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Inside Bulloch Business - East Georgia Regional Medical Center working through ACA carrier change
ACA Open Enrollment

Individuals entering open enrollment for their health care insurance this week are in for quite a surprise.  Blue Cross and Blue Shield has decided to pull out of the individual under 65 market on the exchange for 2019.  

Blue Cross made the decision after Ambetter Health announced they would expand coverage into Bulloch County. Ambetter never has offered coverage in Bulloch County and because they are new, their provider network is not nearly as strong as Blue Cross.  

Most importantly, at this time, our local hospital, East Georgia Regional Medical Center and Statesboro Imaging Center, which are both owned by EGRMC are not in network with Ambetter Health.  If this does not change, thousands of Bulloch County residents will not have an option to purchase an individual insurance plan that includes the Medical Center or Statesboro Imaging in network. In addition, neither local urgent care center is in network.

Currently, Optim Medical Center in Sylvania, Effingham Hospital in Effingham and St. Josephs/Candler in Savannah are the closest hospitals that would be in network. This leaves more than 5,000 Bulloch County residents without a local hospital option.

If you get your healthcare through your employer or if you are on over 65 and on Medicare, you are not affected by this.  This only affects individuals under 65 who do not have health care through an employer and are purchasing their insurance through an agent or the Health Insurance Marketplace online.

East Georgia Regional owns several physician practices in Statesboro, thus employing more than 20 doctors serving our community.  These doctors would be included in the Ambetter network.  But East Georgia is continuing talks with Ambetter to come up with an agreement so the hospital itself can be included in the local network.

“We have been in negotiations with Ambetter and will continue these negotiations,” said Paul Theroit, CEO of East Georgia Regional Medical Center.  “We recognize the issues this creates for so many and hope to be able to continue to serve the healthcare needs for everyone in Bulloch and surrounding counties.”

Open enrollment for individual healthcare begins on Thursday. The open enrollment period has been shortened to just 45 days and ends Dec. 15. That 45-day window is the only time anyone purchasing individual health insurance on or off the Affordable Care Act exchange can purchase healthcare for 2019 coverage.

Financial assistance in the form of tax subsidies remain in place for many, but not all Georgian's buying individual health care.

According to Georgians for a Healthy Future, 90 percent of state residents who get their insurance through the ACA exchange are eligible for a subsidy to assist with the increased rates. Individuals with incomes up to 400 percent of poverty, which is $48,580, can qualify for subsidies to help pay for premiums.

The highest income and lowest income individuals are hit the hardest by raising health insurance costs. Because Georgia did not expand Medicaid, individuals who make less than $12,140 are not eligible for any financial assistance to help them purchase health care. The same is true for individuals making more than $48,580.

Log on to www.healthcare.gov and “window shop” for plans and rates now and find a local insurance agent to help you. It costs you nothing to use a local agent. I would encourage you to use a local insurance agent who is familiar with plans and networks to help you navigate the very complex and confusing health insurance market. Especially this year with the added uncertainty of the provider network.

The most important advice: Do not procrastinate! 

Also, do not assume that what you have is fine and do nothing. If you do nothing, the ACA will automatically select a plan for you, which may not be the best option in coverage or price. However, you will be locked into that plan for all of 2019. 

Remember, Dec. 15 is the last day you can purchase individual health insurance for 2019 through the ACA Exchange.


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