If you have a grandfathered plan, this information does not apply to you.
Grandfathered plans were purchased prior to 3/23/2010, when the Affordable Care Act (ACT) was signed. Since that time, your policy has not changed per ACA guidelines. You should not change your grandfathered plan without consulting one of our JME team members.
We know the following about 2017 non-grandfathered individual ACA-compliant plans:
Your effective date depends on the date you submit your application:
After 1/31/2017, one can only apply if you have a special enrollment event. Proof of a special event is required to get a policy in 2017 after 1/31/2017.
Click here to view the flowchart.
The rules have become stricter, particularly if the company does not have employees who are not owners related by marriage. If the group’s owners do not file 1065 forms for tax filing, they must have at least one employee (can even be part-time) to qualify as small group. The employee must appear on the latest quarter Texas Workforce Commission (TWC) return to pay State Unemployment Tax. If you are considering this option, please talk with a JME team member to be sure you qualify. It may be best to apply for a 2016 small group policy to delay the small group 2017 increase. The small group rate filings for 2017 are much lower than individual, but they ran 10% – 19%.
If available, this will give them better access to providers and lower cost. Individuals attending college should look at writing coverage through their college, which usually has better pricing and excellent networks.<
If you have a non-grandfathered UHC individual plan, you will need to find another option. Other carriers may also get out of the individual market (just not announced yet) or may get out of certain area markets within Texas.
They can auto renew your current plan OR, if they eliminate your current plan, they usually move you to a similar plan. If you want to change plans, it must be done during open enrollment. Please contact a JME agent to assist you with this process.
Some of the increases have not yet been approved. BCBSTX has filed for a 58% rate increase. Most major carriers have filed for 30% to 34% rate increases. These increases are not the exact increase for your policy as they adjust upwards or downwards depending upon your area in the State and your plan metallic value. A few local HMO plans like Molina Healthcare filed for smaller increases, about 10%-15%. These plans are usually limited to one or a few counties and have a significantly smaller network for doctors and hospitals.
Some rural areas may have only the BCBSTX HMO plans to choose from or they may also have a local hospital plan to choose from. In most cases the local hospital plans will be lower in premium cost, but will have smaller networks as they only include doctors and hospitals in their system.
Baylor Scott and White (BSW) is a hospital plan, but unlike small local hospital systems, it encompasses many counties and has numerous doctors and hospitals in its network. BSW also offers a PPO option and their HMO does not require a primary care physician (PCP) like most HMO plans. BSW has announced that they will NOT be writing policies ON EXCHANGE, but WILL sell limited Bronze plans OFF EXCHANGE. You must reside in their service area to have a BSW plan.
For example, UTSW (University of Texas Southwestern) and THR(Texas Health Resources) in the DFW metroplex have formed a partnership called Health Alliance. Now they have entered into a joint venture with Aetna in order to offer individual and group plans. We do not know if they will be ready for 2017, nor do we know the types of plans they will offer or what the rates will look like.
They will continue to offer only one Bronze plan OFF EXCHANGE in the DFW area (Dallas, Tarrant, and Collin Counties) for 2017.
They will continue to offer plans OFF EXCHANGE in specific counties.
Your subsidy will depend upon your plan selection for 2017. Subsidies are based on the 2nd lowest cost Silver plan offered on exchange in your area. For example, in Dallas County, since Molina Healthcare has the 2nd lowest Silver plan and now the lowest filed rate increase, you will see your portion of the premium increase if you have a plan other than Molina Healthcare.
As we learn more details, we will be sharing them with you.