Up to $230 a month less on average than other small group and individual plans
Includes all of the ACA’s essential health benefits
Designed for small businesses and individuals who are uninsured or unable to afford other ACA plans
DURHAM, NC – A new plan called myChoice will be available in the 1-50 small group and individual markets in 2019. The plan will cost on average more than 30 percent less than other small group and individual plans. The myChoice plan will be administered by ACS and underwritten by Blue Cross NC and is ACA compliant. The premium savings will equal an average of 33 percent, or $230 per member per month, for individual plans. Premium savings will equal 30 percent, or $140 per member per month, for small group plans.
In North Carolina, close to a million people have no insurance. Many of those were previously insured, but now cannot afford the more expensive marketplace plans and are not eligible for a subsidy. On top of that, small businesses do not receive any premium assistance to purchase health insurance for their employees, and cite affordability as the number one reason they can’t offer it. The result is that people can’t afford the care they need. Blue Cross NC wants to help them become insured.
“myChoice is a less expensive option for families and small businesses who may not be able to afford other, higher-priced ACA plans,” said John Roos, Chief Growth Officer of Blue Cross NC. “We know that premiums are too high, particularly if you don’t qualify for a subsidy. This new plan is one way we can offer coverage at a lower price point.”
Members using myChoice plans will take on more responsibility for managing their out of pocket costs and care. In exchange, members will get significant premium savings with no provider network limitations and all the ACA’s essential health benefits.
myChoice is designed for small businesses and individuals unable to afford other ACA plans. Average premium rates for ACA plans in the 1-50 small group market have increased by 40 percent and individual markets by 205 percent since the ACA came into effect in 2014. This high rate of increase has made coverage unaffordable for many and caused both small groups and individuals to drop coverage and go uninsured.
No Provider Restrictions, Members Must Comparison Shop
myChoice reimburses customers directly for medical procedures at rates that are up to 40 percent higher than what the doctor or hospital would receive for providing the exact same services to a patient on Medicare (i.e., 140 percent of Medicare rates). There are no restrictions on which providers a customer can see. The customer is responsible for paying the provider.
However, because there is no network of providers with negotiated prices, doctors and hospitals are not restricted in what they can charge patients. If a provider charges more than 140 percent of Medicare for a particular service, including emergency care, the member may be billed the difference by the provider and will be responsible for paying the balance owed. While approved claims go towards satisfying deductibles and out of pocket maxes, balance billing does not count towards the plan’s deductible or out of pocket max.
The plan has a contracted network of pharmacies with agreed-to prices. There is no balance billing if a member goes to an in-network pharmacy.
Blue Cross NC encourages myChoice customers to talk with their provider before any appointment or procedure to make sure they will accept the benefit payments that are provided, or find providers who will.
In addition, myChoice advisors are available to help members find providers who may accept their benefits. Advisors can also help guide members as the member negotiates billed amounts with their provider.
myChoice is a high-deductible plan. Like other high deductible products in the market today, no benefits except preventive care will be paid prior to meeting the deductible. The plan is eligible for a Health Savings Account which gives customers the opportunity to save for medical expenses on a tax-free basis.
Because myChoice is so different from traditional Blue Cross NC products, in that customers need to shop for providers and compare prices to the allowed payment offered by the plan, it will come with a unique insurance card. While the card will not carry the cross and shield logo, it will state that the plan is underwritten by Blue Cross NC.
Blue Cross NC will continue offering ACA-compliant plans with a contracted network of providers on the Federal Marketplace exchange in 2019 and beyond. As in past years, these plans will be available for small group employers and individuals in every county of North Carolina.
myChoice is an ACA-compliant plan, meaning it complies with all ACA requirements. For example, the plan includes all of the ACA’s essential health benefits, and no one can be denied coverage or charged more based on a pre-existing condition.
A person’s rate is determined by their age and where they live.
For individual members, myChoice will be sold off-exchange, meaning premium subsidies are not available and the plan cannot be purchased on www.healthcare.gov. The plan can be purchased at www.myChoiceHealth.com.
For small group employers, myChoice will be sold through normal channels. Small employers do not receive any premium assistance to purchase health insurance for their employees.
For small group customers, myChoice will be available in all 100 North Carolina counties.
For individual market customers, the plan will be available in all counties except Mecklenburg, Union, Anson, Stanly, Cabarrus, Rowan, Gaston, Lincoln, Cleveland, Wake, Johnston, Franklin, Lee, Chatham, Alamance, Orange, Durham, Caswell and Person.
In August, Blue Cross NC announced individual ACA rate reductions of 21 percent and 16.5 percent in the Triangle and Charlotte metro regions respectively. The rate reductions were the result of a competitive process between the area’s hospital systems.
In other areas of the state, most of which do not have multiple hospital systems, a similar competitive process was not possible and rates increased. myChoice is being offered as a lower cost, ACA-compliant option to customers who live in these areas.
Open enrollment begins for individual under 65 customers on November 1, 2018. To learn more about myChoice and to find out if the plan that is right for you, visit www.myChoiceHealth.com.