Changes to the PPACA Marketplace coming in 2019The largest insurer in the individual marketplace, Blue Cross and Blue Shield of North Carolina (BCBSNC) recently announced rate and plan design changes for 2019. After years of double digit rate increases, members will be happy to finally have some stability in the market and a lower cost.

While the news of a rate decrease is positive, BSBCNC also announced it will discontinue offering their Blue Local Plan with Duke Health and WakeMed. This move will likely impact nearly 50,000 members. Members currently enrolled in  the Blue Local Plan with Duke Health and WakeMed will now have to decide to stay on the Blue Value Plan with UNC Health Alliance or leave Blue Cross Blue Shield altogether. While members can still use their current doctors through the end of 2018, it might be a good idea to start looking for a new doctor in the UNC Health Alliance soon to avoid the flood of people looking January 2019. You can find a provider directory for the new UNC Health Alliance here.

BCBSNC will continue to be the only carrier offering marketplace plans in all 100 counties and Cigna will continue to offer coverage in Chatham, Johnston, Nash, Orange, and Wake counties. Additionally, insurance giant Centene will offer PPACA plans under their Ambetter brand. These potential plans will be offered in Durham and Wake counties and according to a recent report from WRAL, Ambetter will include Duke and WakeMed doctor’s in-network.

Another option for individuals are the newly expanded regulations regarding short term health insurance. CBS News broke down the impact that the new regulations will have on potential members and highlighted a few key points. While the expanded regulations are being touted as a great improvement to the healthcare landscape, there are still a few provisions of short term health plans that must be considered before buying. A breakdown of pros/cons can be found below:

  • These short term health plans are not PPACA compliant; therefore, they do not have to cover the “10 essential health benefits” that PPACA compliant plans are required to, resulting in leaner coverage.
  • These plans are not required to comply with current rules regarding pre-existing conditions. PPACA plans must offer coverage to people with pre-existing conditions and cannot exclude coverage for those conditions.
  • The policies can now be offered for up to 364 days, which is a drastic increase from the previous length of 90 days.

Ultimately, we are seeing another year of changes on the individual marketplace. With regulations constantly changing, members should keep abreast of changes to make sure their plan best fits their needs. Employers may want to review eligibility definitions for dependents and retirees as the instability of the individual marketplace makes it hard for some to find quality and affordable coverage. Employers may also see an increase in enrollment on their group plan from employees or dependents who currently have plans on the individual marketplace. Contact a consultant today to learn more.

Tim Woolley

Tim Woolley

Tim's focus is consulting for the small group market. He provides advice and guidance to clients on the design, implementation and management of their benefit strategies.