Open Enrollment is here
It's time to finalize your health plan for 2018. And as promised, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is here to help you compare your options and make a decision with confidence.
Keep in mind that this year's Open Enrollment ends on December 15. But if you want to choose a different plan, it's best to make the switch as early as possible in November. That way, the transition will be easier.
Select a topic below to learn more. Note the icon showing which sections have been updated this month, if you'd like to jump right to them.
Blue Cross NC will no longer offer your health insurance plan next year. To ensure you remain covered, we'll move you into a new Blue Cross NC plan that meets Affordable Care Act (ACA) requirements. This will be your health plan for 2018 – unless you choose a different plan during Open Enrollment.
Making this change was a tough decision. Other insurance companies in North Carolina eliminated their pre-ACA plans several years ago. Yet Blue Cross NC chose to offer such "grandfathered plans" for as long as possible to serve our loyal members, like you. Unfortunately, we cannot maintain these plans for another year.
Our goal is to match you with a plan that fits your needs to make this transition easier. Blue Cross NC analyzed which doctors you or your family visit most often – then tried to find a plan where these doctors are in-network. We also did our best to place you into an ACA plan with similar benefits to your current plan.
By now, you've received your rate notice in the mail. It has details on the ACA plan we're moving you into for 2018 – including your monthly premium. Review this information carefully, then use it to compare your options during Open Enrollment. And if you find a different health plan that's a better fit, now's the time to make the switch.
Your monthly premium might be higher next year than it currently is. That's largely due to the expanded benefits and extra protections required by the ACA. For instance, more preventive services are covered at 100%. The next section looks at the ACA in greater detail.
We understand that these changes can be frustrating. That's why we've been reaching out often with information. And we'll continue supporting you during Open Enrollment. From comparing plan options to lowering out-of-pocket costs, our tools will help at every step.
Monthly premium rates increase because health care costs are rising. Any increase in the cost of services or the number of services used can mean an increase in premium rates for our members. And we've seen a large increase in both over the past few years. Visit StateofCosts.com to see what Blue Cross NC is doing about rising health care costs.
What is the ACA?
You've likely heard a lot about the Affordable Care Act (ACA). However, 2018 will be the first time that you have an ACA health plan. So, let's explore what the ACA is – and what it might mean for you.
The ACA is intended to address issues with our health care system by increasing access to health insurance, introducing many health care reforms and improving quality. Here are a few important things you should know about the law:
- You must have health insurance coverage: The federal government requires that most people purchase health insurance. Those who don't have health insurance coverage may be subject to a tax penalty.
- You might be eligible for financial help: Subsidies from the federal government can lower what you pay for insurance.1 Your authorized Blue Cross NC agent can help you see if you qualify for a subsidy – or you can use this online calculator.
- This year's Open Enrollment period runs from November 1 to December 15: If you wish to change the health plan we moved you into, you must do so by December 15 for coverage to start on January 1, 2018.2 If you're happy with the plan we've placed you in, simply pay your January premium and your new plan will go into effect.
ACA health plans
The ACA uses metallic categories (bronze, silver and gold) to indicate a health plan's level of coverage. These "metal levels" make it easier to compare plans with different deductibles, coinsurance and copays. This helps you select a plan that works best for you.
Each metal level may include several types of plans and provider networks, like health maintenance organizations (HMOs) and preferred provider organizations (PPOs).
Keep in mind that metal levels don't account for all health plan features – such as provider network. As you compare plan options in the next section, we'll help you check that your doctors are in-network.
Essential health benefits
Like all ACA plans, your 2018 health plan must cover 10 essential health benefits. They include:
- Ambulatory patient services (outpatient care without being admitted to a hospital)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (helps people with injuries, disabilities or chronic conditions gain or recover mental and physical skills)
- Lab services
- Preventive and wellness services and chronic disease management
- Pediatric services, including dental and vision care
These essential health benefits are one of the perks of moving to an ACA plan.
The Health Insurance Marketplace
The Marketplace (or "exchange") is a shopping and enrollment service for medical insurance created by the ACA. In most states – including North Carolina – the federal government runs the Marketplace at healthcare.gov. You're not required to purchase your plan through the Marketplace unless you qualify for financial assistance and wish to receive that assistance.
To help make health insurance more affordable, the federal government offers Advanced PremiumTax Credits (APTC) – called subsidies – to those who qualify based on income and household size. These subsidies lower the monthly premium amount of a health plan.
