While many regions are being forced to switch to a new carrier those members residing in region 1, 7 or 10 have the option of retaining coverage. What that means in simple terms is that those members residing in the very north part of the state (Humboldt, Trinity, Mendocino, Del Norte, Lake, Siskyou, Shasta, Tehama, Glenn, Colusa, Modoc, Lassen, Plumas, Sierra, Nevada, Amador, Alpine, Calaveras, and Tuolome counties) and those in Santa Clara and the Central Valley can choose whether or not they keep their Anthem plans or switch to another carrier.
As an agent serving much of the north part of the state and a top producer with Anthem Blue Cross I feel a responsibility to share insight regarding what we expect to see with Anthem’s exit of much of the individual market. I have spent several months researching and seeking information about what was going to happen with the Anthem provider network in the year ahead. Though information was difficult to obtain and not transparent early on after the announcement I have confirmed through numerous phone calls, emails and conversations with my internal contacts at Anthem is that there will NOT be providers or a network available outside of the geographical area in which Anthem is offering coverage. For those residing in large cities this might not be such an issue however for those who reside in rural areas in the north part of the state this is a catastrophic loss. Many north state residents choose to seek care outside of the area they live in. It can be difficult to obtain an appointment with a specialist or even find a general practitioner accepting new patients. Many folks believe the care they are offered in their rural areas is inadequate, untimely or outdated. This statement is not intended to discount the medical community in our area as we have many phenomenal providers. Prior to 2018 Anthem has provided freedom of choice to travel to network providers in other regions. Most commonly I see folks traveling south to seek orthopedic, neurologic, cardiac, ENT, women’s health, pediatric and cancer related treatments. The wait locally for things like MRI’s can be several weeks and in some cases as much as a month or more. For many it is imperative to be able to seek care or second opinions from doctors at larger facilities and outside the local area. This is also something to consider if you travel frequently through the state or have children who play sports in other areas, as only emergency (life or limb threatening) care will be covered when seeing an out of network provider. Will we see the entire network disappear on January 1st, 2018? My best guess, it is not likely however I have been advised time and again that it will happen and it will happen rapidly. All that said, on a more positive note Anthem has confirmed they will maintain a contract with both UC Davis and UCSF for the 2018 plan year. As of today they will not be contracted with any of the other UC’s. Deciding whether to keep your Anthem coverage is a personal decision and not one you should take lightly. You must really consider where and how you would choose to access care if you were dealing with a major health crisis. It is important to evaluate what providers and facilities you would choose to seek treatment at. I have many clients who are in the course of life saving treatment for medical issues like cancer and organ transplant who seek care within the UC System and many of these folks are electing to maintain their Anthem coverage simply for continuity so they do not have to go through the tedious procedure of seeking new pre-authorizations and approvals.
The only other option for individual health insurance coverage in the north part of the state is Blue Shield. As an agent I am shifting the bulk of my clients over to Blue Shield to secure them a larger network as well as coverage both in and out of network. Deciding which carrier best meets the needs of an individual must be done case by case as there is no one size fits all answer for who is best. In terms of cost, Anthem remains the most cost effective option for those enrolled in Bronze level, high deductible coverage with a significant monthly savings over Blue Shield, however at the Silver level Blue Shield is more cost effective. The difference between the two carriers in terms of cost is most notable to those who purchase their plans privately without premium assistance. Those who are enrolled through Covered CA receiving premium assistance (subsidy) do not see such a striking difference in cost, although it is still there but offset or made less impactful by the premium assistance.
It should be noted that none of the above information relates to Grandfathered plans. Members on grandfathered plans will retain the same large network of providers with both in and out of network coverage they have always had. That said, last week Anthem began notifying a large volume of grandfathered members that their plans were being discontinued and they were losing coverage. It turns out that many of these letters were sent in error and the members who received these letters of termination are not actually losing coverage. Anthem is working to resolve this issue and notify members that their coverage is not at risk and that there will be no changes to those grandfathered contracts. I have confirmed this information for every single one of my grandfathered clients, no one is losing their plan. I continue to advise my clients who have maintained grandfathered coverage to continue to do so if it is within their financial means. Unfortunately, during this timeframe there were agents who did not do their homework and instead began shifting clients into non grandfathered ACA plans. If there is anything I have learned over the last 5 years since the implementation of the Affordable Care Act it is to take nothing at face value and to research and question everything.
It has come to my attention over the last few weeks that there are many agents who take a less proactive approach to the way they conduct business both in and out of our immediate area. There are agents who are responsive and do the hard work and research on the front end and those who are reactive and respond only after there is an issue. As a consumer I encourage you to consider who you trust to assist with your health insurance needs. Is the agent you are working with aware of the impact of the changes occurring in the year ahead? Do they have your best interest or their own bottom line in mind? Health insurance is a full time business. There are changes happening constantly. There are many agents out there who are simply not keeping up with the changes as they occur. I can speak personally that it is not in my best interest to move my clients to a new carrier but I am doing it any way. I am taking somewhere between a 50-70% pay cut in the year ahead. I entered this business to help people and though I feel nervous about the security of my job in the year ahead I will ALWAYS put my clients’ needs and best interest first. Humboldt and Mendocino counties have many amazing and talented health insurance agents to assist you with your needs. It is vitally important to connect with one of these agents and make sure your best interest is protected. Now is not the time to enroll directly or manage your own health insurance, nor to call an 800# and hope the person on the other end provides service after the sale. It does not cost you anything to work with an agent and in doing so you get someone who understands the lingo, has developed relationships with the carriers and knows the questions to ask as changes occur. Consider aligning yourself with someone who does the research and keeps up to date so that you don’t have to. I spend a fair amount of time answering questions and correcting issues for folks who are not my clients. I have prided myself on being available and willing to assist anyone who needs help whether I had their business or not. In order to continue to provide for both my employee and myself I need to focus on my clients and those who wish to become my clients as opposed to servicing the clients of other agents.
I realize the above is a lot of information but I felt that it was important information for people to have as they make coverage decisions for 2018. I wish to thank my clients for their dedication, support and continued business as well as the patience they have shown during this open enrollment season. If you have questions or need assistance please feel free to contact my office.