Individual Market 2018_2 Weeks Away

Open enrollment for individual health insurance for 2018 is less than 2 weeks away from commencing, as it will begin on November 1. This is the second of a series of blog posts designed to ease confusion during this open-enrollment window.
There is a lot at stake this year, as open enrollment will run from November 1, 2017 until December 15, 2017, just 45 days including weekends and Thanksgiving. This is by far the shortest open enrollment period since the creation of The Affordable Care Act/ObamaCare. With this in mind, we urge you to be prepared to enroll on, or very close to November 1. As you can see, the window is very short this year, and large rate increases are expected for those who have nonsubsidized health insurance. Here is a rundown of the facts as we know them to be at this time:
If you are on an Anthem Grandmothered plan, you may keep that plan for all of 2018. Those renewals are being cycled to January 1st. For those of you who were used to renewing on December 1st, this will result in a 13-month rate guarantee, rather than 12 months. We are strongly urging the few people we have left with those Grandmothered plans to keep them, as they are irreplaceable and better than everything else that is in the market today.
As you may know, Minuteman is leaving the market on December 31, 2017. Those who have Minuteman coverage through the federal exchange will be automatically mapped to the closest plan among the other carriers (Anthem, Harvard or Ambetter). Those who are NOT covered through the exchange will NOT be mapped and coverage will end if no action is taken. We are urging all Minuteman clients to log into our HealthSherpa website to actively, affirmatively choose another plan. Unfortunately, whether you choose a plan with Harvard Pilgrim, Anthem or Ambetter, it is very likely your rate is going to be higher, and for those of you who do not receive a subsidy, much higher. That will be difficult for many of you, because Minuteman was clearly the lowest cost carrier in the market last year.
For those of you who are on Harvard Pilgrim plans with the New Hampshire network, all of those plans have been discontinued for 2018. If you want to stay with Harvard Pilgrim, you will have to move to their ElevateHealth plans, which have a smaller New Hampshire network than the plan you were on in 2017. Harvard Pilgrim will still offer their ElevateHealth Options program, which is the only individual plan in New Hampshire with some access to the major Boston hospitals, but those two plans are very expensive and not available on the exchange, which means they cannot be purchased with subsidy dollars.
Ambetter will be available in 2018. Although they were also available in 2017, they only sold about 100 non-Medicaid plans throughout the state last year, because they did not actively market their plans. This year they will be actively marketing their plans. For those of you who must have Parkland Hospital and Portsmouth Hospital, they will be the ONLY carrier in New Hampshire with those two hospitals in their regular network.
Unfortunately for many of you, if you must have certain hospitals, or must have Boston access, there will likely only be one choice of insurance companies for you this year. To give some perspective, last year there were 49 plans for sale on the exchange across the four companies doing business in New Hampshire. This year there will only be 15 plans for sale across the three carriers we have for sale in New Hampshire. Very little choice, and for some, a Hobson’s choice.
To be prepared for November 1, we would recommend logging into our HealthSherpa website to familiarize yourself with it.

The most important thing to keep in mind about this website is that it can calculate subsidized rates based upon income. To see the actual rates (unsubsidized) for any particular health plan, enter a high income, like $100,000 or more, should you choose to enter one at all. To see subsidized rates, make sure to enter with near-accuracy your expected income for 2018, or the rates you receive may be inaccurate.

Maureen Reardon and I will do our best to answer questions and be a support during this compressed open enrollment window.

Special Enrollment Periods for the Health Insurance Exchange

The Health Insurance Marketplace has recently compiled a streamlined list of acceptable life situations that create an SEP (special enrollment period) for an individual or family. An SEP is a time period outside of the annual open-enrollment period (November 1st – January 31st) in which an individual, based on their life circumstances, becomes eligible to apply for insurance through the Health Insurance Marketplace.

I encourage you to take a look at this list to determine if you or your family qualify for a special enrollment period, and feel free to call our office for assistance.

Special Enrollment Periods for the Health Insurance Exchange

CMS: Special Enrollment Confirmation Process

The Centers of Medicare & Medicaid Services (CMS), the agency that oversees the Federal Marketplace Exchange is buckling down on special enrollment periods (SEP) in an effort to minimize adverse selection for insurers. In the past, the rules have been fairly loose, and as a result many individuals were able to enroll on a medical plan through the Exchange outside of the annual open-enrollment period with no proof of their said circumstances. I encourage you to read the new SEP standards that are being implemented now.

