Individual Open-Enrollment 2018: Market Update

Open enrollment for individual health insurance for 2018 is less than 3 months away from commencing, as it will begin on November 1. This is the first of a series of blogs our office will be posting as we get closer to November 1 in preparation for the Open Enrollment period, November 1, 2017 until December 15, 2017. As you may notice, this is only 45 days including weekends and Thanksgiving. This is the shortest open enrollment period since the creation of The Affordable Care Act/ObamaCare. As you can see, time will be the essence. As we communicate to you further in the coming weeks, we will be urging you to be prepared to enroll on, or very close to the first day possible, November 1. The window is very narrow this year, and there could be a lot of chaos and confusion in the marketplace for reasons that I am about to explain further.

The Trump administration and many of the Republicans in Congress want to end the Affordable Care Act/ObamaCare, for this reason there is a lot of uncertainty regarding how subsidies and cost-sharing payments will be handled in 2018. As a result of this uncertainty, it is possible that some or all of the insurance companies doing business in New Hampshire will either have significant rate increases for 2018, or perhaps even cease doing business in New Hampshire in 2018. There is no guarantee as of this time if either Anthem or Harvard Pilgrim will have plans available for the individual NH market, and even if they do, what their rates are going to look like. Lastly, there could be significant changes in the networks of the plans that are offered in New Hampshire. There may be little, if any access to Massachusetts doctors and hospitals, unlike today. The State of New Hampshire Department of Insurance has recognized all of these negative possibilities, and has been trying to come up with a plan to entice/keep insurance companies offering plans to individuals in NH in 2018, but there remains much uncertainty about their ability to do so, as the legislature has refused to allow them to use an approach they proposed. Following that legislative showdown, the insurance department announced that rates could increase an average of about 40% in 2018, and the likelihood that only two (or less) companies will be in the marketplace next year. The bottom line is that we will be posting regularly because you must be prepared to act quickly in this uncertain and tumultuous market.

As you consider and prepare for open-enrollment 2018, it is important to remember the NPN #. This is the National Producer Number (NPN) which connects your policy to our agency. This way, we can answer question for you and service your policy as needed throughout the year. When you apply, always indicate you are working with your broker, Raymond White, and/or input my NPN broker code, which is 68433.

We will be back soon with more valuable information about the 2018 open enrollment process and the health insurance landscape for individual health insurance in New Hampshire.

Can I change to another Carrier now that I may be losing my providers with Community Health Options?

Community_Health_Options_Logo_RGB_HighRezSomeone who is enrolled on a Community Health Options (CHO) plan through the individual market may switch to a new plan during the course of the year if they experience a Special Enrollment Period (SEP), otherwise they must wait until Open-Enrollment 2017 (November 1, 2016 to January 31, 2017) to select a new plan for 2017. On the other hand, there is more flexibility in the group market if a group administrator decides the plan is no longer working for their group. We can work with groups on a case-by-case basis if they decide they need to make a move.

CHO is a co-op, it operates under different rules than a traditional insurance company and is directly accountable to The Center for Medicare and Medicaid services (CMS). If CMS determines that CHO’s financial stress is a clear and a present danger to existing policyholders they would allow all of the members of CHO a special enrollment period (SEP) to find other coverage. This has happened with some of the other co-ops that failed or, were on the verge of failing in other parts of the country. At that time, CMS would notify all affected members of their eligibility to move to another carrier. Fortunately, CHO has not reached this point as of yet. The recent newspaper article printed in the Union Leader pointed out the fact that CHO is being monitored with heightened supervision by both CMS and the Maine Department of Insurance due to the losses they sustained last year and projected losses they expect for this year.

Behind the scenes, CHO is telling brokers, including myself, that they are working through their problems and have a plan to get back to financial health. For example, they have raised their group rates substantially and have discontinued writing individual business as of December 15th, 2015. They have also changed their network in New Hampshire, and are no longer allowing members to utilize the First Health Network as an in network provider;  unless, they are outside the states of Maine and New Hampshire. In Maine & New Hampshire, members must utilize doctors that are directly contracted with CHO in order to be considered in-network. Lastly, they have implemented some administrative cost-cutting measures. They believe that all of these steps together will steer the company back on track to be sustainable and competitive in the long term.

In conclusion, take comfort in the fact that two regulators are monitoring this situation; the State of Maine Department of Insurance and CMS. They are requiring CHO to report their financials on an ongoing basis, and continue to closely monitor them from a financial standpoint. If CHO should fail its financial obligations to consumers, then it’s reasonable to expect CMS to protect all of the affected members, as they have done historically with the 12 co-ops that have already gone out of business over the last two years.