Category: ACA and Policy, Cost of Healthcare, Health Insurance

IF IT SOUNDS TOO GOOD TO BE TRUE…

Healthcare.gov Open Enrollment 2021-22

So, it’s 1985, and 24-year-old me is having a conversation with my Dad about credit cards…

Me: “Dad, I don’t see what the big deal is! The store sent me a credit card in the mail with a $500 limit, and I needed one of those new microwave ovens and it was only $400. I was going to have to save that up, but with this credit card, I can pay for it a little at a time, AND I get to start cooking with the oven NOW!”

Dad: “Son, what you don’t understand is credit cards encourage you to live above your means. They trick you into believing you have the ability to afford a bigger lifestyle than you can actually afford. Before you know it, you are buried in debt, and all you have to show for it is a bunch of stuff you don’t really need, trips you’ve already taken, or meals you’ve already eaten.”

Me: “Silly old man. Times have changed! This is so easy!”

Dad: “If it feels easy, and it sounds too good to be true, you really ought to start worrying.”

Even now, 36 years later, I’ve burned that conversation into my brain because, as usual, Dad was right. It’s a lesson we should all learn: “if it sounds too good to be true, beware!”

It Sounds Too Good to Be True

Open Enrollment for the Healthcare.gov health insurance market for 2022 plans is starting Nov. 1. And here in Louisiana, you are going to have many more choices this year than you did last year. New competitors are in the market. I love when this happens because the more competition we have, the more we have to sharpen our axe and make sure Blue Cross remains the best choice for you. Unfortunately, new competitors are bringing new  strategies designed to limit your choices of doctors and hospitals. You might wonder how they can do that? Let me explain.

One of the siren songs you are going to hear during Open Enrollment this year is about the price of health insurance. You are going to see lots of new plans offered by new entrants into the Louisiana Healthcare.gov market. These newbies are creating and flooding the market with health plans that have very low prices, especially for Bronze and Silver plans.

“So, Mike, cheaper insurance. What’s the catch?”

Ah, I love it when you all think like Dad did.

Here’s the Catch

The catch is, these newer, cheaper plans severely limit YOUR CHOICE of doctors, hospitals, clinics and prescription drugs. The new competitors, who are not based in Louisiana and who answer to shareholders, have not taken the time or done the work to cover people in all 64 parishes in Louisiana who are receiving coverage on healthcare.gov. They have not built comprehensive provider networks so you can use your ACA plan if you need to get care outside your own parish (let alone outside the state). They cover NOTHING when you leave their extremely narrow network; no out-of-network benefits at all.

To make matters worse, these new competitors are gaming the federal pricing system. The amount of subsidies and tax credits available to you to help you afford your coverage through healthcare.gov is calculated on one of the lowest-priced silver plans. When these competitors offer plans with low prices and bare-bones coverage, they lower the over-all subsidies available to you.  Their pricing and provider networking strategy is designed to force the entire Healthcare.gov market into cheaper, narrower plans with fewer benefits and medical providers, while driving up the costs for any customer who wants a statewide network plan, or a plan that works nationwide, or offers any coverage outside the limited in-parish network. Its almost as if these competitors aren’t interested in giving you the coverage you need.

In other words, I believe these newcomers would like to gain market share and profits by limiting your choices and manipulating the healthcare.gov system to drive up your premiums. We’ve seen this happen in other Healthcare.gov markets. Many plans that cover a lot of docs and hospitals, go between parishes/counties or state-to-state and have out-of-network benefits have disappeared from the market, leaving only the skinniest plans with the fewest benefits.

Keep Your Eyes Open

“So, what do we do about this?”

You must be careful, vigilant, even, in your choices this year for your health insurance  –more so than ever. You may notice that the final cost to stay on your Blue Cross Healthcare.gov Gold or Silver plan has gone up. That’s not because we raised rates, but mostly because new competitors purposely took away your federal dollars with their pricing strategy in order to steer you to their less expensive, less comprehensive plans.

Remember, these new competitors have no individual customers in Louisiana yet to base their prices upon. They are guessing how much healthcare their new customers will use, and to make sure they minimize that spending, their plans will severely limit choices of hospitals, doctors and drugs. That’s fine if you are aware and OK with getting all of your healthcare within a very narrow network that’s only available in a specific market in the state. But your out-of-pocket costs could be devastating if you didn’t realize how narrow your choices were when you signed up for coverage.

If you want a wider choice of medical providers and healthcare facilities to use, stick with Blue Cross coverage. It might cost you a little more, but in exchange you get the peace of mind knowing your own doctor, preferred hospital or prescriptions are covered in the larger network. Did you know Blue Cross plans now cover more than 130 drugs at $0 copays?

If the premium increases in your Blue plan, triggered by the competitor’s pricing strategy, cause you to go shopping for a cheaper plan, PLEASE make sure you verify that your doctors and hospitals, along with any prescription drugs you take, are covered by any new plan. Make sure you can use your insurance in areas to which you commonly travel. A geographic limitation on a health plan can be really tough to deal with. And if you know you’ll have a big healthcare need next year, like having a baby or having surgery, make sure the providers and facilities involved will be covered on your new plan.

More than ever before, there will be lots of plans on Healthcare.gov that work in VERY limited areas and have $0 benefits outside the areas and provider network that the plan offers. Such limited plans have been quite rare in the past here in Louisiana, but new competitors are flooding the market with these skinny, low-value plans. So, please be vigilant.

Your best bet here is always to use a state-licensed and regulated agent to help you understand your choices. You can connect with one by checking out www.GetPlanOptions.com or calling 1-844-GET-BLUE (1-844-438-2583) and they will set you up. These agents charge you nothing to help you make the right choice for your healthcare needs. And, there’s no obligation to buy because you speak to an agent.

The Straight Talk is, now more than ever, a lower price may leave you with fewer choices and insurance that is useless when you really need healthcare. Like Dad said, if it sounds too good to be true, it’s time to get smart and be vigilant before you buy anything. Check out where your new insurance works and which docs, hospitals and drugs they cover before you sign up for coverage. You’ll be so glad you did!

Posted on: October 28, 2021

2 comments on “IF IT SOUNDS TOO GOOD TO BE TRUE…

  1. Mary Ann Cardinale

    Thanks for the straightforward explanation! I’m keeping this edition in my favorites so I can forward to customers who call to say they are thinking about these other options for next year. It comes across much better than me saying to them “those other companies are rip-off artists” LOL

    Reply

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