Individual

Individual health insurance in Tennessee 2019

by Dannie

 

**updated 11/07/2018 , we will continue to update this blog as information comes in**

More options and lower premiums! 2019 brings many a sigh of relief to the 229,000 people who signed up for individual health insurance in Tennessee! Individual health insurance premiums are dropping slightly which will allow the state to recover from double digit premium increases in years past. Tennessee hasn’t seen a drop in premiums in years so they’re welcoming this change! We’ve recently learned that Blue Cross Blue Shield is dropping their premiums by 14.8% while Cigna is dropping just under 5%. Let’s break it down below so you know what to expect this year compared to last year!

What’s different this year?

  • Availability of short term plans that can last a year. These short term, limited duration plans (STLDs) come with more restrictions, such as limits on preexisting conditions, and offer less coverage (i.e., good bye well-visits and maternity coverage), but their lower price point can be attractive to those that are relatively healthy and looking for more affordability. 
  • Association health plans: While recent legislation has opened the doors for association health plans, where small businesses and individuals can come together to buy group plans, we don’t expect this to have much of an impact this year since people are still trying to figure it out. 
  • Premiums have stabilized.  In contrast to the startling jumps in premium pricing the past few years, Modern Healthcare reports that 16 states will see premium declines, two will see no change, and the rest see marginal, single digit increases.  On average, CMS reports that rates are dropping 1.5 percent on average across the country. 
  • Individual mandate disappearing. Beginning in 2019, the Individual Mandate which fines Americans who skip out on health coverage will no longer be in effect. While some think this measure could send premium prices up as the markets adjust for an exodus of healthy young people, it might have less effect than people think. You see, healthy young peeps weren’t buying plans the way families and older folks so and the markets are priced for that. Even with the individual mandate in place, healthy young people could decide to pay $200 a month for health insurance they didn’t think they needed or a $200 fee once a year. 
  • QSEHRAs are becoming more popular. For small companies and startups that can’t afford traditional group plans, QSEHRAs (aka Qualified Small Employer Health Reimbursement Arrangements) offer a new way to reimburse for premiums and medical expenses tax-free. Plus, in addition to being reimbursed for plans and alleviating the financial burden of individuals buying their own health insurance, employees can choose their own plan that works best for them instead of fitting into a one-size-fits-all group plan! If you or your employer wants to learn more about this, we have a first-of-its-kind QSEHRA guide that explains everything you need to know!  

What’s the same

Despite a lot of talk in Washington, the Affordable Care Act (also known as Obamacare) is still intact. 

  • Doctor networks continue to stay small: An ongoing trend since the start of Obamacare, many plans will cover an increasingly smaller percentage of doctors in a given area. That leaves the consumer with fewer choices and a greater chance of having to go out of network to get the care they need. This is a strategy used by carriers to keep costs down, but it leaves consumers financially vulnerable for shouldering those scary and sky-high out-of-network costs. Even if your doctor is on your plan this year, it’s worth double checking for this coming year, since things might have changed. Our doctor search tool on our website is a simple way to do that!
  • Shortened enrollment period: Just like last year, open enrollment is only 6 weeks—Nov 1 to Dec 15.
  • Slashed funding: Funding for the marketplace has been further reduced, which means there will be less advertising and awareness campaigns helping people make smart choices. Federal 'navigator' grants to states that are meant to help educate and enroll people in health insurance were slashed by more than half this year. Tennessee used $220,000 of federal grant funding in 2018 to help enroll Tennesseans in health plans that were right for them. This year Tennessee has opted to not apply for the federal money. 
  • Subsidies: Federal subsidies are expected to be available to those who qualify.
  • Outages: Just like last year, there are 60 hours of scheduled downtime for scheduled maintenance that could get in the way of individuals researching and signing up for plans. Take note that from 12 a.m. to 12 p.m. every Sunday, except for the last Sunday of open enrollment, you can’t access healthcare.gov. 

Who’s in, who’s out

Two new companies enter Tennessee for 2019 adding to the three existing carriers that covered Tennesseans last year. 

New for 2019 Ambetter (on and off) Ambetter/Celtic will be available for those living in Memphis and Chattanooga. 

  • Ambetter Essential Care (Bronze)-low premiums, higher out of pocket costs
  • Ambetter Balanced Care (Silver)-best if eligible for government assistance. Balanced premiums and low out of pocket costs 
  • Ambetter Secure Care (Gold)-higher premiums, lower monthly costs

New to Tennessee for 2019 is Bright Health Plan. They have never serviced Tennessee before and will be covering Nashville, Knoxville, and Memphis.  

