FAQs for BlueChoice HealthPlan ACA Exchange Members
BlueChoice HealthPlan will not offer any health plans for 2017 on the federally facilitated marketplace (FFM), also known as the "exchange" or Health Insurance Marketplace (www.HealthCare.gov). This change only impacts you if you are a BlueChoice®member who purchased your Blue OptionSM plan through the FFM or if you purchased your gold level Blue Option plan directly with BlueChoice (off exchange). BlueChoice will continue to offer silver and bronze Blue Option products off exchange (i.e., not through the FFM).
Medical costs for people in ACA plans offered on the federal exchange are much higher, because these members tend to be sicker and require medical care more often. Those high costs are why other insurance companies have left the market. As these companies drop their plans, their members have turned to BlueCross and BlueChoice. In order for us to stay in the market, we needed to find ways to streamline our operations and cut out any duplication. The best way for us to do that is by rolling BlueChoice members who have a Blue Option exchange plan over to BlueCross. While this change may seem big, it really has a small impact on our members. BlueCross plans are very similar to BlueChoice plans and use the same provider network.
Your current Blue Option coverage stays in effect, as long as you pay your plan premiums, until the end of the year (Dec. 31, 2016). Keep using your Blue Option ID card until then. You will receive a new ID card from BlueCross for you to use starting Jan. 1, 2017.
Many members with ACA plans will see their premium rates increase for 2017 because customers in this market are sicker and use more services. This is the reason that many insurance companies have left the market. Companies like BlueCross that are staying in the market must raise premiums to keep up with these rising costs.
If you are receiving tax credits (subsidy) for a plan you purchased on the exchange, the impact of a premium rate increase may be minimal because the amount of subsidy you qualify for in 2017 will be adjusted as well. If you are not receiving tax credits (subsidy), you may want to check to see if you qualify for 2017. It’s always a good idea to do this just in case something has changed that could now make you eligible for this extra financial help.
You should receive a letter in early October that shows the BlueCross plan that is the most like the Blue Option plan you have today with BlueChoice. If you want to keep this plan for your 2017 coverage, all you need to do is to update your application with the Health Insurance Marketplace and select that plan. If you want to shop around and see other plans that might better fit your needs for 2017, you still have the option to do so. The Open Enrollment Period starts Nov. 1. Just be sure to select a plan by Dec. 15 to have your coverage take effect Jan. 1, 2017.
We mapped plans using out-of-pocket costs for core plan benefits, such as your deductible, copayments for primary care and specialty doctors’ office visits, pharmacy benefits and cost, and total out-of-pocket amounts.
Under the law, all qualified health plans must offer the same set of essential health benefits. However, you may see some differences in pharmacy, dental or vision coverage, or added-value programs and services.
You can view all plans for 2017 by going to BlueCross’ website at www.SouthCarolinaBlues.com starting on Nov. 1, 2016. If you are eligible for financial help (tax credits/subsidy), or think you might be, you should go to the Health Insurance Marketplace at www.HealthCare.gov. You’ll also be able to enroll in a plan for 2017 starting Nov. 1, 2016.
The EPO network that BlueCross uses for its ACA individual plans has the same South Carolina providers as the EPO network that BlueChoice uses for your current Blue Option plan. You do not have to switch doctors.
BlueChoice and BlueCross ACA plans contain the same essential health benefits, so BlueCross will cover these services. Your out-of-pocket costs may be a little different, depending on the BlueCross plan you get.
If you have an authorization for a medical service or maternity care under your Blue Option plan, we will transfer that authorization to your new BlueCross BlueEssentials plan. When that occurs, you and your doctor will get a new authorization letter. Your doctor can also use our website to verify authorization status.
If you have refills left on your original prescriptions, you will be able to refill them. After that, you will need a new prescription. Keep in mind that your pharmacy benefits and out-of-pocket costs may be a little different under your new BlueCross plan. So you may pay a different amount at the drug store once your BlueCross coverage begins.
Some specialty drugs may require pre-authorization. BlueCross will automatically re-authorize some medications for chronic conditions, but others used for more complex illnesses may need to be re-authorized. If this is the case, we will notify you and your doctor. If the drug is approved under your new BlueEssentials plan, we will send a new authorization letter to you and your doctor.