Health Care Exchange Delays

laptop16Another week has gone by and the health care exchanges are still not up and running. This is starting to get very frustrating for everyone in the equation. Here at Nefouse & Associates, we have been pulling as much information as we possibly can for you.

Anthem looks to be the only carrier being proactive and not reactive at this point. So far, we have Anthem plans designs and the Anthem Pathway Network.

The network is a critical aspect of any health plan. The pathway network is at least 35% smaller than the Anthem traditional PPO network. This is going to create a tough decision for potential policy holders. Do I take the exchange plan with much lower premiums and have to switch doctors?

We are still waiting for master contracts on the health care exchange plans. The contracts will go into detail on what is covered and what is not. The drug formulary is another key component of any health insurance plan, and something we are still waiting on.

Usually all of this information is out before you go live.

The online enrollment process has had huge issues. We are hearing that initial applications for enrollment through are not complete. There is rumor that 99% of the applications originally submitted do not have enough information for the insurance carriers to issue a policy. This was reported by CNN but there has been little coverage there after. If you applied thought, I think you should call the insurance carrier you applied with to make sure you have coverage starting January 1, 2014.

It looks like we will not be live until November. If you want network info or plan design info please contact us. We are happy to provide this information!

Exchange Quote Engines Update

computerresearchAs we speak, there are rooms full of IT professionals working on getting the quote engines up for the health insurance exchange. Here in Indiana, we are going to be running through a Federal Facilitated Exchange. We are already starting to see serious progress with the quote engines, and ours should be live by October 1.

When you come back to this site in October, you will have the ability to quote policies inside the exchange/market for Indiana. You should also be able to apply for subsidies/tax credits through the same quote engine. This will allow you to apply for the tax subsidy and find out in real time what that subsidy is. Then, you will be directed back to the insurance quotes, where you will have the option of electing a policy with the premium being reduced by Federal Tax Credits.

When you start to look at plans, you will want to purchase that plan from someone that know not only knows plan designs but market conditions. One of the biggest market conditions is going to be the network. The network is going to have a huge impact on where you will be able to get health care. There are going to be several other aspects of the plans that will impact you. Drug Formulary is going to be a big one; some of the carriers may limit what drugs you can take, so it will be important that you deal with a broker like us.

Here at Nefouse & Associates, we are dedicated to providing you with the best possible deal, either inside or outside the exchange. We will be the ones that will deliver you a policy that has the lowest premium cost and lowest out-of-pocket claims cost. This will happen through a combination of subsidies for premiums and cost reductions in actual medical care. Contact us to find out what the best plan will be for you and your family!



Silver Plans in the Exchange

healthcarePlans in the silver level tier look like they are going to win the popularity contest for the Indiana exchange. These plans are offering much more coverage than the bronze plans and have been marked for the subsidies. Now, you take the subsidies you receive for the silver and put them towards the bronze or gold plan if you choose.

We are going to have four carriers offering silver plans inside the exchange. Each carrier is offering multiple options for the silver plan.

  • Deductible levels: $1,250 to $3,500 and then times 2 for family.
  • Out-of-pocket max (including deductible):  $4,000-$6,350/single and $8,000-$12,700/family.
  • Ambulance Services: $250 co-pay per transport to deductible and coinsurance
  • Diagnostic Services: $25 co-pay to deductible and coinsurance depending on what plan you choose.
  • Emergency Room: $350 co-pay to deductible and coinsurance
  • Coinsurance: Anywhere from 10%- 20% after the deductible is met.
  • Office Visit Co-pays: $15 -$25 as long as you use your Primary Care Physician (PMP). One carrier is stating in their contract that if you do not choose a PMP, then they will chose one for you.
  • If you see a specialist: Co-pay of $40- deductible and coinsurance. All care is going to have to go through your PMP.
  • Therapy & Rehabilitation: Surprisingly, we are seeing limitations on these procedures much like we have in place today:
    1. Speech Therapy: 20 visits per year
    2. Manipulation Therapy: 12 visits per year
    3. Cardiac Rehabilitation: 36 visits per year
    4. Pulmonary Rehabilitation: 20 visits per year
  • Urgent Care Center: We are seeing co-pays from $50-$100 for these services. There are also a lot of notes out there about diagnostics not being covered at these facilities.
  • RX Benefits: Generic is either a $10 co-pay or could apply towards the deductible, brand name is around $40-$60 and speciality drugs are around $75 to deductible and coinsurance.

This is just a snap shot of what the silver plans are going to look like according to the Indiana department of Insurance website.

These plans have richer coverage than the Bronze plans but still have cost-sharing to the insured. If you have had health insurance coverage in the past, these plans may take some time to adjust to. With these plans being an HMO with a narrow network, the insured are going to have to take time to understand how these plans work. Members may want to practice some patience with scheduling medical services since the wait time to see a doctor may be a lot longer than what you are accustomed to.

Even with only four carriers participating in the Indiana exchange, you will want someone to explain the differences in the plan designs. There are serious differences in the plans that fall into the silver category. A broker will be your best source of information.