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TWO OPTIONS BCBS, Sanford remain in ACA exchange

Medica health insurance subscribers who receive coverage through North Dakota’s Affordable Care Act exchange will be forced to make changes in November, according to Jon Godfread, North Dakota insurance commissioner.

"Somebody who was on the exchange and getting Medica will have to make some changes. If they have Medica insurance but not through the exchange and without a subsidy, there is no effect.

ND JON tax GODFREAD commissioner ,

“With Medica withdrawing from the exchange, it leaves a situation that puts stress on about 3,000 folks that receive subsidies for their Medica insurance,” he said.

The change does not affect all Medica insurance customers, according to Paul Witthauer, owner of Witthauer Investment and Insurance Services. His company has received a limited number of calls from subscribers in the two weeks since Medica announced it would not participate in the exchange.

“Somebody who was on the exchange and getting Medica will have to make some changes,” he said. “If they have Medica insurance but not through the exchange and without a subsidy, there is no effect.”

Medica insurance purchased through the exchange remains in place until the end of the year. Medica will also continue to offer Medicare plans and group health insurance in North Dakota, Godfread said.

About 84 percent of North Dakota residents receive health insurance through their job. The remaining 16 percent receive health insurance through the ACA exchange, if their income is low enough to qualify for a subsidy, or from an individual policy through an insurance agent if they have a higher income.

Subsidies are available for families with incomes of up to 400 percent of the poverty level or about $90,000 for a family of four.

Godfread said Medica expressed uncertainty about the federal cost share and subsidy when it dropped from the North Dakota exchange. He also speculated other insurance companies may consider exiting the exchange unless the program is stabilized.

For 2018, insurance consumers who utilize the exchange have two choices, Witthauer said.

Blue Cross Blue Shield and Sanford Health Plan will continue to participate in the exchange and are available in every county of North Dakota, Godfread said.

“We like people to shop,” Witthauer said. “There are slight rate differences and people need to decide what works best for them.”

Most exchange insurance policies are categorized as bronze, silver or gold plans. Plans from different companies but within the same category would be comparable although each plan may have slight differences, Witthauer said.

This year, the open enrollment period for health insurance is Nov. 1 through Dec. 15. Any changes in insurance coverage made during the enrollment period take effect Jan. 1.

Witthauer expects the insurance exchange to be very competitive this year.

The North Dakota Insurance Department reports an average increase in costs from Blue Cross Blue Shield of 22.6 percent. Sanford Health Plan has submitted an average increase of 7.9 percent.

Witthauer said people have a tendency to be loyal to their insurance company rather than shop for the best coverage. With a lot of volatility in the health insurance market this year, consumers should consider all their choices, he said.

“We send out letters and call people,” he said. “We want them to take a look at the options.”

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