By now, you should have a good idea of how the Affordable Care Act (ACA) has impacted your company’s health insurance plan.

For those employers benefiting from the ACA, we’ve seen consistently low premiums from United Healthcare.

For employers facing higher premiums and less benefits from the ACA, we’ve seen more and more options from each carrier to help companies get out of the regulation.

In this article, I’m going to give an overview of the ACA and non-ACA plans available from each carrier.  Hopefully, this gives you an idea of what you should be considering going into your next renewal.

 

Pre-ACA / Non-ACA plans

Most of my clients were hurt by the ACA.  The average small group I work with would have a 32.49% increase in premiums if they had to move to an ACA plan.  Fortunately, we’ve worked hard to keep these groups’ pre-ACA plans in place.

Today, we have several other options available to look at that still keep these groups out of the ACA market.

 

Underwriting Requirements Loosened

Many small groups don’t want to complete applications.  The time involved is just not worth the 20% premium savings.

Fortunately, this year, most carriers have loosened their requirements.  For groups with at least 10 covered employees, several of these options are available with just a census.  The census has to have legal names and accurate information but it’s a great way to get underwritten quotes for pre-ACA plans without the hassle of applications.

 

Keep the same pre-ACA plan you’ve had in place since before 2014

Most of my clients still have their pre-ACA “grandmothered” plans through Anthem, Humana, and United Healthcare.  This year is no different.  You can still keep these plans for 2019.  Just as last year, you will be able to change plans on the Anthem and United Healthcare pre-ACA plans.

 

Association Health Plans

Anthem Association plans have been around since the 1970s.  While these plans are assigned to specific brokers, they are an option to get out of the ACA.  Anthem association plans are industry specific (architects, car dealers, CPAs, etc) so you have the risk of being in a pool with little diversity and higher healthcare costs than a normal pool.

Humana established a new association plan in mid-2017 through Commerce Lexington and Greater Louisville Inc.  This association has a diverse group of industries included in it and any broker licensed with Humana can work with this association.  On the first renewal dates for this group (6/1) we saw very high renewals.  With that said, I would be cautious of giving up my pre-ACA coverage to move to this program.  However, groups in the ACA market that would save money should move to this association immediately as the increases at renewal will probably be less that the ACA premiums you are paying.

Finally, United Healthcare started an Association plan through the Jeffersontown Chamber of Commerce in 2018.  United makes brokers join the J-Town Chamber just to get quotes but any broker willing to do so can get quotes and place business in the association.  This association has not had renewals yet so it is unknown how the association is performing just yet.

 

Alternatively Funded Plans

Anthem, Humana, United Healthcare, Aetna, and National General all offer Alternatively funded plans in Kentucky.  Each carrier calls their plan something different but they all work the same way.

Employers pay a fixed monthly premium, just like a fully-insured plan.  However, if their claims are lower than expected, they will receive a check or credit toward premiums from the carrier.

There is no risk to the employer of paying a penny more than their monthly premiums.

You pay a fixed cost for admin and stop-loss coverage and your claims expense varies based on your experience, but you only benefit form lower claims.

These plans have been slow to catch on in Kentucky.  Most brokers in the small group market don’t understand the technical side of how these plans work.

With all the built-in wellness tools, if you’re someone who truly has healthy group of employees, this is the way to go if it lowers your costs.

Additionally, groups get claims data just like a large group.  This allows you to manage your health insurance program with more knowledge and facts rather than the hoping and praying that usually takes place in the small group market.

 

ACA Plan Options

In 2019, Anthem, Humana, and United Healthcare will all be offering ACA plan options.  Bluegrass Family Health left the market in mid-2017 so we now only have 3 options.  As in years past, we’re seeing out of pocket expenses increase every year.

What’s particularly unique about this year are the benefit designs.  Anthem seems to be the only carrier who still has truly mid-tier plans ($1,000 – $2,000 deductibles).  So, while United Healthcare is still the lowest priced, I’ve seen groups spend a little more to get the better benefits offered by Anthem.

Outside of Jefferson County, I have yet to see a competitive ACA quote from Humana as their premiums are higher than United Healthcare and their plans are not as good as Anthem’s.

 

Final Takeaway

You should shop your insurance with every carrier this year.  If you are in an either a pre-ACA or post-ACA plan and it didn’t’ make sense before, you should double-check through all of the underwritten options at least every 2 years.  A slight change in your census could have changed the entire picture for your company.

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