Tom Schrette and Alan Cash

Tom Schrette and Alan Cash

J.L. Sousa

Dear Tom and Alan:

What a surprise!

I just got a letter from Anthem Blue Cross saying they will no longer have my plan in this area.

Actually, they won’t have my plan in any area because they’re leaving California except for three separate regions that are not where I am.

So, here I am in Napa County and by the end of the year Anthem will have no plan for me to get on.

Recommendations?

Dropped

Al: Yup, Dropped, they dropped us, too.

I was signed up for an Anthem Blue Cross webinar to update us on what to expect for the open enrollment period starting Nov. 1.

The webinar lasted about 10 minutes because, the day before, Anthem announced that most individual plan offerings in California will be ending Dec. 31, 2017.

Tom: Specifically, the “Anthem News Flash” on the Producer Newsletter stated:

“Next year, we will offer plans in three regions of Northern California only, which will include Redding, Santa Clara County and Stockton/Modesto. The coverage options will include EPO plans available both on-exchange and off-exchange, and at all metal levels.

It’s important to note that these changes do not immediately impact the benefits of members currently enrolled in our individual health plans. They can use their health benefits without interruption until the end of the year.”

Al: To explain some of the terms above: EPO is Exclusive Provider Organization.

It’s similar to PPO in that it has a network of doctors, but usually, a much smaller network than a Preferred Provider Organization (and no out-of-network benefits); the “metal” plans referred to are bronze, silver, gold and platinum.

Anthem Blue Cross has 19 rating areas in the state, they are reducing it to only 3.

Tom: Really, really important that everyone understand that this change affects only those on individual and family plans that are Affordable Care Act-compliant.

It does not have anything to do with senior plans, group plans, “grandfathered” plans (before 2010), dental or vision. These will all be in place.

Al: The Affordable Care Act (Obamacare) had what was called the “ten essential health benefits.”

Among these were maternity and prescription drug coverage on every single plan.

If your plan was not compliant with all features, and you were not on a “grandfathered” plan, you were subject to fines for not having a compliant health plan.

I don’t know how many actually paid fines to the government over the last few years, but we definitely didn’t hear too many complaints in our office.

Tom: For those others also being dropped, so far we still have Blue Shield, Kaiser, Western Health Advantage and Health Net as options that will be available for new enrollees effective Jan. 1, 2018.

Again, open enrollment starts Nov. 1 this year and whatever you apply for, they have to take you. Unless something else changes(!).

Submit questions at schrette@gmail.com or alancash@gmail.com.

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