Unless they take action before Dec. 15, about 20,000 Arkansans will find themselves on Jan. 1 in health insurance plans that they never signed up for.
That's because, at the end of this year, Arkansas Blue Cross and Blue Shield is discontinuing six plans that it had offered through healthcare.gov.
People who are in them can choose other plans during the annual sign-up period that started Nov. 1.
If they don't, they automatically will be transferred on Jan. 1 to another plan with "either similar benefits or lower premiums," company spokesman Max Greenwood said.
After that, she said, they won't be able to change plans until the next open-enrollment period, which starts Nov. 1, 2018.
In some cases, the new plans offer significantly different benefits.
Jeff Gaiche and his husband are covered by Arkansas Blue Cross and Blue Shield's Gold 500 plan, which has a $500 deductible for medical expenses for an individual and no drug deductible.
When Gaiche visited healthcare.gov earlier this month, he discovered that, unless the couple make another selection, they will be transferred to the company's Silver Plan 2, which has a lower monthly premium but higher deductibles: $4,000 for medical expenses and $1,000 for prescription drugs.
After using the federal website to look through the details of other plans, Gaiche said he couldn't find one with coverage similar to what he has now.
"Yesterday was not a good day," said Gaiche a day after visiting the federal health care portal. His medical and drug expenses run into the thousands of dollars each year, as do his husband's.
"I was just blown away when I saw what had changed."
The plans Blue Cross is eliminating include all three of the Little Rock company's gold-level plans, which are designed to cover 80 percent of a typical customer's medical expenses.
According to information distributed to insurance agents, those plans were covering 9,773 people as of Aug. 1.
The company is offering two new gold plans. One, Gold Plan HSA M1, which has a $2,700 medical deductible, is being offered under a contract with the federal Office of Personnel Management as part of the Multi-State Plan Program.
The other plan, Gold Plan 1, has a $900 medical deductible and is not being offered on the exchange. It is available only to customers who sign up for unsubsidized coverage directly through the company, rather than through healthcare.gov.
The company also is eliminating one silver plan, designed to cover 70 percent of a typical customer's expenses; one bronze plan, designed to cover 60 percent of such expenses; and its catastrophic-coverage plan.
The company is offering seven new plans, including the two new gold plans, and changing the names of the five older plans that will continue in 2018.
For the first time, the company also is adding separate deductibles for drug coverage to most of its plans.
Greenwood said in an email that the changes in plan offerings were the result of a "business decision that was based on feedback from our customers and analysis of the marketplace."
"Since the start of Exchange plans in 2014, we have made only minor changes to our plans each year," Greenwood said. "We believe the changes we are making for 2018 will better meet the needs of our customers."
The addition of drug deductibles is "something we've looked at for some time," Greenwood said.
"It's another choice for consumers and one that has the impact of lowering the premium charged for a particular plan," Greenwood said. "Again, it is part of the balancing act in offering benefits that customers find attractive and keeping plans affordable."
Established under the 2010 Patient Protection and Affordable Care Act, exchanges in each state allow consumers to shop for coverage and apply for subsidies to help pay for it.
Arkansas is considered to have a state-based exchange, but customers access it through the federal online portal at healthcare.gov.
According to the state Insurance Department, 53,031 Arkansans were covered in non-Medicaid plans on Arkansas' exchange as of Nov. 1.
The open-enrollment period is the time each year when people who buy coverage on their own, rather than through employers, can sign up or change plans.
The changes in benefits for Arkansas Blue Cross and Blue Shield plans for 2018 come in addition to premiums that will increase an average of 14.2 percent.
That's less than the average premium increase of 21.4 percent for plans offered on the exchange by St. Louis-based Centene and 25 percent for exchange plans offered by Little Rock-based QualChoice Health Insurance.
Neither Centene nor QualChoice are eliminating plans in 2018, according to filings with the Insurance Department.
Part of the companies' premium increases stems from a decision by President Donald Trump to end subsidies that companies had received in exchange for offering enhanced benefits to low-income customers.
Before the decision was announced, the companies had been planning smaller increases: 7.8 percent for Arkansas Blue Cross and Blue Shield, 9.9 percent for Centene and 9 percent for QualChoice.
Consumers who qualify for income-based federal tax credit subsidies will be largely shielded from the higher premium costs.
But those, like Gaiche, who don't qualify for the subsidies will face the full impact of the increases.
The 48-year-old software developer, who lives in Little Rock, said he and his husband pay about $924 a month for coverage under the Gold 500 plan.
A card issued by a drug manufacturer covers Gaiche's copayments for drugs, allowing him to fill prescriptions at no charge that would otherwise cost thousands of dollars each month.
After he meets the $500 deductible, the plan covers about 80 percent of many of his other expenses, which also run into thousands of dollars each year.
Until he spoke to a reporter, Gaiche said he didn't know about Arkansas Blue Cross and Blue Shield's Gold Plan 1, which isn't listed on either healthcare.gov or the company's website.
He said he and his husband will sign up for that plan even though the premiums will be higher: about $1,185 a month for the couple.
Greenwood said the high premium is the reason Gold Plan 1 isn't listed on the company website.
The company doesn't want to encourage people to sign up for it unless they consult with an insurance agent or company representative, she said.
"We want to make sure that folks that want to purchase that plan are fully aware of what the plan entails," Greenwood said.
Insurance Department spokesman Ryan James said the state doesn't require companies to list all of their plans when displaying options to customers.
Like Gaiche, Roger Fitzgibbon Jr., a 47-year-old Little Rock attorney who has muscular dystrophy, will be moved into Arkansas Blue Cross and Blue Shield's Silver Plan 2 unless he makes another selection.
He said a new plan offered by his employer would be a better option, but it's too late for him to sign up for it.
He said he didn't learn until just after the enrollment period for that plan had closed that his Arkansas Blue Cross and Blue Shield plan, Gold 1000, will be discontinued Jan. 1.
Like Gaiche, Fitzgibbon said he didn't know about Gold Plan 1 until he was told about it by a reporter.
After learning about the new plan, he said he asked an insurance broker about it and was told he wasn't eligible to sign up for it.
Even if he could, he said, he's not sure he would want to sign up for it because the premiums would be so much higher -- about $619 a month, compared with $503 a month for Gold 1000 and $480 a month for Silver Plan 2.
"It's pretty depressing," Fitzgibbon said.
Greenwood said in an email that she didn't know of a reason a broker would say a consumer such as Fitzgibbon was not eligible to enroll in the Gold Plan 1.
"As long as this consumer is an Arkansas resident, a citizen or a foreign national not eligible for or enrolled in [Medicare], he is eligible for the Gold plan, and we would gladly enroll him," she said.
Metro on 11/23/2017
Print Headline: Jan. 1 to deliver insurance shock for some