Aetna Canceling CA Health Plans, What About My Health Plan?

Kelley-Jensen2Aetna Canceling CA Health Plans and leaving California. I heard that Aetna is leaving California, and that people with Aetna plans have received cancellation notices.  What about my health plan with a different insurance carrier, will it be cancelled too?People with Aetna plans have received cancellation notices.  I’m with another carrier, will that happen to me? I know that health insurance reform is set to start in 2014, but I already have my own health insurance plan, not through any employer.  Can I keep the plan I have, or do I have to buy another one.  I do not really want to buy a new one because I like my doctor. 

Any Californian, who currently has an Aetna individual plan, will be required to find coverage elsewhere 01/01/2014.

And if you are with another carrier, will your plan also be cancelled?  Maybe.  It depends on whether your health plan meets certain health care reform requirements and can be “grandfathered”.

Under Health Care Reform, insurance carriers will be discontinuing many of their existing health plans because they do not meet the criteria established by the Affordable Care Act.  Most carriers in this situation will transfer or “map” you to a new, compliant plan that closest resembles your current plan.  In this case, there will be minimal action required on your part and you can continue with your current carrier on the new plan.  In the case of Aetna, they choose to no longer sell health plans in certain States, as Aetna has done in California.  So if you had an Aetna plan, you will need to shop for a health plan.

In other words, even grandfathered plans, those plans that were in existence the day the law was signed, March 23, 2010, could be cancelled by health insurance carriers.  Why?  Many of the essential health benefits requirements of health plans sold after the law was created do not apply to plans in existence prior to the law.  At a minimum, all plans, grandfathered or not, must adhere to the following:

1)    No lifetime or annual limits

2)    Prohibition of rescission of coverage

3)    Extension of dependent coverage 

4)    Prohibition of pre-existing condition exclusions

5)    No excessive waiting periods for eligibility

6)    Providing a summary of benefits and coverage to participants

So, if your plan does not comply with one of these six criteria, it may be dropped by your carrier.

How will I know if my plan will be cancelled?

You will receive a notice from the carrier.  The notice may advise you of your options to roll into another plan, if that carrier is still selling health plans in your state.  People in California have already received notices from Aetna that they will be canceling their plans and they need to buy new health plans.

Will there be rate increases?

Most likely, unless you qualify for premium assistance credit (subsidy).  Your new plan will be more expensive, mainly because the plan will have more benefits, in accordance with the Affordable Care Act.

Can I keep my same doctor under a different plan? 

Your doctor accepts more than one insurance plan, so the first step is to call your doctor, find out what plans he is considered in-network, and shop for a new plan from there.

What other things should I consider?

Networks of doctors, subsidy, how often you go to the doctor, all play a role in deciding a health plan.  Answer this set of questions before you shop for health insurance.

What about just staying uninsured? 

Being uninsured is gambling with your health, and never advisable.  Health Care Reform makes it more difficult for uninsured individuals to receive health care, because hospitals and clinics will receive less compensation for treating the uninsured.

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