banner logo

Purchasing individual Health Insurance in Atlanta for January 2018? Now is the time to think about this, before crazy begins!

By Victoria J. Braden

President/CEO Braden Benefit Strategies, Inc.

As of 1/1/18 Blue Cross Blue Shield will no longer offer individual health insurance in the Atlanta Metro Area. The only insurance available for an individual to purchase will be Kaiser. I personally like and have great respect for Kaiser and the quality of care they provide. I also recognize not everyone feels the way I do.

Ambetter, the Medicaid network (very few doctors, does use the Emory hospitals), will offer individual health insurance. Unfortunately, over the many years Ambetter has been available to the general public, we hear complaints that the network is very limited. It is health insurance and, in my opinion, would be better than not having insurance if you only need catastrophic coverage. Ambetter, like Kaiser, meets the Obamacare individual mandate requirement.

Then there are a variety of insurance look-alikes in the market such as the Christian coverage, short-term medical insurance, and insurance that covers a specific illnesses or injury such as cancer, hospital confinement or accidents. If you decide to explore any of these options, please read the policy carefully. Read what will not be covered.

The policies covering a specific illness or incident are paying a dollar amount to you. This dollar amount is not guaranteed to cover the cost of your actual medical expenses. AFLAC is an example of illness or injury specific coverage. This coverage alone does not meet the individual mandate.

The short-term medical policies have preexisting condition clauses and the deductible starts over every quarter. The policy has a financial cap and will only pay up to this amount with no consideration of the total cost of a medical procedure. You will pay a fine if this is your only coverage as this policy will not meet the individual mandate requirement.

The Christian coverage is not insurance and works a little like a ‘go fund me’ program. This coverage is an alternative to the high cost of health insurance. However, the coverage is very different, and individuals will have to adjust to paying for a greater portion of their healthcare. Again, I would rather see people have something than nothing, at least until we can put new systems in place. The Christian programs are recognized by our government and meet the individual mandate.

Braden Benefit Strategies focus is companies with 10 to 300 employees. Within the GHAA partners there are two who work with individuals in selecting the health insurance that best meets your needs. They charge a fee starting at $150 upwards. Rick Bailey and Associates at 770-569-9333 and CDA at 770-449-7369. Both know the individual health insurance market extensively. I highly recommend either if you would like someone to present options and discuss what would work best in a particular situation.

There is the option of creating a group plan. The insurance companies will not write a group without very specific verification of an employee – employer relationship documented by W-2 reporting. Husband and wife groups are generally not eligible for group coverage unless there is a third, unrelated, employee enrolled in the insurance. A company with only two employees, where one of the employees is on Medicare or covered by a spouse, can be written as a group.

Again, the insurance companies are not paying agents to work with small companies. One carrier pays $5 per employee per month when a company is insuring less than 5 employees and another $20 per employee per month no matter the number of employees. We believe in transparency, our breakeven is $400 per month. We cannot afford to write a very small business.  Several of my GHAA partners are developing a consulting fee schedule for very small employers, this will provide small businesses the advice and direction of a professional. If you would like a referral, let me know.

One Last Word on the 2018 Open Enrollment – If you are considering putting in group insurance, a benefit you have previously not offered, you may keep your individual insurance until it expires on 12/31/2017 AND purchase group health insurance now to begin on 1/1/2018. In fact, we are recommending small groups and employers new to offering insurance complete your enrollment paperwork and submit your application to the insurance carriers NOW as we believe the end of the year is going to be overwhelming. By completing your paperwork now, you will be ahead of the curve, have ID cards and be able to enjoy the Holidays.

Open Enrollment for a 1/1/18 start date, ends December 15th. You must complete the paperwork before 12/15 if you want your insurance to begin on January 1st. There is NO wiggle room here.

OR, if you are watching costs, the rates are now available for group policies beginning 1/1/2018. If you want to save, what is appearing to be a significant amount of money, you would begin your group insurance on 12/1/2017.