Decision to Exit ACA-Compliant Individual Market in 2018

June 1, 2017 - Blue Cross and Blue Shield of Nebraska (BCBSNE) announced today the company’s difficult decision to discontinue the two remaining Affordable Care Act (ACA)-compliant individual health plans we offer on the private market, effective January 1, 2018. This decision will affect ACA-compliant Bronze and Catastrophic individual plans.

BCBSNE will continue to sell and maintain our Medicare Supplement and Medicare Advantage plans, as well as our small and large employer group plans. Also unaffected by this decision are the nearly 20,000 members covered under one of our grandfathered pre-ACA individual plans.

We have a responsibility to all our members to remain stable and secure. That responsibility will be at risk if we continue to sustain losses in our ACA-compliant individual plans. Claims costs have continued to far outpace premiums for Bronze and Catastrophic plans, and this, combined with the continued instability of the ACA and increasing uncertainty about what will replace it, led us to make this difficult decision.

In fact, we are projecting that by the end of 2017, the Bronze and Catastrophic individual plans will generate a loss of approximately $12 million. This in in addition to the $150 million loss we previously experienced on the individual ACA plans we sold on the federal Marketplace from 2014-2016. Because of these losses, we will stop selling individual ACA plans on the federal Marketplace in 2017.

We continue to work at the state and federal level to advocate for reform that’s in the best interests of all Nebraskans, making health care and health care coverage as accessible and affordable as possible.

If you are affected by the discontinuation of our individual ACA-compliant individual plans, the following FAQs may help answer your questions. You may also call our Member Services Department to speak to one of our representatives.


What plans are impacted by this decision?

Effective January 1, 2018, BCBSNE will stop selling our ACA-compliant Bronze and Catastrophic individual plans, and the customers currently covered under these two plans will need to enroll in a new plan with another carrier for next year. This impacts approximately 12,500 individuals. Members who currently have an ACA-compliant Bronze or Catastrophic plan will continue to have coverage through December 31, 2017.

This change does not affect our members with Medicare Supplement, Medicare Advantage, individual health plans purchased prior to January 1, 2014 (known as grandfathered pre-ACA), nor members with plans through their employers (including small group ACA plans).

Does this mean you are no longer selling individual health plans?

We will no longer be offering individual health plans for people under age 65. We will continue to offer Medicare Supplement and Medicare Advantage coverage.

If my plan is being eliminated, when will I be notified and receive additional information?

If you’re covered under the Bronze or Catastrophic individual plan, you will receive a letter from us via the US mail. Open Enrollment begins November 1, so you will have time to shop and find a new plan before January 1.

In addition to my Bronze / Catastrophic plan, I also have separate dental coverage with you. What happens to that? Am I losing that as well?

If you also purchased our separate dental coverage, that plan is NOT being terminated. You can continue your dental coverage with us even after your health plan ends on January 1 of next year.

If my plan is being eliminated, what are my coverage options?

We encourage you to talk to your broker or agent about your health coverage options for next year, or go to www.healthcare.gov.

What should I keep in mind when I’m looking for a new plan?

Take a look at the plan’s provider network. Make sure your hospitals, doctors and other health care providers are in that plan’s provider network. Likewise, check to make sure the prescription drugs you and your family members take are on the new plan’s drug list (also called formulary). Also, it’s a good idea to let your doctors know that you will have a new insurance company starting January 1, so that they’ll know to bill 2017 charges to us, and 2018 charges to your new carrier.

I have coverage through my employer. Is my coverage impacted by your decision to stop selling individual health plans?

No. This does not affect our customers covered under their employer’s group health plan.

I have a Blue Cross and Blue Shield Medicare Supplement / Medicare Advantage policy. Is my coverage impacted by your decision?

No. this does not affect our customers covered under one of our Medicare Supplement or Medicare Advantage plans. Your coverage remains in force and unchanged.

I have one of your old pre-ACA individual plans. Am I impacted by this change?

No. If you’re covered under one of the grandfathered plans we were allowed to retain as part of President Obama’s “Keep Your Plan” promise, our decision to stop selling individual ACA-compliant plans does not affect your coverage. Your coverage remains in force and unchanged.

Why are these plans losing so much money?

Very simply, the claims we are paying out for the Bronze and Catastrophic plans are significantly higher than the premiums we are taking in, and we don’t see that imbalance changing. About 12,500 individuals are covered under a Bronze or Catastrophic plan. These two plans make up less than 2 percent of our overall business, yet we project that by the end of the year, they will have generated more than $80 million in claims in 2017.

If we would have continued to offer the Bronze and Catastrophic plans, current calculations indicate the need to increase their premiums by more than 50% in order to pay projected claim costs. That’s a pretty steep increase to absorb. Plus, the higher premiums go, the more likely that people (especially healthy people) will drop their coverage. This means the majority of people remaining on the Bronze and Catastrophic plans would be sick, with increasingly higher claims, which would drive up their premiums even further. This structure simply can’t be sustained indefinitely.

Will the Republican-sponsored health plan fix things?

The Republican-sponsored bill is still in development stages, so it’s too early to speculate how it will change the current health care law – and what that means for our members. Until such time as the bill is finalized, passes both the House and Senate and is signed into law by the President, the current Affordable Care Act remains in place.

We continue to work at the state and federal level to advocate for reform that’s in the best interests of all Nebraskans, making health care and health care coverage as accessible and affordable as possible.

What do you think should happen?

We believe Americans are best served by a competitive private health insurance market that offers consumers the choices they want at a price they can afford. We believe to achieve this goal, any future health reform must adhere to three key principles:

  1. Health insurance should be available to everyone, regardless of pre-existing conditions;
  2. States know their local health care systems best, and they should be empowered to meet the needs of their local communities; and
  3. Health care must be more affordable for patients, families and taxpayers, while key protections such as no lifetime caps on benefits, equal rates for women and men, and allowing young people to stay on their parents’ plans until age 26 should remain in place.

Read more about how to make the health insurance market work »

What are you doing to control costs?

Our goal is simple: we want our members to get the best possible health care at the lowest possible cost.

Blue Cross and Blue Shield of Nebraska rewards hospitals, doctors and nurses based on the quality of care provided and for improving and maintaining the patient’s health. We are partnering with Nebraska hospitals, doctors and nurses on prevention, wellness, disease management and coordinated care programs – all with the goal of better health.

Our value-based care programs help doctors and nurses choose evidence-based medical treatments that will best meet the unique needs of each patient and help people get healthy faster and stay healthy longer. We do this by using payment approaches that pay for care coordination and offer rewards for improved outcomes and lower costs. We also support doctors in their efforts to make their practices more effective, efficient and patient-focused.

Blue Cross and Blue Shield of Nebraska is not-for-profit and member owned and operated. Our board of directors is made up of our members. The decisions we make are by Nebraskans and for Nebraskans. We don’t answer to shareholders, don’t pay dividends, and aim for a 0-1 percent profit margin.

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. 


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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.

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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

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