Health care rate increase, one plan offered
August 15, 2016
The health insurance choices for those needing individual plans in Grand County are shrinking dramatically. Effective December 31, 2016, Rocky Mountain Health Plans, Humana, and United Healthcare will cancel all individual plans through Connect for Health Colorado, the state insurance exchange. Anthem will be the only carrier available via the exchange in Grand County, but with an expected 25 percent plus rate increase. These announced increases are statewide. We have not seen specific numbers for Grand County as of this date.
The only plans offered by Anthem will be HMOs. This is not necessarily bad since their HMO has the same network of providers in Grand County as their pricier PPO plans, and does not have the dreaded "gatekeeper" requirement. You will be eligible to enroll in this plan during November and December, with a January 1, 2017 effective date.
These changes only impact individual health insurance plans. Medicare supplement plans are NOT changing.
why this is happening and what we can do about it
The Affordable Care Act (ACA), commonly referred to as Obamacare, requires insurers to offer a plan to anyone, regardless of their health. The insurance companies cannot exclude coverage for any pre-existing medical conditions. ACA also requires all to obtain a plan, with fines imposed on those that go without medical insurance.
While this has been outstanding for those with high medical bills who were previously uninsurable, the fines have been too low to encourage the young and healthy Americans to jump into the system. While the tax penalty for not having a plan is increasing each year, it still amounts to only one or two months' worth of premiums for most. The penalty for 2016 is the greater of $695 or 2.5 percent of your income, and is expected to increase for 2017.
Rocky Mountain Health Plans claims they paid out $2 in claims for every $1 collected in premiums. They have chosen to pull their individual plans out of every county in Colorado except their home county of Mesa.
United Healthcare will offer individual plans in some areas, but not through the exchange, where they experienced similar losses.
I believe the concepts behind Obamacare are sound. I have previously written papers expressing my belief that one of the potential solutions to skyrocketing healthcare premiums is to get EVERYONE in the system. You cannot legislate for businesses to lose money. Unless the fines reach a point that will get the young healthy individuals into the system, insurers will flee.
what options do we have in January and what can we do to improve this difficult situation
When you had to qualify medically for an individual plan, assuring a healthier group of enrollees, premiums for an individual plan were less than those for a similar group plan through your employer. This has changed. Group plans are now less expensive than individual plans. So one solution is to encourage your employer to offer a group health plan.
Otherwise, there are few options available. If you have another home in a less rural location, and can establish this as your primary residence, there are likely more options available there. Premiums for plans in Denver are less than in Grand County.
If your income is relatively low, the only way to get the premium subsidy is to purchase a plan via the exchange. If you are not eligible for a subsidy, then you will have a choice of United Healthcare. They were already quite pricey though, and anticipate 40 percent plus increases next year.
Often times, problems as broken as our healthcare system need to take one step back before taking steps forward. In this case, the steps backwards are large, and the improvements seem years away under the current system.
But reach out and express your frustration. Below is a list of people and entities you can contact: Colorado Division of Insurance: 800-930-3745 or DORA_insurance@state.co.us, US Senator Cory Gardner: B40B Dirksen, Senate Office Building, Washington , DC 20510; Phone: 202-224-5941
Gary Glass is the founder and owner of Rocky Mountain Benefits, LLC. Started in Evergreen, Colorado in 1995, he now lives in Grand Lake. He received his BA and MBA from the University of Georgia (long ago). His daughter Leah Denzel now handles most of the day to day operations of RMBen. They can be reached at 303-674-4773, or Leah@RMBen.com. They can assist you in enrollment in individual plans with the exchange or off-exchange, as well as helping to establish group plans. RMBen has worked, in association with Kim Long from the Grand County Rural Health Network in Hot Sulphur Springs, for several years helping to enroll Grand County residents.