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.

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

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.

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.

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.

Individual Health Insurance Marketplace Exchange Information for 2016_Post 3

When the open enrollment commences on November 1, 2015, there will be two avenues for enrollment on 2016 individual plans. The first avenue is “passive enrollment” for those who are already enrolled on an individual plan who are happy with it; they will basically do nothing, and just continue with the plan that they already have (read your renewal letter and look for changes that are highlighted in the letter). The vast majority of people choose this route, because they have already spent time in the past to carefully choose the plan that works well for them, and so they are perfectly happy remaining on that plan. The second avenue is “active enrollment”, for those who are just entering the individual market or who are already enrolled but would like to make a plan change. This avenue means that you must do something proactive to change your plan. Many of you have already contacted our office for assistance with this. If you would like help making a change because of your current plans price, scope of coverage, network, or personal health changes, please contact our office right away so that we can assist you with that change.

This year our office will be rolling out several helpful tools, including Health Sherpa, which will simplify the enrollment process on the exchange for you. We also have a wealth of tools available on our website to help you with all elements of your insurance and financial life. Make sure you check it out!

If you have not done so already, make sure you contact our office if you need assistance or want to make changes once the open enrollment begins. In your correspondence, be prepared to provide your zip code, the dates of birth and names of all of the people you want to cover, whether or not anybody uses tobacco, what insurance plan you have currently, what doctors and hospitals are important to you, and if you have any special needs from a medication standpoint. Also indicate whether or not you think you are subsidy eligible. By providing this information, we are able to narrow down the plans that you should be looking at.

Thank you for reading this message, and for preparing yourself for Open-Enrollment 2016. We look forward to working with you!