Nov. 3, 2014 – The upcoming nationwide open enrollment period for individuals and small employer groups to purchase health insurance coverage through the various Affordable Care Act (ACA) online insurance exchanges, commonly called marketplaces, existing in the 50 states, presents a good opportunity for you to re-examine your health insurance coverage options for 2015. That open enrollment period begins Nov. 15, 2014, and ends on Feb. 15, 2015. The State Bar of Wisconsin’s Insurance and Member Benefits Committee expects participating insurance companies to release their premium rates for 2015 ACA-compliant plans offered through the Wisconsin marketplace around Nov. 4.

If you currently have non-ACA-compliant health insurance coverage, consider whether your insurance company will permit you to continue that coverage into the 2015 plan year. You will find additional information about this permitted extension online through the Department of Health and Human Services’ Center for Consumer Information and Insurance Oversight.  

Consider Options Through and Outside the Marketplace

When evaluating your health insurance coverage options, consider what’s available through the marketplace and outside the marketplace.  For your convenience, State Bar members can access resources and information through two trusted insurance advisers:  Professional Insurance Programs (PIP), using Wisconsin Physicians Service Insurance Corporation (WPS);  and Bultman Financial Services (Bultman), which has access to 13 of the 19 health insurance carriers in Wisconsin (contact information for both is below).

Through the marketplace, there are four standardized coverage levels for the ACA-compliant policies offered to eligible individuals and small employer groups. They must follow the “metal levels” that roughly translate to:

• Bronze = 60% coverage level
• Silver = 70% coverage level
• Gold = 80% coverage level
• Platinum =90% coverage level

Other Factors to Consider When Evaluating Coverage

There are many other important factors to consider when deciding which insurance company’s health insurance policy is best for you and your family. These include, but are not limited to, the following:

1) Are the doctors that you and your family want to use included in the insurance company’s provider network for that policy?

2) What additional out-of-pocket costs will you have to pay in order see a doctor, clinic, or hospital that is not participating in your policy’s network? These can very significantly for HMO, PPO, and Point-Of-Service (POS) policies.

3) How many health care services do you and your family expect to receive in 2015, and what is the total out-of-pocket cost to you including premiums, deductibles, coinsurance, copays, and other costs? In general, higher usage of health care services will favor a policy with higher upfront premiums and lower out-of-pocket costs. Lower expected usage of health care services may favor buying a policy with lower upfront premium costs and higher out-of-pocket costs.

4) Do you have enough dollars in your 2015 budget to cover your actual out-of-pocket costs arising under the policy if your and your family’s actual usage of health care services far exceeds what you were expecting for 2015?

Government Subsidies for Health Care Coverage

You may also want to consider whether you are eligible for government subsidies for health insurance policies purchased through the marketplace. Both PIP and Bultman will help you determine whether any government subsidies are available to you based on your annual household income. They can assist State Bar members living in Wisconsin, and will provide resources and information to our members living outside of Wisconsin. For more about government subsidies, refer to the Kaiser Family Foundation’s online calculation tool.

Options for Mid-sized Law Firm Employers

Mid-sized small employer law firms may wish to consider self-funding the firm’s group health benefits plan for its eligible employees and their eligible family dependents. A number of plan administrators that administer these types of plans are bundling services together designed for self-funded plans, including plan design, administration, and stop-loss insurance underwritten by an insurance company, which they sell to law firms to help the law firm manage its health insurance risk.

Firms down to 20 or 30 participants might find that their best cost option is to use one of these self-funded plans using a third-party administrator. However, such a plan’s annual health insurance risk presented to the firm needs careful study and evaluation in consultation with the firm’s own trusted health insurance professional.

Need More Information?

State Bar members can get information about the possible health insurance coverage options available to them from the following:

1. Professional Insurance Programs (PIP)
   (414) 277-0154 or (800) 637-4676

2. Bultman Financial Services
   (262) 782-9949 or (800) 344-7040

3. HealthCare.gov

4. Your own trusted health insurance professional