By Jenny Deam
Published 10:58 am, Wednesday, September 2, 2015
With the Nov. 1 sign up for the Affordable Care Act marketplace fast approaching, consumers are being urged to look carefully at the offered plans as some options have changed from last year.
“As we enter the third year of the ACA, many Americans are still learning about the whole system and the evolving healthcare landscape,” said Joseph Sanginiti, president and chief operations officer of FamilyWize, a Pennsylvania-based community service organization that works to make prescription medication more affordable for families.
“Not understanding your policy can result in inadequate insurance or high deductibles,” he added.
In Texas, which leads the nation in the number of uninsured and where about a third of those eligible for marketplace policies have not signed up, it is especially important to be diligent, local health policy watchers say.
For example, Blue Cross and Blue Shield recently announced it is dropping its Blue Choice PPO (preferred provider organization) from its marketplace offering. The move means as many as 367,000 Texans will lose their individual health insurance policies next year.
In addition, some of the state’s largest carriers have asked for double digit rate increases for policies offered on the exchange. Scott & White Health Plan, for example, has asked for a 32.4 percent increase on average in its individual silver plan and a 31 percent increase in its bronze plan; Humana proposed raising one of its individual plans by 29.73 percent; and Blue Cross Blue Shield of Texas has asked for which for a 19.97 percent hike for its Blue Advantage HMO individual plan. The final price will not be known until close to the start of enrollment.
There is growing speculation that to keep their policies affordable consumers will have to change plans this year.
FamilyWize offers these tips to consumers as they prepare to wade into the marketplace:
- Plan ahead if possible: With only about two months to go until open enrollment begins, it is extremely important for consumers to conduct research on available plans. If they don’t, consumers may choose a plan that doesn’t meet their current or future healthcare needs and that could have negative consequences such as large out-of-pocket costs.
- Short window to shop: The open enrollment period will last only three months, from Nov. 1 through Jan. 31. If consumers miss this tight timing window, they may go without insurance for 2016.
- Possible sticker shock: For those renewing their coverage, premiums may not be the same as in previous years. Consumers should contact their health insurance company now to see if there premium will change in 2016.
- Check with provider: Before choosing a plan, consumers should contact their doctors, local hospital and pharmacy to see if they will continue to accept their soon-to-be renewed or future new plan. If they don’t contact their health-care providers, consumers may have to pay a high out-of-pocket cost for doctor’s appointments, procedures or prescription medications.
- Look at start date: Some insurers officially start covering and billing consumers before Jan. 1, consumers need to assess their current plan to see when coverage ends for 2015 and when their future plan will begin. If they don’t, they could end up being double-billed.