If your estimated income falls between 100% and 400% of the federal poverty level for your household size, you may qualify for a subsidy. It's paid directly to the insurance company – and you'll pay the difference between the full premium and the subsidy each month.
In addition to premium subsidies, there are also cost-sharing reductions (CSRs). This is another type of subsidy that provides further help for those who qualify. CSRs lower the amount you pay for out-of-pocket costs like deductibles, coinsurance and copays.
Think of a CSR as an upgrade in your benefits. Based on your income level, it helps cover some of the costs of your medical services. That means you pay less money for those services. Keep in mind, to get these benefits you must choose a Silver plan on the Marketplace.
See if your income falls in the range to qualify for savings. Note that if you do qualify, you must buy your health plan through the Marketplace to get APTCs or CSRs. We'll remind you about this once Open Enrollment begins in November.
The Kaiser Family Foundation provides answers to many ACA-related questions.
A note on health care reform:
While it's been a hot topic in the news this year, Congress hasn't taken any final actions to repeal or replace the ACA. That means the ACA and all its requirements are still law. You can follow any updates on health care reform at bcbsnc.com/updates.
What are my options?
In October, we sent two items in the mail to help you understand your options:
- Rate notice: It shows which ACA plan you've been moved to for 2018 — and what the monthly premium will be for that plan.
- Personalized shopping guide: It lists key benefits of your current plan and your new ACA plan side-by-side. That way, you can easily compare them. We also suggest some things to think about before finalizing your health plan for next year.
Take another look at these materials now that Open Enrollment has begun. The information will be valuable as you evaluate your choices and make a final decision on your 2018 health plan.
Factors to consider
As you research health plans, these three factors will help you compare different options:
- Provider network: If you have a preferred doctor or hospital, first check to see if they're in-network. That way, you'll get the most savings. We provide links to search each plan's provider network in the tool below.
- Metal level: Picking a metal level in advance narrows down your options right away. Here's a good overview of them. In general, bronze and silver plans have lower premiums, but higher cost sharing — while gold plans have higher premiums, but lower cost sharing. If you don't use a lot of health care services, a bronze plan may be a good choice. Those that need more care may opt for a gold plan. And those in-between may see a silver plan as the safest bet. Finding the right balance of premium rates versus out-of-pocket costs is up to you, however.
- Cost sharing: We offer deductible and coinsurance plans — and copay plans. If you're not familiar with how they work, check out this short summary. The type you choose determines how much you'll pay at the doctor, pharmacy or hospital. So, it's worth learning about!
Which factors are important to you? Keep them in mind as you use the tool below. It offers a detailed look at the ACA plans offered in your county. While premium amounts aren't listed, you can compare costs by visiting the Manage Your Policy page in Blue Connect℠ and selecting "Rate Quote Tool." For now, focus on finding plans that are a good fit for you and your family. This short list can then be your starting point as you finalize your plan on Manage Your Policy.
If you want to make changes to your health plan during Open Enrollment, you must do so by December 15 for your coverage to start January 1. Keep in mind that you can't buy a plan after December 15 unless you have a qualifying life event.2
Explore your plan options
Just enter your ZIP code and select your county to see the plans available in your area.
When comparing our plans, remember that with Blue Cross NC:
- You never need a referral to see a specialist.
- In-network preventive care services are covered at 100%.3
- You can earn rewards for taking part in health programs.
- You get customer service based in North Carolina from a local company focused on your community.
Our Customer Service team or your authorized Blue Cross NC agent can walk you through all of these options. And in the next section, we offer step-by-step instructions for finalizing your 2018 health plan during Open Enrollment.
What should I do this month?
November is the time to compare your options, make a decision and finalize your health plan for 2018. Below are two steps that'll help make your Open Enrollment experience go smoothly.
1) Compare your plan options.
While we've chosen an ACA plan to move you into for 2018, only you can decide if it's a good fit for you and your family. These resources will help you evaluate all of your plan options before making a final decision:
- Review the rate notice and personalized shopping guide you got in the mail once again. They have a lot of good information about the ACA plan we've chosen for you.
- Use the comparison tool in the previous section to see which health plans are available in your area — and which factors to consider when shopping for a plan. See if your preferred doctors are in-network, too. Jot down a short list of plans that interest you.
- Visit the Manage Your Policy page in Blue Connect and click "Rate Quote Tool" to compare costs and other details for the plans on your short list.
