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The 2016 CO Health Insurance Landscape & FAQs

Hello everyone.  I’ve been working with a number of you and getting your plans changed for 2016.  Since CO HealthOP is not being offered for 2016, we will need to find a plan that is going to meet the coverage that you need or desire, as well as the doctors that you want to continue to see.  I wanted to give those of you that I haven’t had a chance to connect with yet some of my observations and findings on the current 2016 health offerings so you can begin to think about the kind of coverage that you want to move to, as well as the company you want.  For those that I’ve already assisted, feel free to forward this to any friends that are trying to figure out the health insurance landscape for 2016.
Which companies have the best “value” coverage for 2016?
After having surveyed the roughly 100 plans in the market the last couple of weeks, the best “value” coverage belongs to Cigna, Humana, UnitedHealthcare, and Kaiser – depending on how good of coverage you want.  Which company is a better value actually depends as you move up the coverage level of a lower deductible.  If someone is wanting a “better coverage” plan i.e. a lower deductible and coverage for doctors and specialists, then UnitedHealthcare has some very good offerings in the better Silver plan ranges, as well as one of the cheapest high deductible plans.  Kaiser, Cigna and Humana are offering some very good value Bronze and lower level Silver plan offerings.
What have I been seeing people switch to for 2016?
I was just asked this by one of you over the weekend.  It’s really been all over the board!
2015 was a pretty easy year to pick a plan frankly because CO HealthOP killed everyone else on price and had 2 plans with good networks – with their more expensive, larger network plans being still cheaper than other companies and pretty much having nearly every doctor in it.  This year is a lot more nuanced and difficult to figure out.  So I’ve got kind of a mix frankly of Cigna, UnitedHealthcare, Kaiser, Anthem, and Humana enrollments at this point.  I hadn’t really thought about the numbers until now, but it’s kind of a weird year.  It’s very competitive in a lot of respects amongst the plans, with a LOT of nuance between the networks, and a LOT of nuance as you start walking up the scale of deductibles.

 

