Enrollment season brings changes in health care arena

As the enrollment period for health care insurance under the Affordable Care Act opens, employers will see a continued reduction in carriers and insurance plans.

Individual carriers, such as Anthem Blue Cross Blue Shield, pulled out or scaled back in various areas of Nevada. In many areas, carriers have reduced their plan choices.

“Since the ACA (Obamacare) has been passed, insurance carriers are limited in the profit they can make and are looking at ways to cut overhead. Instead of administering 50, 60, or 100 plans, they are keeping their most popular plans or ones most people are enrolled in, streamlining their business models,” said C.J. Bawden, sales and marketing manager for Hometown Health, a nonprofit health insurance provider and part of Renown Health in Reno. “Sometimes it’s good for the employer, but sometimes they may have enjoyed the plan offering that was discontinued, and now they have to crosswalk their employees to a different set of benefits.”

In the health insurance market, employers are looking at cost savings or cutting costs when shopping for coverage. When employers switch carriers, that means switching providers and possibly physicians covered under those plans.

“Employers have to weigh how they are going to find the best pricing and options and stay competitive in today’s business climate,” Bawden said.

As late as this past summer, insurance carriers left rural Nevada, which includes Carson City and other counties except for Washoe, Clark and Nye. That threatened to leave some 8,000 residents, even those with employer group plans under Obamacare, without health care coverage. However, Centene Corp., a Missouri-based carrier, entered the Nevada market under the name Silver Summit In Nevada, ensuring coverage for people in those areas.

“Centene came into Nevada and offered to help with coverage in rating areas 3 and 4. They didn’t have a provider network, so they partnered with Hometown Health and leased our provider network to cover individuals in counties without coverage and are using Hometown Health’s provider network to service those individuals,” Bawden said.

Gene Furr, a consultant with Menath Insurance Agency in Reno and legislative chairman for the Northern Nevada Association of Health Underwriters, said regardless of what health care plan employers choose, they need to keep employees informed of changes in rates, plans and when enrollment period begins under the ACA guidelines. Often, employers will give a notice of any changes in health care coverage or the open enrollment plans.

“Employers should notify employees at least two months in advance that rates and plans are going to change,” Furr said. “Most will give 30-day notices, but 60 is actually required.”

The enrollment period for employee group plans begins Nov. 1, and ends Dec. 15.

The uncertainty over the fate of the Affordable Care Act in Congress is still on the minds of those in the industry.

“If the government repealed or replaced the ACA at this time, the federal government would have to allow for a new open enrollment period,” Furr said in an email to NNBW. “Carriers would have to develop new plans and rates for them. They would need to submit them to the (Nevada) Division of Insurance for review and approval.”