29
June
2016
|
06:54 AM
America/Phoenix

Frequently Asked Questions (FAQ) IU65 2017 Plans

The 2017 changes to BCBSAZ’s Affordable Care Act plans do not affect group, federal or Medicare coverage.

 

 

1. Are you offering plans statewide?

After seeing significantly higher healthcare needs among newly insured ACA plan members, resulting in a $185 million loss over a two-year period, we’ve made the decision to offer five plans in a select number of counties in 2017. We will offer plans in 14 counties including Mohave, Coconino, Navajo, Apache, Yavapai, La Paz, Gila, Graham, Greenlee, Cochise, Santa Cruz, Pima, Pinal and Yuma.

2. I thought you considered pulling out of the market, why didn’t you?

Blue Cross Blue Shield of Arizona (BCBSAZ) has served Arizonans for more than 75 years. While many other insurers decided to no longer sell plans in Arizona, BCBSAZ is offering individual ACA plans in 14 counties. Many of these counties would have had no options if we exited the market. As a local company with deep community roots, it was important to us that all Arizonans have options. With changes to our plans and limiting where we offered them, we believe we can continue plans in these areas for at least one more year.

3. Why did you decide to withdraw plans only from Maricopa?

The ACA has many challenges that have made it difficult to offer affordable plans. With a desire to keep monthly costs as low as possible and an understanding that Maricopa residents would have other options for health insurance coverage, we focused on many areas that wouldn’t have coverage if we didn’t participate—the rural areas of our state. In doing so, we were able to adjust the plans and keep premiums lower than if we offered coverage in all counties.

4. Did the other insurers exiting influence your decision?

Yes, knowing that Arizonans would have no or limited choice in most counties if we didn’t stay in the market greatly influenced our decision to serve those areas. For months we reviewed options and talked with regulators and community partners about the difficulties in serving the entire state. In the end, we believe we have found a mix of plan types and benefit changes that will make these ACA plans sustainable for at least another year.

5. How many plans are you offering?

We will have five different plans available through the Marketplace, including our EverydayHealth, Portfolio and SimpleHealth plans.

6. Are there other any changes to the plans?

Yes, there are a few changes the state is requiring insurers to include in our plans.

We have also added new coordinated care requirements to ensure our members get the most efficient care possible, avoid out-of-network charges and get more consistent advice. Members will be required to select a primary care provider and seek referrals before seeing a specialist.

7. Your rate increases appear to be the highest in the state, and one of the highest in the nation…why?

Insurers nationwide are needing higher rate increases than in prior years to cover the cost of ACA individual plans. When the ACA passed, we knew that many new enrollees would need additional care to address previously undiagnosed conditions or support ongoing treatment. We took this into account when setting premiums. However, members used more services than anticipated and fewer healthier individuals enrolled to offset the costs. Another reason that made increases necessary is Arizona’s premiums have been some of the lowest in the country, which compounded the problem of not enough premium dollars to cover the services used.

8. If the rate increases are so significant or unaffordable, why even offer plans?

We believe it is important to offer coverage, especially for Arizonans who use subsidies to pay a portion of their premiums. Depending on the plan and where an individual lives, subsidies can help make plans more affordable than they would be otherwise. However, we understand that even with a subsidy, some individuals and families could end up paying more for health insurance depending on the plan they choose. There are alternatives to consider such as short-term medical coverage and indemnity plans.

9. Does this impact any other types of BCBSAZ plans?

BCBSAZ serves almost 1.5 million customers. A majority of them have employer, federal or Medicare coverage. The plan changes we announced to our 2017 individual product line only affect those with ACA plans or approximately 5 percent of our customers.

Member Specific Questions

1. If I have a BCBSAZ ACA plan, what should I do now?

Once CMS approves the plans, we will notify all ACA members whether they can renew their existing plan or if they need to select a new one. We anticipate this will take place late summer. For most ACA members, that means they can expect to receive more information in September.

2. Will the premium increase affect my tax subsidy?

Subsidies will continue to pay a portion of the premium for those who are eligible. Subsidy levels are based off the rates filed by insurance companies in that area. They vary from county to county.

However, even with the subsidy, some individuals and families could pay more for health insurance depending on the plan they choose.

3. How much will my premium go up?

You may have read in the news that our premiums are going up. While most plans will see an increase, how much will depend on where you live, what plan you have and if you receive a subsidy. Once we received approval on our plans, we will send you more information about plan costs and any changes to your benefits.

4. Are there any changes to my plan?

Yes, there are a few changes the state is requiring insurers to include in our plans. You will learn about those along with any other benefit changes in your renewal notice.

To help our members with their care, get more consistent advice and avoid out-of-network charges, all of our ACA plans will now require members to select a primary care provider and get a referral to see a specialist.

5. When will I receive more information about my 2017 plan options?

You can expect to receive information from us at least 60 days before your plan renews. If your plan is discontinued, we will notify you at least 90 days before the plan ends. This will give you time to renew your plan, or if needed, to enroll in a new plan through the Health Insurance Marketplace. Open enrollment begins November 1, 2016.

6. What if I can’t afford the new premiums and there are no other options in my county?

Subsidies may help reduce what you pay each month for your plan. To learn if you are subsidy eligible go to healthcare.gov. If you are not eligible, you may want to consider a short-term medical plan. Short-term medical plans provide coverage for 30 days or up to 364 days and are often less expensive than ACA-compliant plans. They offer benefits such as inpatient hospital coverage, outpatient services and doctor office visits. However, they do have some restrictions and require health underwriting. Even with a short-term medical plan you are responsible to pay for the government’s individual health coverage tax penalty.