What is going to happen if and when Obamacare is repealed?

This is the ultimate question, and one that I receive many calls on since the election. The answer is, at this point nobody knows. I have written an extensive blog post on this issue which can be found here. Suffice to say that there will be replacement of some kind, and initial indications are that it appears any changes will not take place until 2020. The ACA sky is not falling for now, and we will have to see what Congress enacts in the future.

I am Self-Employed, and for the last 3 years my plan has either been cancelled, or my carrier has gone out of business, so I have had to keep changing coverage every year. Is there an alternative to individual plans on or off the Exchange?

Yes there is, but you must have at least one full time employee that can't be your spouse. Group insurance rules allow for a group of 2 to be created as long as you employ 1 additional person that is a W-2 employee at 30 hours per week at minimum wage. There are several advantages to this approach. One would be the fact that for the first time in my health insurance career, group market premiums are now lower than their individual market counterparts. The second is that on the group side, there is more carrier and plan choice, and the provider network is much larger, with most plan options offering nationwide in-network services. The third would be that as a business owner, you can write off all health insurance costs including your premiums. This is a huge advantage over individual plans as in this case you can write off only a percentage of your health care expenses.

If you are a bit of larger company and employ 15 or more people, then another alternative would be to see if a self-insured plan would make sense for your company. These plans eliminate the traditional group insurance model by effectively making the Employer the insurance carrier. The business is provided with a guaranteed stop loss, and they are free to create any plan design of their liking. Not too get to technical here, but by utilizing Reference Based pricing, these plans eliminate the need for carrier network contractual obligations, as the self-funded plans pay any provider up to 150% of the Medicare re-imbursement rate, effectively eliminating any balance billing to the member. Another benefit to this plan design is that if the group experiences low claims history throughout the year, the company is reimbursed the portion of the premium dollars that are set aside for claims. Conversely, if the company has a large claim experience within the plan year, the self-funded group sponsor can shop this risk to multiple re-insurers which more times than not comes back with favorable rates comparative to the traditional open market carrier model. Companies who wish to keep their best and brightest talent really like utilizing this approach because they can create very rich plan designs that feature lower copays, zero deductibles, and very low maximum out of pockets that are no longer available in the traditional carrier model group based insurance. Yes, these premiums can be higher, but given the tax advantage, coupled with very high talent retention, this can be a cost effective way to solve the health insurance merry go round.

I recently discovered that my doctor has recommended a specialist to see as soon as possible. This physician is not in my current plan. I know that there is another carrier in my State that she accepts, so I would like to enroll in this plan. Is this possible?

Great question, and this comes up quite often. As we are past the open enrollment period for 2017 which ended on January 31st, the answer to this question is no, you may not. While all carriers who were active in the individual market space both on and off the exchange the last 3 years have lost several million dollars, most of this loss was due to members enrolling after the open enrollment period. So the consequence of this is to strictly enforce the barriers to purchasing health care outside of the open enrollment period. Qualifying events for this include a permanent move to a new State, loss of Group insurance coverage, marriage, divorce, etc. Not finding a physician in your plan is not a qualifying event, and you are stuck with this plan until the following year.

I was laid off from my job, and have just received the Cobra letter asking me if I want to enroll. Can I shop around for a different individual plan?

Yes, but only if you have been offered and have yet to accept the Cobra coverage. If you accept it, you are compelled to stay on in until either you are offered other group coverage, or until open enrollment begins in November. Most of my clients have no clue how much their coverage with their current company health insurance costs until they are in the situation of enrolling in Cobra, as you must pay for the entire premium cost of the plan usually with an administrative fee of 3% or so. Recent times suggest that electing Cobra is more than likely your best option for many reasons. While the cost is high, it is usually lower than the individual market options, and as stated above, the network access is better. Further, enrolling in Cobra allows you to retain your current fulfilled deductible obligations, so this would certainly be a consideration. The later in the year the layoff occurs, the better Cobra is, due to the fact that any individual plan you start in 2017 ends on December 31st, 2017, and deductibles reload on January 1st. NOTE: You have the right to cherry pick Cobra extension of benefits to just the medical, not the dental or the vision. These coverage's may or may not be worth it, but don't let the administrator tell you it is an all or nothing deal. This includes that fact that your spouse or dependents are all Cobra eligible regardless who retains the coverage.