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New regulations starting soon for health insurance exchanges

Copyright © 2019 Albuquerque Journal

A few changes are in store for individuals and small businesses signing up for insurance on the state’s health insurance exchange, which will hold an open enrollment period from Nov. 1 to Dec. 15.

In a change for small businesses, which used to have to contribute a minimum of 40% to employee health plans, they will be able to contribute any percentage down to zero, or any dollar amount toward employee plans, as of Oct. 1.

Eliminating the minimum contribution gives employers “the flexibility to decide what might match their upcoming budget,” said Jeffery Bustamante, interim CEO of beWellnm, the state insurance exchange, and director of policy and compliance for the exchange.

Most of the small employer groups that bought coverage through the state exchange paid about 75% of employee health insurance premiums, Bustamante told the Journal.

Health insurance exchanges are marketplaces for individuals who don’t qualify for Medicaid or who may not have access to affordable health care through an employer. It’s also a marketplace for small-business owners who have 50 or fewer employees.

New Mexico, Bustamante said, is “a competitive marketplace for coverage,” with four carriers available in every county, some offering four tiers of coverage: bronze, silver, gold and platinum. Bronze plans have the lowest premiums but the highest copays and deductibles. In each higher tier, plans have higher premiums but lower out-of-pocket expenses.

A new feature for employees enables them to buy up or buy down in their employer-provided health plans. Historically, employees had to stay within tiers in plans to which their employers contributed. Now employees can buy into any tier within any plan from any carrier available to the employer, Bustamante said.

New Mexico’s health insurance exchange for individuals, which currently can be accessed online at HealthCare.gov, eventually will join small businesses on a new state-run platform at beWellnm.com.

The beWellnm board approved the change last September, and the new platform will be launched in the fall of 2021, with enrollment beginning on Jan. 1, 2022.

“We’re doing it because we anticipate it will come at a cost savings to the state, and give us more control over our own destiny and more control over our own data,” Bustamante said. The new platform will save the state more than $700,000 and will put administrators of the exchange in a position to “know our population with much more clarity.”

More than 47,000 individuals have bought health insurance on the state exchange, as well as about 600 employer groups.

According to the new schedule of insurance rates released last week, the average cost of insurance offered through New Mexico’s health insurance exchange will fall a bit next year, state regulators said, but the impact will vary based on the consumer’s individual plan and other factors.

Consumers can visit bewellnm.com or call 505-827-4601 to learn more.

“Overall, rates are decreasing slightly, but some policyholders may experience a more significant decrease while others see an increase to their rates, depending on the company, region, plan and age of the policyholder,” said Viara Ianakieva, a staff manager in the Office of Superintendent of Insurance.

Nationwide, New Mexico is among the 10 states with the lowest premiums, Bustamante said.

New Mexico is also among the 10 states with the highest percentage of people who are living at or below the federal poverty level.

The Affordable Care Act required all plans to cover 10 essential health services, including hospitalization, maternity, newborn and pediatric care; mental and behavioral health treatment; prescription drugs; and laboratory services.

Last December, a U.S. district judge in Texas ruled the ACA was unconstitutional. That decision is being appealed. If the lower court’s ruling is upheld, it’s not clear whether carriers on the state exchange will continue to cover those services, Bustamante said.

Journal Capitol Bureau reporter Dan McKay contributed to this story.

 

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