Blue Cross Blue Shield + Tennessee - What's the Latest?

Where We Are Now

As many former policy holders know, BlueCross BlueShield dealt an unwelcome blow to many Tennesseans in 2017 when they stopped offering ObamaCare coverage for residents of Nashville, Memphis, and Knoxville. The Chattanooga-based company is the state’s largest insurer and was initially the only provider to offer coverage across all of Tennessee, so the withdrawal left many policyholders scrambling for coverage.

Good News

The good news is that new proposals indicate that Blue Cross may be poised to reenter the Nashville and Memphis markets in 2020. This news come after they reentered the Knoxville market in 2019. Additionally, Cigna is planning to expand their coverage to include Chattanooga and Jackson and surrounding counties in 2020.

According to Tennessee Department of Commerce and Insurance office, the five major insurance companies in Tennessee have proposed the following (as reported by the Tennessean):

• BlueCross BlueShield of Tennessee: Proposed coverage adds Memphis and Nashville areas to be available Statewide. Proposed 2020 rate request seeking an average increase of 1.4%.

• Bright Health: Coverage continues in Knoxville, Memphis and Nashville areas. Proposed 2020 rate request seeking an average increase of 2.93%.

• Celtic/Ambetter Insurance: Coverage continues in Chattanooga and Memphis areas with proposed coverage expansion into Nashville and Knoxville areas. Proposed 2020 rate request seeks an average decrease of 1.6%.

• Cigna: Coverage continues in Knoxville, Nashville, Memphis, and Tri-Cities with proposed coverage expansion into Chattanooga and Jackson and surrounding counties. Proposed 2020 rate request seeking a premium decrease of 5.7%.

• Oscar Health: Coverage continues in Nashville and Memphis. Proposed 2020 request seeking an average decrease of 8.3%.

Blue Cross originally cited heavy financial losses for the reason they dropped coverage for much of Tennessee in 2017, and the withdrawal prompted many to fear a collapse of the Affordable Care Act in the state. However, the new proposals, which show that providers are hoping to either cut premiums or hold increases to a minimum, seems to indicate a stabilization of the market.

The proposals are not final yet, but it does appear that the market in Tennessee is more competitive compared to a few years ago, which should translate to more choices and more attractive premiums.

I’m based in Nashville and an agent for BlueCross BlueShield, Cigna, Bright and Oscar, and am pursuing a contract with AmBetter. I will do my best to answer your questions and keep you informed. Please feel free to contact me with any insurance questions.

"Nashville" photo by phedot is licensed under CC BY-NC-ND 2.0

Medicare & The IRMAA Cliff

What is IRMAA?

IRMAA stands for Income-Related Monthly Adjustment Amount and is often described as a tax on Medicare. If you’re an individual with income over $85,000/year, or part of a couple with income over $170,000/year, IRMAA will increase your Medicare premiums for Parts B and D.

The good news is that 95% of Medicare recipients will not face this higher cost. Some might say having to pay IRMAA is a good problem, but those who pay the higher fee rarely see it that way.

The amount you pay is based on your MAGI, or modified adjusted gross income from two years ago. The income brackets top out at $500,000+ for individuals and $750,000+ for couples.

With IRMAA, going just $1 into a higher income bracket could result in paying thousands more in Medicare premiums. This is known as the “cliff” and just a few dollars more in income can result in a significantly higher premium. Also, since IRMAA uses joint income for determining premiums, one high-earning spouse can force both spouses into a higher premium bracket.

What to Do

Plan with foresight and know the ramifications of your financial actions. Make sure that you and your financial advisor are aware that large stock trades, the sale of a house or business and other transactions may result in a jolt in your Medicare premium.

If your income drops significantly to due a one-time, life-changing event, you have the right to appeal for a lower premium by filing form SSA-44. Social Security considers any of the following situations to be life-changing events: the death of a spouse; marriage, divorce or annulment; retirement or reduced work hours for one or both spouses; loss of income-producing property due to natural disaster; or loss of a pension. Filing the form is particularly important during your first year of retirement.

One-time cash windfalls such as the sale of a vacation home, a large portfolio distribution or a Roth IRA conversion, do not qualify as a life-changing event and will result in a higher premium two years later.

I’m a licensed Medicare insurance broker in Tennessee and appointed with Aetna, Blue Cross, Cigna, Humana, United Health Care, and many more carriers. If you have questions on IRMAA or any other Medicare issue, please feel free to call me. Thanks.

Photo by Witches Falls Cotages is licensed under CC BY 2.0

Turning 65 and Medicare - What You Need to Know

Turning 65 brings some welcome relief for insurance coverage with the help of Medicare. Medicare is a massive healthcare programs that brings insurance relief for millions of older Americans, but qualifying and enrolling in Medicare brings confusion for many people.

Here are answers to some of the most common questions:

When can I enroll in Medicare?

You are able to apply 3 months before you turn 65, even if you’re not yet ready to retire. However, if you have health insurance through your employer, you may wish to wait to enroll in Part B. You may be able to enroll sooner if you are disabled and can qualify.

Many people think that if they start claiming their Social Security benefits at age 62, they can enroll in Medicare at the same time, but that’s not the case. You have to wait until age 65.

How do I enroll in Medicare?

Basically, you enroll for Medicare through the Social Security website.

If you are already claiming Social Security benefits at age 65, you will be enrolled in Medicare automatically, so you don’t have to do anything. Your Medicare card will be mailed to you about three months before your 65th birthday.

If you are not claiming Social Security benefits when you turn 65, then you will need to apply for coverage through the Social Security website here. The process only takes about ten minutes, then you just wait for your card to arrive in the mail. If you don’t already have a Social Security account, you will need to create that first.

What Exactly Does Medicare Cover?

There are 4 parts to Medicare:

• Part A (Hospital Insurance) - covers hospital stays and some stays in skilled nursing facilities. Most Americans pay no premium for Part A. It has a deductible of $1,364 per benefit period. For hospital stays of over 60 days or skilled nursing stays longer than 20 days, coinsurance is required.

• Part B (Medical Insurance) - covers doctors' visits, lab tests, outpatient procedures, etc. You must pay a small premium for Part B, and you can opt out if you wish. Standard premium is $135.50/month and goes up to $460.50/month depending on income.

• Part C (Medicare Advantage) - provides additional Medicare coverage through private insurance companies who are approved by CMS.

• Part D (Prescription Drug Coverage) - provides coverage for prescription drugs. Part D plans are also offered by private insurance companies. Premiums are low - generally about $50/month or less.

I hope this information helps. I will be happy to guide you through the process of answering any of your questions. I have many options available for Part C and Part D coverage, as well as many Medicare supplement choices.

medicare photo by Aaron Fulkerson is licensed under CC BY-SA 2.0 

2019 Brings a New Alliance with Fridrich Pinson & Associates

In order to offer more solutions and support to my clients, I’m proud to announce my recent alliance with Fridrich Pinson & Associates. FPA has been a leader in covering the insurance needs of Nashville and surrounding areas since its beginnings in 1957 as the Donnelly & Fridrich Agency. As a part of the team, I will serve as the lead contact for all benefit products for the Agency, including individual and group health plans, disability, Medicare, and life insurance, in addition to developing property and casualty business.

I wouldn’t have gotten this far without great customers, so I made the move confident in the knowledge that everyone I’ve helped serve will benefit from this change. I’ve also just recently received my property and casualty license, so I’ll be happy to provide quotes for anyone’s home, auto, and liability needs.