  • Gold: 1 option with lower deductible but higher out of pocket costs. 
  • Silver: 2 options: moderate deductible with modest out of pocket
  • Bronze: 3 options: highest deductible with lowest out of pocket
  • Catastrophic: in Nashville only

Blue Cross Blue Shield of Tennessee covers West, West Central, East Centra, Knoxville, and Chattanooga counties. They’ve requested a 14.8% premium decrease.

  • Bronze Plan B07 has a low premium with highest out of pocket. 
  • Silver Plan S01 and S04 has an average premium with moderate out of pocket 
  • Gold G06 has a higher premium with a lower out of pocket.

Keep in mind, new for 2019 BCBS of TN is no longer covering out of network services unless there is an emergency

Cigna expands into Knoxville while still offering coverage in Memphis, Nashville, and the Tri-Cities. Cigna has requested to decrease premiums just under 13% for 2019.

*No out of network coverage starting in 2019 or out of state care. 

  • Multiple Bronze Plans (EPO)
  • Multiple Silver Plans (EPO)

Oscar (on and off) expanding into Memphis while still covering Nashville. They plan on increasing premiums 7.2%. 

  • Simple Bronze “just in case” plan
  • Simple Silver: generally healthy 
  • Classic Silver : great for families 

This year has the most coverage options for those in Tennessee since 2016. Many carriers are re-entering or opting into new states due to stability that hasn’t been seen in recent years. 

Affordable Alternatives You Should Know About 

An increasing number of our customers are opting for alternatives to traditional insurance. Here’s a couple of our top picks. They might not be for everyone, but they are worth checking out and comparing to major medical plans on our platform. 

Pivot short term plans: Pivot provides short term medical insurance solutions until a qualified major medical health plan is chosen, helping reduce your financial risk. Pivot plans are renewable 90 day plans which in most states can be automatically renewed 4 times without additional medical screening to provide up to 12 months of continuous coverage. 

Association health plans: For certain states, we are offering a United Health One Plan, which accesses the United PPO network. These states include Florida, Georgia, North Carolina, Tennessee, Texas, and Wisconsin. For the states that it’s in, it’s a really powerful, viable option to consider. 

Faith-based: Faith-based Medi-Share has a state-wide PPO network available in 2019 managed by PHCS (Private Healthcare Systems, now owned by Multiplan). It’s smaller than some of the PPO networks in the past, but it does provide flexibility to see your doctors and will cover out-of-network expenses as long as it meets Medi-Share’s faith-based guidelines. Medi-Share won’t be for everyone, but is a worthy option to consider if it fits your personal convictions and lifestyle. Make sure to check out our Medi-Share review and compare it to other major medical plans on our website before you enroll. 

 

Next steps: What's my best option? 

While more choices are a welcome change, hunting down and comparing all of these options can feel overwhelming. However, at TakeCommandHealth.com we help you compare all of your options side-by-side including off-exchange plans, marketplace plans, and faith-based options. You can use our award-winning tools to search for your doctors, check your prescriptions, and even simulate conditions and health needs to make sure you get the most of for your money. 

A few other updates we'd like to tell you about: 

We've expanded the capabilities of our doctor search tool to search doctor networks from all of the carriers above (no matter if the plan is off-exchange, on the marketplace, or faith-based). We've negotiated some pretty awesome deals for our membersCall a doctor 24/7 for $0, enjoy medical bill negotiation support, a personal health advocate, dental, vision, and pharmacy discounts, etc. These really help save money with some of the higher deductible plans. 

We're pretty confident we have the biggest, most complete line-up of plans in Tennessee this year. With growing demand, we've also put together a bigger support team ready to help you tackle any issue. You can get started by chatting with one of our licensed professionals on our website or emailing us at support@takecommandhealth.com. 

Once open enrollment begins, you can visit our website and we'll walk you through your options. Our goal is to help you get the most out of your money and find the plan that really works for you and your family. 

Remember you have until Dec 15th to select a plan that starts Jan 1st, 2019. 

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Hi, I'm Dannie! I graduated From Salve Regina University in Newport Rhode Island with a degree in Early Childhood Education. I switched careers to the financial industry before being a stay at home mom to my two girls. I love to bake, find new recipes, and travel to visit family. I enjoy educating people through information and Take Command Health is a great avenue to share knowledge on all things healthcare! Learn more about me and connect with me on our about us page. Thanks!