- Have an authorized Blue Cross NC agent? Starting November 1, he or she can recommend a health plan for you. If your agent has done so, you'll see it on the Manage Your Policy page.
2) Finalize your 2018 health plan.
After comparing your options, you can decide which health plan you want for 2018. The steps you'll then take depend on whether you're keeping the ACA plan we've chosen for you or switching to a different plan:
- If you're keeping the ACA plan listed in your rate notice: Simply pay your January premium, and the new plan will go into effect on January 1. (If you qualify for financial help, you must enroll through healthcare.gov to get the subsidy.)
- If you're changing health plans and you aren't eligible for a subsidy: You can choose a different plan by going to the Manage Your Policy page and clicking the "Make Changes" button under "Future Plan."
- If you're changing health plans and you qualify for a subsidy: To get the financial help from the government, you must enroll in your 2018 health plan through healthcare.gov.1 We'll then cancel the plan listed in your rate notice so you don't end up with two health plans. But if you'd like to confirm that it's been canceled, please call us.
Since this year's Open Enrollment process is different from the past, we've made a special instruction booklet (pdf) to guide you. It has screenshots along with step-by-step directions for you to follow. And if you need extra help, the next section offers several sources of support.
If you're enrolled in AutoPay, you will be removed from it after your December premium payment is made. Since we're moving you to a new health plan for 2018, we want to make sure you're happy with that plan first. Once you pay your January premium, you can then re-enroll in AutoPay for your new plan from the Billing & Payments page on Blue Connect.
What do I do?
This guided renewal instruction booklet (pdf) shows how to finalize your 2018 health plan, step-by-step. Whether you're keeping the ACA plan in your rate notice or choosing a different one, you'll learn what to do.
If you have a serious medical condition and your doctor is not in-network for your new ACA plan, you may be eligible for continuity of care. It lets you keep using an out-of-network provider at in-network benefit levels for a short period of time. You must have an ongoing special condition, however. To request enrollment in continuity of care, complete this form.
Where can I get help?
In addition to this site and the tools we provide, you can get help from several other sources.
If you have an authorized Blue Cross NC agent, he or she will help guide you through this year's Open Enrollment. And if your agent has recommended a health plan for you, it will be listed on the Manage Your Policy page of Blue Connect.
BlueConnectNC.com is your go-to online resource for information. It has details about your current health plan and usage – which you can use to compare plan options for next year. From the Manage Your Policy page, you can see your new ACA health plan and make changes to that plan, if you wish. So register on the site today if you haven't yet!
Visit the "Contact Us" area of Blue Connect to get help through secure inbox messaging or chat. You can also call Blue Cross NC Customer Service at 1-888-206-4697. We're happy to answer questions about your new ACA plan or help you explore other available options.
What's the difference between a copayment and coinsurance? How do deductibles work? This special page on Blue Connect answers such benefit-related questions. And getting a refresher on these terms will help you choose wisely during Open Enrollment!
It's best to finalize your 2018 health plan in November. That way, you can focus in December on learning how to get the most out of that plan next year. Plus, it ensures your January bill and member ID card will be accurate if you choose to switch health plans.
Looking ahead, here's what you can expect:
- Early December: We'll share a special site with tips on using your new health plan and starting 2018 on a healthy foot. We think you'll find it rewarding!
- December 13: Your January bill should arrive via mail or email around this date. When paying it, you can then enroll or re-enroll in AutoPay from the Billing & Payments page on Blue Connect. (Note: If you enroll on healthcare.gov, you'll pay your January premium through that process and won't receive a January bill.)
- January 1: Your new ACA health plan will go into effect, as long as you've paid your January premium by this date.
Verification of Coverage
If you haven't received your new member ID card by January 1, you can show your doctor the Verification of Coverage (VOC) that came with your rate notice. This will serve as a temporary member ID until your new card arrives. Note that if you change plans or don't make your January premium payment, the information on your VOC may not be correct.
As always, please reach out to your agent or contact us if you have any questions. We'll be in touch again next month to wrap up this year's Open Enrollment!
Dates to remember
Open Enrollment begins; this is the first day you can choose a different health plan for 2018 if you don't want the ACA plan shown in your rate notice
Open Enrollment ends; this is the last day2 you can change your plan and have it go into effect on January 1
Deadline for your January payment; your new ACA plan goes into effect on this date