NC Has a Preview of where We Are Headed with ACA???

[russelltw]

Just received a letter from our state high risk pool. We have the federal option and state option. Letter says due to lack of funding, State Option will be freezing enrollment (except for hipaa and hctc eligibles) effective 2/1/13. Those that are hipaa and hctc eligible and enroll in the state will no longer pay the $150-200 commission to brokers.

The Assistance program will only be available to those who can re-qualify in 2013.

I would guess with Federal option, the govt can just print money where NC has to get funding from the legislature.

 

[YouGotMyMoney]

Rusty, when u say state option are you referring to "Inclusive Health" ?

 

[russelltw]

Yes, Inclusive Health - State Option. I did not write a ton through them, but it was nice to have a spot for people who were turned down by another carrier due to pre-existing conditions. We still have access to the Federal option, but now a client will have to be without coverage for 6 months to get covered again.

 

[b61mack]

That is 6 months of credible coverage.

 

[russelltw]

In NC, to qualify for the Inclusive Health Federal option, you have to be without coverage for 6 months and have a qualifying condition. (inclusivehealth.org)

 

[b61mack]

The key is credibile coverage. Meaning it has to meet certain goverment requirements, Then you have to get a denial from a legit insurance company. At least that is how it works in PA. If they have a BS, health policy,(not credibile). Then they can apply now, along with a denial letter from a legit insurance company.

 

[russelltw]

Correct, the state option was for people who lost coverage and were declined on the individual market. You had to have credible coverage to exclude any pre-existing conditions with no break in coverage over 63 days.

On our Federal option, you simply had to be without coverage for 6 months and you had a qualifying condition. If you met those, you could enroll with no regard to pre-existing conditions. Federal options is actually less expensive and offers better coverage than the state option. I had several people wait the 6 months to jump on the Federal.

You also could not have access to any group coverage through your work or a spouse's work.

 

[pbbaseball]

got the same letter this weekend. have to say, it's definitely a sign of things to come. you can' t cover those with health conditions, for roughly the same rates as those without health conditions, and then have those customers get a premium subsidy to make it even cheaper.

I've got maybe 20 people in the pool, and each one requires 10 phone calls, and it always takes 3 weeks to issue a virtually guaranteed issue product. A ton of work for a little money. Now that they've taken the broker commissions out of it, I'll be just passing along the 800 number, and web address, and let them have at it.... of course with the rule changes, i bet they'll have even less sign up than they do now... it was pretty successful in NC for the last 3 yrs or so

 

[b61mack]

The commission is 0% in PA. I have tried to pass the information on to clients, but they get confused, and I end up doing it for them.