If You Can’t Beat Them, Join Them

Blue Cross of N. Carolina has announced a new, no network health plan (Reference Based Pricing). Coupled with a high deductible, BCBSNC touts a 33% premium savings.

Blue Cross says new plan can save 30 percent or more, but you have to pay medical bills and wait for reimbursement

By Richard Craver Winston-Salem Journal

Oct 25, 2018

Blue Cross Blue Shield introduced Thursday a 2019 health insurance plan for the small-employer group and individual markets that will carry a significantly lower premium cost.

The myChoice plan is compliant with all Affordable Care Act regulations, including covering preexisting conditions. Enrollment begins Nov. 1 for individuals under age 65.

Blue Cross said the plan will provide an average of 33 percent premium savings over comparable individual plans, or about $230 a month. For small group employers, there is an estimated 30 percent savings, or $140 per month.

However, Blue Cross said that “because there is no network of providers with negotiated prices, doctors and hospitals are not restricted in what they can charge patients.”

It is a high-deductible plan eligible for a Health Savings Account, which gives customers the opportunity to save for medical expenses on a tax-free basis.

Blue Cross said the plan is not in response to the Trump administration approval Monday of a plan that would let states apply for waivers of the Affordable Care Act and offer alternative health-insurance options, including cheaper and limited short-term plans. The Centers for Medicare & Medicaid Services and the U.S. Treasury Department said the guidance allows states to “move their insurance markets away from the one-size-fits-all rules and regulations” and increase choice and competition in the insurance market.

“This is not the type of junk insurance we are hearing about that avoids the ACA’s protections,” said Mark Hall, a professor of law and public health at Wake Forest University and a national health-care expert.

“It is normal comprehensive insurance, with a high deductible, and the main difference being that reimbursement is based on a ‘reference pricing’ approach similar to what state Treasurer (Dale) Folwell has recently proposed for the state employee plan,” Hall said.

For myChoice, a small employer is defined as having up to 50 workers. The small group plan will be available in every county.

The individual plan will be available in all but 19 counties. The excluded counties include Alamance in the Triad, along with Durham, Mecklenburg and Wake.

The insurer said it is offering myChoice as an option for the nearly 1 million North Carolinians who do not have health insurance, including those who are not eligible for a subsidy on the federal health-insurance exchange.

Blue Cross said small businesses owners cite affordability as the No. 1 reason they can’t offer health insurance to employees.

Blue Cross said the average premium rates for ACA plans in the small group market have increased by 40 percent, and in individual markets by 205 percent, since the ACA came into effect in 2014.

“We know that premiums are too high, particularly if you don’t qualify for a subsidy,” said John Roos, chief growth officer of Blue Cross NC “This new plan is one way we can offer coverage at a lower price point.”

MyChoice customers will take on more responsibility for managing their out-of-pocket costs and care.

MyChoice reimburses customers directly for medical procedures at rates that are up to 40 percent higher than what the doctor or hospital would receive for providing the exact same services to a patient on Medicare.

There are no restrictions on which providers a customer can see. The customer is responsible for paying the provider.

If a provider charges more than 140 percent of the Medicare rate for a particular service, including emergency care, the member may be billed the difference by the provider and will be responsible for paying the balance owed.

“While approved claims go toward satisfying deductibles and out-of-pocket maxes, balance billing does not count toward the plan’s deductible or out of pocket max,” Blue Cross said.

The plan does have a contracted network of pharmacies with agreed-to prices.

“Blue Cross NC encourages myChoice customers to talk with their provider before any appointment or procedure to make sure they will accept the benefit payments that are provided, or find providers who will,” the insurer said.

Hall said that “many people would prefer not to have to discuss medical costs with their doctors and hospitals prior to treatment.”

But, for people who are willing to do that, this could be a very appealing option.”

The N.C. Healthcare Association said in a statement that while “we support expanded access and affordable insurance coverage options for North Carolinians … unfortunately, this new product appears to be more of a financing tool than health insurance coverage.

“It puts all the responsibility on the customer to manage and pay their medical bills, in addition to their premiums before and after the high deductible is met.

The association advised potential customers of myChoice to go to https://www.healthiertomorrownc.com/get-covered-2 for comparisons with other options.

On Aug. 22, Blue Cross said individuals who buy individual federal health-insurance plans through the insurer will see different rates and discounts for 2019, depending on where they live in the state.

Overall, rates will drop by an average of 4.1 percent for the plans in the state, but the rate changes will vary from a drop of more than 20 percent in Raleigh to an increase of more than 9 percent in parts of the Triad.

Rates for people in the Winston-Salem metropolitan statistical area will decrease by an average of 2.9 percent. The region is comprised of Davidson, Davie, Forsyth, Stokes, Yadkin and Surry.

Meanwhile, Alleghany, Ashe, Watauga and Wilkes counties will have a 4.8 percent increase, while the Greensboro-High Point MSA counties of Guilford, Randolph and Rockingham will see a 9.3 percent increase — tied for the highest among the state’s regions.

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