Emerging trends in today's health insurance market

  • Jordan Wishner

    Jordan Wishner

 
Updated 7/13/2018 10:43 AM

Today's health insurance landscape will see major changes for 2019, especially with there no longer an individual mandate to be insured by a Qualified Health Plan (QHP), and the large premium increases that are about to hit the individual marketplace for the next enrollment period.

Those impacted by these changes are individuals and families who do not qualify for Advanced Premium Tax Credits (APTC) that make QHP's affordable through The Health Insurance Marketplace. As uncertainty looms, here are a few emerging trends stepping forward:

 

Short term medical plans

Sometimes referred to as "skimpy" plans, which do not include all Essential Health Benefits (EHB) that come with a QHP, short term medical plans will see a significant rise in popularity for the 2019 Open Enrollment Period, as this type of coverage may be the only affordable option for many Illinois residents that are in good health, do not have pre-existing medical conditions, and do not require all the benefits (maternity, mental health, substance abuse) that come with a QHP.

At this time, short term medical plans can only be purchased for a maximum of 90 days; however, the current administration has proposed a bill to allow for the sale of up to 12 months come 2019, and if passed, it would only further progress the sales of this plan type, especially with there no longer being a tax penalty tied to having this type of plan.

Premiums for short term medical plans come at a significantly lower cost when compared to a QHP and can offer consumers either lower or higher maximum out-of-pockets, while offering a larger provider network then what can be found with a QHP. Consumers should be extremely cautious when purchasing an STM plan, especially consumers who are receiving current treatment or have pre-existing medical conditions. They would be well-served to be certain they understand the benefits that come with this type of coverage.

Small employer health insurance

The Affordable Care Act (ACA) does not require small employers with fewer than 51 full time equivalent (FTE) employees to offer health insurance. Many small employers send their employees to The Health Insurance Marketplace to find an individual plan of coverage because they may not be able to satisfy the required contribution requirements toward employee premiums. Even if they can, they may not be able to satisfy the required employee participation requirements.

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Since ACA's inception, there is a little known special enrollment period for small employers that takes place each year between Nov. 15 and Dec. 15 for a Jan. 1 effective date. During this enrollment period, small employers are not required to make any premium contributions and as few as one employee needs to enroll, which now leaves employers without any setbacks to get a plan in force. This special enrollment period is a benefit to small employers and their employees, even though the employer may not be able to afford contributing toward employee premiums.

Employees who work for small employers and rely on the Health Insurance Marketplace for coverage without qualification for Advanced Premium Tax Credits (APTC), will benefit tremendously from this special enrollment, and there are several reasons as to why. (1) Employer plans provide access to more plan options and larger provider networks compared to what is available in the marketplace, and most importantly the (2) monthly premiums will be lower, and employees will get to pay their premiums (3) pretax through payroll deduction.

To learn more about this option, you'll want to discuss with your employer who can then reach out to a local insurance agent. Just a simple inquiry can open up the door to a lot more affordable options come 2019.

• Jordan Wishner is president The Health Insurance Shoppe.

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