Is there a PPO plan available for 2016?
Yes, Anthem is the only major company offering PPO options for 2016, although Cigna has “Away From Home Care” on their Vantage Plans.
How do the networks compare?
For some people it all comes down to network and being able to have their doctors covered.  For others, it comes down to price and coverage and they are more flexible and open to which doctors they go to.  Generally, the more flexible in your doctors that you are, the cheaper coverage you will be able to get.  Plans with larger networks tend to be more expensive than smaller network plans.
Cigna has 2 different network offerings:  their Connect plans and their Vantage plans.  The Connect network is smaller, but is still very large.  I have found that most doctors are in this network.  Their Vantage network is a decent amount larger.  It also allows for people to access “Away from Home” care i.e. you can see Cigna contracted doctors outside of the state of CO.  Out of Network is NOT covered, but this does give you access to a good network of out of state doctors if you travel.
Humana’s network is a smaller one, but their coverage is a very good value in comparison to other coverages.  If you are willing to go in network with a Humana contracted doctor, then they will be a good route for many.
Kaiser is Kaiser.  Pretty self-explanatory – you have to go to Kaiser doctors and facilities.
UnitedHealthcare has 2 networks:  Compass and Navigate.  Compass is a very good network but smaller.  The Navigate network is available only off-exchange.  Navigate very well may be the BEST network of any plan in the marketplace.  I have found very few doctors who DON’T participate in this network yet.  If you want a good plan i.e. a good Silver level plan with good coverage and an excellent network, then UNH will be a go to company for 2016, however their Select Saver plan is also pricing to be the cheapest, highest deductible plan in the market outside of Kaiser.
Anthem has 2 different plan networks available:  the Pathway network and the PPO network.  Pathway is a much smaller network.  The PPO network is a VERY large national network and so far I would say is rivaling the UnitedHealthcare Navigate network as potentially the largest network.  It allows you to access the network while traveling in other states, and also offers out of network coverage, although at a steeper price.  Unfortunately all but the most expensive Anthem PPO plan is offering immediate coverage to a specialist with a simple copay.  All specialist visits are subject to the deductible, unless you’re on the Gold level plan which is fairly expensive.
How do the other companies you haven’t mentioned compare?
There are other plans in the marketplace like Rocky Mountain Health Plans, Denver Health etc.  In my judgment, these companies will not be good options to go on due to network and steeper prices for their coverages.  I believe 2016 is a year where people will want to gravitate towards the larger, more established companies in the marketplace.
How do the insurance subsidies I’ve heard about work?
If you are within a certain income range for ESTIMATED 2016 income, then you may qualify for a subsidy, aka Advanced Premium Tax Credit.  You have to apply for and be denied Medicaid first, and then go through the application to apply.  Keep in mind, this process is if you want the subsidy ADVANCED to you in the form of a lower insurance premium.  If you qualify, you will get a higher tax return when you file the next year, even though you may not have had it applied on a MONTHLY ADVANCED basis towards your health premium.  For example, the income range for a single person is between $11,690 – $46,760 for 2016 income.  If you are within that range, you will get a subsidy.  HOWEVER, you will not actually get it ADVANCED monthly unless you make BELOW roughly $35,000.  The person who makes $35,000 will get a higher tax return when they file their 2016 taxes in 2017, but will NOT get an ADVANCED premium tax credit to lower their premium monthly.  A family of 2 is between $15,730 – $62,920; family of 3 is $19,790 – $79,160; family of 4 is $23,850 – $95,400.  If you get an Advanced Premium Tax Credit, but your income turned out to be higher when you file your taxes, you will pay that money back to the IRS at time of filing.
When do I have to decide on coverage?
We need to have your enrollment completed by December 15 in order to have coverage effective for January 1.  Open Enrollment continues till January 31, but coverage purchased on January 31 won’t be effective until March 1.
Are there stand-alone dental plans available?
Yes, there are a number of companies offering dental plans including Delta, UnitedHealthcare, Cigna, Anthem, etc.
What other options are there to help pay a deductible?
You may want to take a Critical Illness plan as well which will pay out a lump sum of money upon diagnosis of a critical illness such as a heart attack or stroke.  This can go to help pay a deductible if you decide to take a cheaper premium, higher deductible plan.  A lump sum $10,000 policy is roughly $8/month.
Where do I get started in narrowing down my coverages?
For those I have not gotten a chance to connect with yet, you can send me an email letting me know any doctors that you currently see that are “deal breakers” for you i.e. you NEED to have them in your plan and are willing to “pay up” in coverage to get them into your plan, as well as any doctors that you would like to see, but are willing to lose if it saves you money.  Also, if there’s anything else I should know like an upcoming surgery for 2016, that would help determine which coverage we will want to go with.  I will try to find something that fits either coverage or price wise to what you had in 2015.  But if you’d like to make a change in coverage, like willing to sacrifice a higher deductible so that your premium is lower, then please let me know.  Unfortunately, since CO HealthOP essentially priced their plans to buy the market last year, pretty much everyone’s premium is going up for 2016 unless we look at a higher deductible than what you had in 2015.
Just a reminder that I AM A FREE SERVICE TO YOU!  Your plans will be the exact same price and offerings whether I assist you with your coverage or you go through another company in the marketplace or the carrier itself.  No insurance company or broker has the ability to charge you a higher premium for the coverage offered in the marketplace.  We are compensated by the companies the same.  I’m happy to assist you with a plan from Kaiser, Anthem, Cigna, UnitedHealthcare, Humana, RMHP etc.  It all comes down to the price and coverage that works for you and the doctors you want to see.  I’m here to assist you in narrowing that down and finding the plan that works for you, regardless of company.
Let me know any questions that you have and thank you for allowing me to assist you!