Insurers ‘Recalibrate’ As Enrollment Increases

Nov 18, 2015

The third year of open enrollment under the Affordable Care Act is now under way, and this week on Florida Matters (Sunday, Nov. 22 at 6:30 p.m.),  WUSF's Carson Cooper takes a look at some of the changes coming for health insurance in 2016 with Florida Covering Kids & Families Project Director Jodi Ray, Tampa health insurance agent Eric Brown and WUSF News Director and Health News Florida Editor Mary Shedden.

  ERIC BROWN: Well, it’s all about cost, and not just on HealthCare.gov. Employer plans are the same. The out-of-pocket costs are extremely high. In addition to that, what employers are doing, is they’re shifting any costs onto their employees. So if there’s an increase, which there will be one every year, the employees are usually stuck handling those additional premiums, and what we’re finding also (is) voluntary benefits are on the rise now to help fill those gaps.

CARSON COOPER: Are the rates going up in the private market? Are they on par with  the Obamacare rate increases? Are they tied in any way?

BROWN: I’ve seen them across the board. What I’ve observed, I’ve seen some increases with employer health plans go up as much as 30 percent. On the Affordable Care Act side, I’ve seen an average of about 9 to 10 percent increase.

COOPER: Are the networks smaller? Are there fewer doctors available?

BROWN: In a way for the carriers to control their costs, they restrict the networks, and it’s like a shell game. You can enroll in a plan, and you can see your doctor. You can go online and look at your doctor, and you’ll see him there, call the doctor, and the doctor will say, “Oh, I don’t take this plan anymore.” So, you gotta kinda really stay on top that. But I highly encourage anyone, before you enroll, check the network to make sure the availability of whatever doctors that you use are there.   

COOPER: Mary Shedden?

MARY SHEDDEN: I would also encourage folks who have employer-based plans to do the same thing. Networks are getting more narrow every year with insurance companies because they are trying to recalibrate the economics of having 17 million more Americans with insurance. The fact is that can change every single year, whether you’re on HealthCare.gov, have an employer-based plan or Medicare. Your doctor may change.  And really, the best way to do that is to talk to that doctor -- don’t just assume what you see on a computer screen. And that’s taking ownership in your healthcare.

COOPER: Alright, Jodi Ray, finally, what questions should someone ask themselves before signing up for a plan?

JODI RAY: Well, I think the first thing they need to know is what is the most important thing about their health care. That’s the first thing we ask them when they come in. Is it going to be access to a certain medication? Do they need access to a particular provider or hospital or particular kind of care? And what is their usage like? So they can start to look at a balance between what their health care needs and what their cost needs are.

And I think they should be clear about all the complicated terminology about health care coverage. It’s not part of their typical vernacular to talk about things like co-insurance versus a co-pay versus a deductible and cost sharing, so it’s very important that they get all of those kinds of things answered, and that they’re clear before they select a plan. So when we’re sitting down, we’re able to have all of that information under consideration when they’re looking at what could be a large array of options of plans, so they’re getting what really serves their needs best. 

Lottie Watts is a reporter with WUSF in Tampa. Health News Florida receives support from the Corporation for Public Broadcasting.