Network, Network, Network!!!!

I have spent a lot of time talking about how businesses can possibly avoid some of the rating provisions of the Affordable Care Act through Association Programs.  I am a strong believer that if you have a small to mid sized company; you NEED to look into what is available through your professional trade association.  If they have a program, you owe it to yourself to explore that option.  The worst thing that can happen is that you end up participating in a benefit offering that is community rated, which is exactly where you would have been had you not looked in the first place. 

Additionally, I feel that you need to know how confusing the “Health Care Exchanges” are going to be for your employees.  I have been told by a very reliable source, that the web site is ULTRA confusing.  My fear is that for the average person, it will be overwhelming.  Most will give up after page 3 of 16 or so.  In my experience, frustrated employees become non-productive employees and something that you as an employer are trying to clear from your to do list becomes a source of torment for you.  Another thing to keep in mind as we enter into this brave new world is attraction and retention of quality employees.  As the economy slowly recovers, the forward thinking employer that offers a plan that meets the requirements will be head and shoulders above the employer who decides that insurance is not a part of the overall compensation package that his employees should have.

But if that is not a compelling reason for you to look in to providing group insurance for your people, I think it is vital that you know what the biggest surprise of the Health Care Exchanges will be, in my opinion.  Networks, Networks, Networks!!

As individuals go to the Exchange to shop” Travelocity style” for health insurance, most will be thinking that price is the only factor that is important.  While price is a component of the overall decision making process, access to the doctors and the hospitals that you wish to use in the event of a health related episode may in fact be more important in the long run.  In Kentucky, you will have three (3) choices for individual coverage through our exchange; Anthem, Humana, and the Kentucky Co-op.  All three of those carriers will be offering limited networks to the policy holders.  Although I don’t know what they will look like as of this writing, I have been told that they will be restrictive.  So someone who is used to the Anthem network may be in for a rude awakening when going to use their insurance at a provider that is not in network.  I have also read that in some parts of the United States, some carriers will be offering plans with NO out of network coverage at all. This means that if you go intentionally or unintentionally to a provider that is not IN NETWORK, you will pay for the entire cost of those services.  Therefore, please relay this information to people that you know who will be shopping for coverage on the exchange.  One way to avoid those potential disasters is to contact a professional insurance agent like the ones at Logan Lavelle Hunt.  Don’t let the details pass you by. 

Lastly, I have updated the Subsidy Calculator from Kaiser.  It now includes a place to add zip codes so you can determine what cost may look like in certain areas of the country. This is from them:

The Kaiser Family Foundation has updated its health reform subsidy calculator to provide ZIP code-specific estimates of the insurance premiums and tax subsidies available for people who buy coverage for 2014 through the new state health insurance marketplaces.

By entering their ZIP code, income, age, family size and other factors into the calculator, consumers can get estimates of the tax subsidies and insurance premiums available to them if they were to purchase insurance through the marketplaces, or exchanges, once open enrollment begins Oct. 1.

The calculator includes local premium data from 46 states plus the District of Columbia. The remaining four states (Kentucky, Massachusetts, New York and Vermont) either set premiums using different formulas than other states or have not yet provided needed premium data.

 Peace