Open Enrollment starts November 1!

Posted by Phil Dougherty
September 30, 2015

The annual health insurance open enrollment period is fast approaching! This is the time when individuals and families already enrolled in ACA-compliant coverage can review their health insurance and make a plan change, and when those without coverage can enroll as well.  This year, more than ever, it is important to be informed of the changes coming to your specific plan and California’s health insurance marketplace in general.  Read your carrier renewal packets thoroughly!

Important dates to remember:

  • November 1, 2015: First day to enroll in a plan or make changes for the 2016 plan year.
  • December 15, 2015: Last day to enroll in or change plans for new coverage to start January 1, 2016.
  • January 15, 2016: Last day to enroll in or change plans for new coverage to start February 1, 2016
  • January 31, 2016: Open Enrollment for 2016 ends. Enrollments or changes between January 16 and January 31 will take effect on March 1, 2016.

Health Insurance Marketplace changes:

Plan benefit changes to the standard metal-tier (Bronze, Silver, Gold and Platinum) plans are also being implemented. Here are a few important changes to be aware of (all good news!):

  • In 2016, all metal-tier plans will now have a maximum monthly out-of-pocket cost on specialty drugs (once any pharmacy deductible is met). For Standard Bronze Plans, there is a $500 monthly maximum per prescription; and for Silver, Gold, and Platinum the monthly out-of-pocket maximum is $250 per prescription after the pharmacy deductible is met.
  • Another significant change in benefits for 2016 affects the Bronze Plan. The first three office visits will still not be subject to a deductible but can now include a specialist visit in addition to primary care, mental health, and urgent care visits.
  • HSA-compatible plans will have embedded family deductibles. This means an individual family member need only meet the individual deductible and individual out-of-pocket maximums; not family deductible and out-of-pocket.

These changes affect California’s standard Bronze, Silver, Gold and Platinum plans. In the private off-exchange marketplace, carriers offer other plan options in each category which are actuarially equivalent to standard plans, but with slight changes to the plan design. These changes may benefit consumers with a specific need.

Carrier updates:

  • Blue Shield of CA and Anthem Blue Cross will no longer be offering Exclusive Provider Organization (EPO) style plans, which is good news. These plans had smaller networks and no coverage when going to out-of- network providers. Both carriers will be offering Preferred Provider Organization (PPO) plans in all regions in 2016.
  • Blue Shield and Anthem Blue Cross will both be offering their BlueCard program, which will provide coverage for Urgent Care and Emergency Care while out-of-state, and will allow access to Blue Cross/Blue Shield providers in all 50 states for non-emergency care. Good news to those with college age kids who are out-of-state.
  • 2016 will see the addition of two new carriers, UnitedHealthcare and Oscar Health. However, California has restricted their participation next year and will limit plan availability primarily to rural areas and Southern CA, respectively. Inclusion in other regions will likely be granted in the future.
  • Carrier provider directories and search tools are better than previous years but still have inaccuracies. Anthem Blue Cross and Blue Shield will still have serious holes in their networks and, regardless of carrier provider list results, we recommend you contact “must have” providers directly to confirm their participation before enrolling in a plan.

Rate increase news:

While the statewide average rate increase for 2016 is projected to be around 5%, there are regional pockets that will see much higher increases consistent with past rate actions.  Rate information is just now trickling in. Benefit and rate comparisons will be available in the coming weeks. We’ll be happy to prepare a proposal for you once these are available.

Phil Dougherty