11/3/2017 By Agent Ken CobbBy Agent Ken Cobb
For people living in the Bemidji area who are looking to buy health insurance on their own for 2018, the choices available are rather limited. While most Minnesotans get their insurance from their work, through Medicare or via medical assistance or MinnesotaCare, four percent of state residents buy coverage in the Individual and Family market, and options in this market aren’t great in Bemidji.
Like in the majority of greater Minnesota, there are only two options available for purchase in the Bemidji area – Blue Plus and Medica.
Unfortunately for us in Bemidji, Medica announced that Sanford hospitals and clinics would not be part of their 2018 network for Individual and Family plans.* This means that Bemidji residents with a privately purchased Medica major medical policy will face much, much higher out of pocket costs to get their care from Sanford in 2018. While this restriction doesn’t apply to emergency care and the newly opened urgent care clinic MedExpress is in Medica’s network, Medica members* needing most other services will find their closest options for in network care to be in Bagley, Walker or Park Rapids.
This really leaves only Blue Plus as a viable alternative for many people living in Bemidji. The Blue Plus plan being offered locally, Blue Plus Western Minnesota, features the Sanford Health system and certain other local facilities in the western Minnesota region. So Bemidji’s Sanford facilities are definitely in network. However, the network does not extend to providers in the metro area or Rochester or in other states.
Blue Plus offers three plan options for 2018:
Note that all three Blue Plus plans have annual out of pocket maximums of $6650 per person and $13,300 per family. After you have paid this much out of pocket during the calendar year, you no longer have to pay a percentage of your covered costs – the plan will now pay one hundred percent.
Just like with Medica, with Blue Plus your out of pocket cost for medical care will be dramatically higher than what I described above if you receive care from a provider who is not within the Blue Plus Western Minnesota network. You can check whether a provider is in network here (make sure to select “Blue Plus Western Minnesota” from the “View other networks” dropdown menu on the left on the search results page).
Many people may be disappointed to learn that these Blue Plus plans do not provide hardly any benefits before you meet your annual deductible. While many of us our used to being able to visit urgent care for a small copay, Blue Plus doesn’t pay anything towards this until you reach your deductible. The good news is that all three Blue Plus plans do provide full coverage for preventive care. In addition, the Gold plan does cover generic prescription drugs prior to meeting your deductible, with a $20 copay.
How much are rates for Blue Plus in the Bemidji area? Here are some examples for someone living in Beltrami County. (I rounded these to the nearest dollar):
If you are looking for coverage for your family, you would add up the individual premiums. For example, a couple both age 62 would pay $1942 for Silver ($971+$971) or a family with both spouses age 45 and two children under 18 would pay $1360 for Bronze ($421+$421+$259+$259). The good news for larger families is that you only pay for up to three kids on your family plan.
Note that these are just examples for these ages; click here to request rates for your age. You can read more about the Blue Plus Western Minnesota plans by clicking here.
Not only are plan options limited in our area, but they might get even worse before open enrollment closes on 12/15/17 (or 1/14/18 if buying through MNsure). This is because Blue Plus announced an enrollment cap; once they reach a certain number of statewide enrollments, they will close for the year. While I'm not certain how long they will stay open, if they fill up, our options will go from bad to worse.
It goes without saying that health insurance has grown inconceivably expensive in the past few years, to the point where many people simply aren’t going to be able to afford it. What other alternatives are available?
For many, there may be financial assistance available through MNsure, either in the form of subsidies to reduce the rates shown above or via medical assistance or MinnesotaCare. Many people who assume their income is too high might actually be surprised to find that they qualify.
Let’s take a family of four as an example. If their annual income is under $32,718, all the members can can enrolled in free medical assistance. If they make more than $32,718 but less than $49,200, their kids 18 can get medical assistance and the parents may qualify for low-premium MinnesotaCare. Between $49,200 and $67,650, the kids still qualify for Medical Assistance and the parents will have to buy private coverage but may qualify for a subsidy to reduce their cost. If their household income is more than $67,650 and less than $98,400, their only option will be private coverage but they will likely be able to get a subsidy to reduce the premiums I illustrated above.
These income levels vary depending on the size of your household. For example, in a family of six, the kids qualify for free medical assistance all the way up to $90,640 in annual income. I should also point out that these details are a summary, and there are eligibility restrictions and other terms and conditions that apply. To find out for sure what financial assistance your family might qualify for, you will need to visit mnsure.org, create a login account and complete an application.
Beyond government financial assistance, one other alternative many are now considering are faith-based cost sharing plans. These plans are not insurance and are not guaranteed to cover your health care costs. In addition, they may have unexpected exclusions and troubling annual or lifetime maximums. However, they are considerably less expensive than insurance and are certainly worth considering if you simply can’t afford to buy a major medical policy.
Unfortunately, I have also seen some people tricked by unscrupulous sales people into buying Short Term or Defined Benefit plans thinking that they are buying major medical coverage. While these plans might be a good fit for certain situations, see my previous blog post about why these plans often fall into the “too good to be true” category and probably won’t provide you the benefits you are expecting.
What I continue to see is that now more than ever, people are looking for a trusted advisor to guide them through this frustrating and confusing process of choosing a health insurance plan. While I don’t carry around any miracles in my bag of tricks, if you are looking for help, contact me and I’ll be happy to do what I can to assist you.
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*Medica announced that Sanford Health would no longer be part of its Applause network for 2018. The Medica Applause network is used specifically for Individual and Family plans and does not impact Medicare or employer-based plans, to the best of our knowledge.
About the Author
Agent Ken Cobb
Ken is the owner and principal agent at Pine Country Insurance in Bemidji. Active in the insurance industry since 2000,Ken uses his years of personal insurance knowledge and experience to assist clients in customizing insurance coverage to fit their needs. Ken considers himself a "farmer" rather than a "hunter"; rather than focusing on writing a lot of new policies as quickly as possible, he works on cultivating long term relationships based on trust with his clients. When writing new policies and meeting for annual reviews, Ken spends time with his clients explaining and helping them understand their insurance, and he is also pleased to share his knowledge with his blogging audience as well.
Ken Cobb is owner of Pine Country Insurance and has been active in the insurance industry for over 15 years. Meet Ken.
Coverage descriptions found in this blog are summaries provided for general educational purposes and cannot fully detail the terms, conditions, limitations or exclusions of a specific insurance policy. Please read your policy carefully.