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Looking Ahead with a 2017 Health Insurance Marketplace Preview  

Ed GussioDuring the past 60 days, insurance carriers have had to show their cards in terms of what they will and will not be offering during the annual open enrollment for marketplace individual coverage for next year. Open enrollment for Affordable Care Act (ACA) Marketplace plans begins Nov. 1, and runs through Jan. 31, 2017. This will be here before we know it!


For those of us who live in Coconino County, we have one returning insurance carrier: Blue Cross Blue Shield of Arizona (BCSAZ). Yes, that is correct, we have AN option. Don’t get me wrong, BCBSAZ is a very good company; but a little competition wouldn’t hurt! When the Marketplace first opened, there were approximately eight insurance carrier options and 124 plan choices (each company had many plan options). Now we are down to one insurance carrier and we are still waiting to see how many plan options there are! More to follow on this one as details emerge.


So if everyone is supposed to have it (or face a fine), it would seem logical that the insurance carriers would have plenty of customers with whom to share the risk with and even thrive. Unfortunately, this has not been the case. In the past couple of years, the financial losses from this segment (Affordable Care Act Marketplace plans) have caused most of the insurance carriers to pull out of the market. Why offer a product where there is almost a certainty for losing money? Last year, Meritus (one of the many health care cooperatives whose startup was funded through the Affordable Care Act, closed its doors because of insolvency. Let’s not feel too bad for the health insurance industry. In other market segments (Medicaid, Medicare Plans, Group Plans…) the insurance industry is doing just fine.


So if there is only one insurance carrier option, then enrollment should be a snap…right? Well maybe and maybe not. We are expecting some interesting changes to the plans being offered. So it will be very important to look carefully at the plans as well as the network of providers available. In addition, it is also important to provide updated income information to the Marketplace to avoid having to repay subsidies when filing taxes.


Small business owners may want to revisit group health insurance options. The rates, plans and networks available may be more appealing. In order to qualify as a small group for health insurance you must have at least one common law employee. So unfortunately, a business run solely by a husband and wife cannot qualify as a group.

By Ed Gussio

Should you have any questions, please call the Benefit Logic Team at 928-526-5691 or drop by our office at 2321 N 4th Street Flagstaff, AZ 86004.

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