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Inside Bulloch Business with DeWayne Grice - Navigating tricky health insurance changes
Grice-H-DeWayne Web
DeWayne Grice

            Health insurance providers are requesting huge rate increases and many are pulling out of the individual medical insurance markets altogether. Since health care reform began in 2014, with the passage of the Affordable Care Act, local businesses and employees have struggled to stay on top of the changes.
        Since more than 80 percent of the workforce in Bulloch County has employer provided healthcare, the issue is not as large of a concern for many of them as it is for their employers. However, for the other 20 percent who have no employer option of healthcare, the reform has been a mixed bag of opportunities and challenges for them.
        Another reason the changes that are heading our way is a huge issue our community is the fact that healthcare is one of the largest engines driving our local economy. Healthcare providers are directly impacted by insurance company's decisions.
        In the last few weeks, three health care companies that currently offer individual insurance through the health exchange in Georgia have announced they will exit the exchange markets at the end of 2016. The three exiting are UnitedHealthcare, Cigna and Aetna. Only UnitedHealthcare, BCBS and Humana offered coverage in Bulloch County during 2016.
        Because of these departures (Aetna is attempting to purchase Humana) BCBS is the only carrier that will offer exchange plans in all 159 counties in Georgia, including Bulloch. What that means locally is that if you currently have individual healthcare (on or off the exchange) with Humana or United your only option for 2017 will be Blue Cross and Blue Shield.
        To make matters even worse, all insurance companies stopped paying commissions to local agents on March 2 of this year on all but their weakest and catastrophic plan options. Now since BCBS will be the only option for 2017, there is reason to believe they will not pay local agents commission or will pay commissions so low that they cannot afford to continue to sell BCBS.
        This change is going to leave thousands of individuals in Bulloch County, who are currently insured through Humana or United, looking for other options when enrollment opens on Nov. 1.
        It is difficult to imagine the uncomfortable position this has placed local agents in with hundreds of individual health clients that need help, yet not being compensated to help them.
       "I am concerned about my clients," said Shanda Rushing, owner of Southern Insurance and Annuities. "One that comes to mind is undergoing cancer treatment and one of her drugs costs $12,000 and is being covered by Humana, which has a very broad network of providers and hospitals. I have no idea what she is going to do.
        "Currently BCBS's provider network is very narrow. If they do not expand the network, it will overload health care providers who are currently accepting BCBS patients. I only see four options for individuals in Bulloch County: 1) move to BCBS, 2) work with your employer to offer a group plan, 3) purchase a weak coverage catastrophic plan, 4) become uninsured."
        As of March 31, 2016, individual enrollment through exchanges in Georgia stood at 478,016 insured. Of those, 89.4 percent were receiving premium subsidies that averaged $291 per month.

            We saw a large number of small employers move from group plans to individual plans offered when this program began in 2014. For lower income employees who qualified for a subsidy, in many cases this was a more viable option. Individuals are not allowed to receive a subsidy, no matter what your income is through a group plan.
        Regardless, because of the very narrow network and projected cost of the BCBS plan, re-instatement or the introduction of a group plan for small businesses may be the best option. Thus, reversing the trend of moving away from groups.
        Two additional wrinkles are that many local agents will not learn pricing or network options for BCBS until October. Also, subsidy calculations will not be known until enrollment opens on Nov. 1.
However, even though Humana and United are pulling out of the local individual market, they will continue to offer the current network options through their group insurance plans.
        "Every small businesses' situation is different," said Brian Glenn, president of benefits, Glenn/Davis & Associates.         "We have built our expertise on helping match employers with the best insurance products at the best value while keeping them in compliance with the complexities of the Affordable Care Act.
        "This is going to be a very turbulent year for everyone involved. For employers that want to remain in the Humana or United network they are currently in, group insurance will give them that option."
        Employers should be reaching out to their local agents before open enrollment begins Nov. 1 to sort out the best plan for them and/or their business.
        It is important that everyone gets ahead of this curve and starts to explore the best options for them individually. I will do my best to keep you as informed as possible of additional changes that may affect our community.
        Please email DeWayne at or give him a call at (912) 489-9499.

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