From CMS:

Special enrollment periods (SEPs) are an important way to make sure that people who lose health insurance during the year or who experience major life changes like getting married or having a child have the opportunity to enroll in coverage through the Health Insurance Marketplaces outside of the annual Open Enrollment period. SEPs are a longstanding feature of employer insurance, and without them many people would lack options to maintain continuous coverage. But it’s equally important to avoid SEPs being misused or abused.


Document Submission by Consumers: Beginning in the next several months, all consumers who enroll or change plans using an SEP for any of the following triggering events will be directed to provide documentation:

  • Loss of minimum essential coverage,
  • Permanent move,
  • Birth,
  • Adoption, placement for adoption, placement for foster care or child support or other court order, or
  • Marriage.

These SEPs represented three quarters of consumers who enrolled or changed plans using an SEP in the second half of 2015.

We will provide consumers with lists of qualifying documents, like a birth or marriage certificate. Consumers will be able to upload documents to their account or mail them in.

Document Verification by CMS: CMS will institute a verification process for consumers who enroll or change plans using an SEP in 2016. The Special Enrollment Confirmation Process is modeled after approaches used by the Internal Revenue Service. We will review documents to ensure consumers qualify for an SEP and will follow up with consumers if there is a question or problem. Consumers need to be sure to provide sufficient documentation. If they don’t respond to our notices, they could be found ineligible for their SEP and could lose their insurance


Centers for Medicare & Medicaid Services. (2016). Fact Sheet: Special Enrollment Confirmation Process [Data file]. Retrieved from

Changes to Community Health Options Provider Network

Community Health Options has announced a change to their provider network effective yesterday, March 1, 2016. In the past, Health Options supplemented its developing provider netwCommunity_Health_Options_Logo_RGB_HighRezork in New Hampshire with the First Health Network. Their provider relations team has been, and are continuing to actively reach out to First Health Network providers to establish contractual agreements that will create a more direct relationship with Health Options. While many providers are responding favorably, not all wish to establish a direct relationship.

As a result, as of March 1, 2016, First Health Network providers in New Hampshire who have chosen to forgo a contract with Community Health Options will be considered out-of-network.

For this reason, we encourage you to reach out to your doctor’s office to ask if they have established an agreement with Community Health Options directly and if they will be considered an in-network provider going forward. I would also suggest doing a search on the Health Options Provider Network to confirm your doctor(s) are in-network. If they are not, you may want to consider temporarily switching to an in-network doctor to avoid higher out-of-network costs associated with out-of-network providers.

Community Health Options has stated that they may continue benefits at the in-network level for up to 90 days after the provider’s termination date if the provider:

  • Continues treatment for an appropriate period of time (based on transition period goals),
  • Shares information about the treatment plan with Health Options,
  • Continues to follow Health Options’ utilization policies and procedures, and
  • Accepts the benefit payments in effect prior to the termination date.

Finally, we are concerned about how little notice Health Options provided to their members about this change. If this network disruption causes problems for you, we would encourage you to call the New Hampshire Insurance Department consumer hotline at 800-852-3416 to express your displeasure at the lack of notice that you were given regarding this change.

We will assist you with finding another plan at the next opportunity, if that is what you desire. Kindly reach out to our office if you are leaning in that direction.

Welcome Maureen Reardon

Maureen_closeWe are pleased to announce a new member of our team, Maureen Reardon. Maureen comes to us from Covering New Hampshire- where she worked as a Certified Application Counselor, helping New Hampshire citizens apply for coverage through the Marketplace Exchange.

For 8 years prior to that, she worked as the Finance and Insurance Coordinator for Ira Toyota of Manchester. She brings a variety of experience to our office, and is currently studying to be a Licensed NH Life, Accident & Health Insurance Agent. Maureen attended Notre Dame College in Manchester, NH where she earned her Bachelors of Arts degree in Psychology and Management.

Maureen has been an asset to our team, especially with regard to assisting our individual clients’ during the 2016 open enrollment period. We will be introducing her to other lines of business over the course of the year. Please help us as we welcome her to our team.

Final Days of Open Enrollment 2016

The individual health insurance open enrollment period of 2016 is quickly coming to a close. If you wish to enroll on an individual health insurance plan in 2016, or if you are already enrolled and would like to switch to a new plan in 2016, you must take action by 1/31/16.

Remember, if you do not have Minimum Essential Coverage (MEC), you may be subject to a tax penalty when you file your tax return.

Please contact our office with any questions or concerns you may have, or if you would like to enroll before the deadline 1/31/16.