Why we are leaving the ACA individual market in 2018

As of January 1, 2018, we will no longer offer ACA-compliant individual health plans. We understand this decision is disruptive and disappointing for the members impacted by our decision.

We wanted to remain in the private individual market—even after significant losses in our ACA-compliant plans forced our exit from the federal Marketplace in 2017. However, claim costs continue to far outpace premiums for ACA-compliant individual plans, and this, coupled with the continued instability of the ACA and increasing uncertainty about the timing, shape and form of its replacement, led us to make this difficult decision.

We have a responsibility to all our members to remain stable and secure. That responsibility would have been at risk if we continued to sustain losses in our ACA-compliant individual line of business, and we didn’t want this to begin to negatively impact rates for customers covered under our other lines of business.

The U.S. health care system is at a critical crossroads. Blue Cross and Blue Shield of Nebraska has been serving generations of Nebraskans for nearly 80 years. We know what it takes to make health insurance markets work. We believe the health care system can be fixed.

HEALTH INSURANCE TERMS


COINSURANCE

The percentage of the bill you pay after your deductible has been met.

COPAY

A fixed amount you pay when you get a covered health service.

Tiered benefit plan

A health care plan featuring multiple levels of benefits based on the network status of a particular provider. 

DEDUCTIBLE

The annual amount you pay for covered health services before your insurance begins to pay.

emergency care services

Any covered services received in a hospital emergency room setting.

SUBSTANCE ABUSE DISORDER SERVICES

Includes behavioral health treatment, counseling, and psychotherapy


in-network provider

A provider contracted by your insurance company to accept an agreed upon payment for covered services. 

OUT-OF-network provider

A term for providers that aren’t contracting with your insurance company. (Your out-of-pocket costs will tend to be more expensive if you go to an out-of-network provider.)

out-of-pocket

Your expenses for medical care that aren’t reimbursed by insurance, including deductibles, coinsurance and co-payments.

penalty

If you can afford health insurance, but choose not to buy it, you must have a health coverage exemption or pay a tax penalty on your federal income tax return.

premium

The amount you pay to your health insurance company each month. 


Preventive services

Health care services that focus on the prevention of disease and health maintenance.

rehab SERVICES

Services and devices to help you recover if you are injured or have surgery. This includes physical, occupational and speech therapy.

special enrollment period

The time after the Open Enrollment Period when you can still purchase health insurance only if you have a qualifying life event (losing other health coverage, having a baby, getting married, moving).

specialist

A physician who has a majority of his or her practice in fields other than internal or general medicine, obstetrics/gynecology, pediatrics or family practice.