grandfathered plans

[frank]

everyone mentions grandfathered plans and my wife has one. I was wondering what the benefit is of having a grandfathered plan? bcbs in iowa where I live has opted out of participating in aca until 2015. anyone have any ideas how this will affect premiums or coverage? I am pretty much ignorant about health insurance except for the fact that I have to pay a premium.

frank

 

[Mulligan]

everyone mentions grandfathered plans and my wife has one. I was wondering what the benefit is of having a grandfathered plan? bcbs in iowa where I live has opted out of participating in aca until 2015. anyone have any ideas how this will affect premiums or coverage? I am pretty much ignorant about health insurance except for the fact that I have to pay a premium.

frank

Here is what I am guessing... BCBS can opt out of the first year, by reenrolling all members Dec. 31. Do to a quirk in the law, the current health plan could stay in effect until Dec. 31 of 2014. They can then enter the exchange program then, Jan. 1, 2015, once the dust has settled. In the short term, this is probably advantageous for both the company and individual. The insurance company can bypass the initial year of getting a bunch of unhealthy people put on their expense ledger. They can just keep the existing members they have for another year, as they as a collective group are probably more healthy due to underwritten status.
The benefits and drawbacks to a grandfathered plan are variable and a lengthy discussion. Me personally, I hope the "Blues" in MO, follow what they did in Iowa, as it will delay the "rate shock" to my wallet. YMMV though... I would imagine your policy will be the same next year as this year. Longterm, the grandfathered plan may not be your best plan, as new healthy people will not be added, others may drop, and you could have an expensive plan, then. When the Iowa exchange site becomes operational this fall, punch in your numbers and you can compare what the exchange providers rates and coverages are to what you presently have. If some miracle happens and one of those companies provides better coverage at a better rate, you are free to drop Blue and join another provider January 1st.

 

[perrytime]

This subject is very concerning to me, just a few weeks ago, Aetna in Florida couldn't tell me what was going to happen to my individual health plan, I am a very concerned my $10,000 deductible plan will not be available, anticipating forced move to higher cost plan.
I hope Mulligan is right and I get 2014 to sort this out.

 

[Mulligan]

This subject is very concerning to me, just a few weeks ago, Aetna in Florida couldn't tell me what was going to happen to my individual health plan, I am a very concerned my $10,000 deductible plan will not be available, anticipating forced move to higher cost plan.
I hope Mulligan is right and I get 2014 to sort this out.

I just read the Blues is offering an end a round the exchange in Georgia for a year also. Maybe others will too.

BCBS of Georgia to Renew Current Plans Until Dec 2014


June 26, 2013
By Katie Banks+

Blue Cross Blue Shield of Georgia (BCBSGA) just announced that current and new members can lock in a plan this year that will keep the same rate until December 1, 2014. This is for individual and family plan members who joined after March 23, 2010 -as plans initially purchased prior to this date may keep their coverage.



This is a clever way for people who don’t want to join the new ObamaCare Health Exchange immediately but want to continue coverage. This loophole works because most providers have policy end dates of one year. So if a member renews by December 1, 2013 they would be able to keep their plan for one more year. After one year these plans will automatically be transitioned into an off-Exchange plan. BCBSGA says that members may at that time opt for any off-Exchange plan or for one of the on-Exchange plans: Bronze Plan, Silver Plan, Gold Plan, and Platinum Plan. This gives members options to merge onto other plans.

 

[frank]

it would be nice if bcbs extends our rate for another year, but it has gone up every year since I have had it, so not likely.

 

[Texas Proud]

Just from the little I know.... and reading these posts.... there are two things happening...


Some people have had their plans for awhile.... they are grandfathered... if the insurance company decides to keep offering that plan... no problem...


Then there are people who have recently purchased a plan... (looks like Mar 23, 2010 is the important date)... they do not appear to be grandfathered at all.... they must comply with the new law... however, because they can offer a plan for a full year they have come up with a loophole that will allow an 11 month delay.... I think after this time there is no way to prevent being included in the new law...

 

[Mulligan]

Just from the little I know.... and reading these posts.... there are two things happening...

Some people have had their plans for awhile.... they are grandfathered... if the insurance company decides to keep offering that plan... no problem...

Then there are people who have recently purchased a plan... (looks like Mar 23, 2010 is the important date)... they do not appear to be grandfathered at all.... they must comply with the new law... however, because they can offer a plan for a full year they have come up with a loophole that will allow an 11 month delay.... I think after this time there is no way to prevent being included in the new law...

