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Who’s Gonna Win This Game? I

t’s too early to say for sure who is going to win the game of health insurance this year. But when one team can change the rules in their favor and cause fewer players to participate, that’s an unfair advantage—and yet, that’s exactly what is happen- ing (again). The players are you and me, insurance companies and the govern- ment. One guess as to who’s changing the rules.


One rule that still stands, and has been in place for six years, is that small businesses with fewer than 50 em- ployees are not required to provide health insurance for those employees. However, many still do. However, another rule, called the individual mandate, says that everyone must have health insurance. So, it is still a problem for all of us in one way or another. In fact, if you do not have health insurance in 2017, you will have to pay a penalty. It is the same amount for 2016: either 2.5 percent of household income or $695/adult and $348/ per child, whichever is greater. Now that is substantial, but apparently not for some. Regardless of the fear of penalties, there still are some folks who cannot afford health insurance even with the subsidies on the federal exchange.


If you are going to pay to play as most of us are, there are many more rules. Like when you must start to play and that you can’t practice any time before or after a certain date. I’m talking about open enrollment and this is important.

Open enrollment begins on November 1, 2016 and ends on January 31, 2017. This is the only time you can buy insurance unless you experience a qualified event. If your insurance needs to be effective by January 1, 2017, then the cut-off date for application is December 15. January 15 is the cut-off date for February 1 and January 31 is the cut-off date for March 1, 2017. Applications received at any other time will be declined unless you have a qualified event, such as: a) marriage or divorce; b) birth or adoption; c) moving out- side of the network area; or, d) involuntary loss of coverage (i.e., cancellation of health insurance by an employer or cancellation of policy by a health insurance carrier). This last example will affect many individuals this year because UnitedHealthOne (UHC) has decided to exit the individual market both on and off the exchange. You should receive a cancellation notice which is your proof that you qualify for a special enrollment. But don’t wait longer than 60 days, or you will be assessed a penalty!


There are more changes to the player roster. Aetna will not be on the federal exchange

18 focus | SEP/OCT 2016 | ISSUE 5

BlueShield of Kansas City still will be avail- able on and off of the federal exchange.

Transitional Plans, that is those plans pur- chased from March 23, 2010 through January 1, 2014 which are not ACA compliant, have been given approval by Obamacare to con- tinue until December 31, 2017. Grandfathered Plans are not affected and will continue, but remember these plans are not ACA compli- ant and therefore still are subject to under- writing and pre-existing conditions.

Networks, or the doctors and medical facili- ties endorsed by a certain carrier, continue to be very important. They are always chang- ing, so you must check to make sure that a certain network still includes your doctor and medical providers. If not, your treat- ment could cost much more, and your health insurance could pay much less. It’s best to call your doctor’s office or hospital direct, as they should know their status with differ- ent networks. Most carriers use a different network for their on-exchange plans. So even though the cost of insurance may be less, the network of medical providers may be more limited.

next year because the Department of Justice postponed a decision on their acquisition of Humana whom Aetna says with- out, they cannot afford to continue participating in the federal exchange. Aetna did purchase Coventry, and Coventry will continue to write off-exchange individu- al plans. Anthem is planning to acquire Cigna, but this also has been postponed by the Department of Justice (although Anthem still will be available both on and off the exchange). Blue Cross/

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