"While the rising cost of the plans will have a muted impact on most people — federal subsidies will offset much of the higher premiums — the shrinking networks could force people to change doctors, drive longer distances for care and could mean losing access to out-of-state specialists they’ve been seeing for decades," Ladwig reports.
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Graphic via Insider Louisville
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The problem is that Anthem Blue Cross Blue Shield, the only health insurance provider offering coverage on the exchange in every county for next year, has dropped some Preferred Provider Organization (PPO) plans and will only offer a Health Maintenance Organization (HMO) plan in 74 counties.
PPO plans typically have higher costs and higher deductibles, but provide access to a larger network of doctors and hospitals than HMO plans do. They also allow consumers to see out-of-network providers and require the consumer to pay a higher share of the costs. HMO plans are cheaper, but offer fewer doctors to choose from and consumers can't see an out-of-network provider, unless they pay 100 percent of the cost for that visit or procedure.
Last year, Anthem offered PPO plans in every Kentucky county, but this year is only offering PPOs in 46 of them. "Of the company’s 75,000 individual customers in Kentucky this year, 80 percent are on PPO plans," Ladwig writes.
For example, Ladwig reports that in Louisville, Anthem's PPO plan this year allows consumers access to 15 hospital in the area, but next year's HMO plans will decrease this choice to 12. And Lexington's hospital network falls from 19 this year to eight next.
While customers in Louisville will continue to have a large network of providers on Anthem, Lexington's customers are complaining because Lexington Clinic is not in Anthem's network, which is one of the main primary care and specialist providers in the area, Ladwig reports. Lexington Clinic's website says it employees more than 200 providers, has a staff of 1,000 and claims about 18 percent of the Fayette County health care market.
Griffin Meredith, president of Commonwealth Insurance Partners, a Louisville-based health insurance broker. told Ladwig that his Lexington clients have not reacted well to this news. “They’re pretty angry,” he said.
Lisa Gillespie of WFPL reported in October that "rural areas will be most affected by the reduced choices," offering an example from Louisa, population 2,482, which will now have to drive 31 miles north to Ashland's Kings Daughters Medical Center to go to the hospital, instead of driving 2.4 miles to Three Rivers Medical Center, which is not in the Anthem HMO.
CareSource and Humana will only offer exchange plans in certain counties. United Healthcare, Baptist Health Plans and Aetna pulled out the Kentucky market, citing financial reasons.
Ladwig writes, "Anthem said that much like in years past, it is making changes to its products based on market dynamics and consumer preferences."
Mike Lorch, the insurer’s regional vice president, told Ladwig that the company has worked hard to expand the HMO networks and that if hospital systems meet their requirements, which includes reimbursement rates, they can become part of the network.
As an example, Lorch cited St. Elizabeth Healthcare in Northern Kentucky, which includes about 90 percent of the adult primary care providers in the region. It was not part of Anthem's HMO network last year, but signed on this year.. Bill Banks, vice president of the hospital, said they were able to become part of the network "after Anthem raised its reimbursement rates to a reasonable price," Ladwig writes.
The state Department of Insurance requires insurance company networks to provide all customers with access to a hospital within 30 minutes or 30 miles.
The deadline to sign up for coverage effective Jan. 1 has been extended until Monday, Dec. 19. The last day to sign up for coverage is Jan. 31, to have coverage in place no later than March 1, 2017. Those who do not sign up for health insurance will have to pay a penalty of $695 per uninsured adult.
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