That is the way I see it. These insurance companies aren't dumb, they will work this loophole to their advantage. I wouldn't be surprised if they for "consumer convenience "
automatically enroll their members in an off exchange plan, to provide a reason not to go on exchanges and compare. Dominant state insurers may be wise to not participate at all first year, and let all the unhealthy people needing insurance jump on the other providers in the exchange. I read this week that a significant amount of counties in Mississippi have NO company willing to participate yet in the exchange. How can you be forced to buy mandatory insurance if there is no one to buy it from?

 

[Animorph]

Dominant state insurers may be wise to not participate at all first year, and let all the unhealthy people needing insurance jump on the other providers in the exchange.

That sounds like a great business plan.

 

[Mulligan]

That sounds like a great business plan.

Blue Cross which was the dominant carrier in Iowa is skipping out the first year, blaming it on the "bumpy implementation" of the exchange during the first year. Maybe I am too suspicious, but if I were running the company I would say the same thing, but knowing I already have the biggest base of insured, I would not expose myself to a possible increase in unhealthy people joining. I wouldn't be surprised if they do not comb their own data base and automatically convert their healthy ones for "consumer convenience " while sending out weekly reminders to the ones they carry that are "expensive customers" that they should check the new exchanges to find a better comprehensive plan on the exchanges.

 

[gauss]

According to this local news story from last month, BCBS of Michigan has filed to offer plans in Michigan. Michigan, while not running their own exchange, will be using the Federal exchange. I was assuming that this was to start in 2014, but it may be interesting to watch in light of the delays of BCBS in other states.

http://www.crainsdetroit.com/articl...ers-apply-to-sell-policies-on-federal-health#

-gauss

 

[MichaelB]

I read this week that a significant amount of counties in Mississippi have NO company willing to participate yet in the exchange. How can you be forced to buy mandatory insurance if there is no one to buy it from?

A positive response to a legitimate concern. Hopefully this will happen elsewhere. From KFF Humana Fills Blank Spots In Mississippi Obamacare Map – Capsules - The KHN Blog

Filling a potential coverage void, Humana Inc. said Friday it will sell health insurance in 36 Mississippi counties that might have otherwise been left out of a marketplace for subsidized policies sold under the Affordable Care Act.

“I’m elated,” said Mississippi Insurance Commissioner Mike Chaney, who had been working to make the deal happen. “I’m grateful. I’m thankful. Every word I could use to say I’m very pleased.”

The health law creates online marketplaces known as exchanges in every state to help consumers fulfill requirements to obtain coverage. But as the Oct. 1 opening date drew near for Mississippi’s exchange, not one insurer had applied to offer subsidized coverage in some of the poorest and most rural parts of that state. Humana’s agreement to expand its exchange offerings from four Mississippi counties to 40 ensures that at least one company will sell subsidized plans to individuals everywhere in the state, Chaney said.

 

[tjscott0]

Frank:

bcbs in iowa where I live has opted out of participating in aca until 2015.

Found an article about this:A few big Blue plans quietly skipping exchanges - HealthLeaders-InterStudy

Several state health benefit exchanges now look a lot less Blue, and that could leave consumers far from happy.

In three states, Blue Cross Blue Shield plans have opted against selling exchange policies. Another one, Regence Blue Cross and Blue Shield, opted out of the Oregon health exchange but will still sell individual exchange policies through a subsidiary.
But a few exceptions have surfaced. Wellmark, the nonprofit Blue Cross Blue Shield plan and largest insurer in Iowa and South Dakota, will sit out both state exchanges in 2014. Given its market dominance and the ability to construct narrow networks around its ACO initiatives, Wellmark seemed tailor-made for the health exchange market.

Wellmark’s pass could have financial repercussions for plans in the exchange. Sicker residents and those previously covered by high-risk pools will be among the health exchange’s first enrollees, so the threat of adverse selection will loom over Iowa’s exchange carriers, most of which will be smaller than Wellmark.

Iowa, however, looks as if it could have a robust market in which to spread that risk. Aetna’s Coventry Healthcare of Iowa and CoOportunity Health applied for the individual exchange. Sanford Health, Health Alliance Midwest and CoOportunity Health applied to sell Small Business Health Option (SHOP) policies. Avera Health Plans and Gunderson Health Plan each will participate in both but only in their regions (northwest Iowa and northeast Iowa, respectively). The state’s demographics should also help. Only 289,000 Iowans, less than 10 percent of its population, go uninsured (HealthLeaders-InterStudy).

For those with BCBS coverage; they might be inytereste in this from BCBS about ACA:
The Affordable Care Act - Blue Cross Blue Shield of New Mexico

Don't worrying about this link being limited to New Mexico. They will ask you to enter your zipcode to pull up your state specific info.

I received a letter yesterday that BCBS of NM is asking for a 10.4% rate increase. 6.4% increase to be effective 12/31/2013. And 3.8% to be effective 1/1/2014. And yes the increases don't add up to 10.4%. I'm clueless about that.