Obamacare orphan? Here's what you can do

After Aetna (AET), the country’s third-largest insurer, announced last week that it plans to sharply scale back its participation in Obamacare, people started counting. 

With other mega-insurers, including Humana and UnitedHealth also edging away from the federal health program, that will leave five U.S. states with only a single insurance carrier offering coverage through the exchanges. More specifically, a report from consulting firm Avalere Health says 36 percent of the approximately 500 rating regions in the U.S., most of those in the rural south, may have just one insurer in 2017. Another 19 percent could have just two carriers.

A rating region is the geographic area used to set the insurance premiums you pay. It could be a county, a zip code or a split between the two. Consumers may only purchase insurance plans offered within the rating region they reside in, said Elizabeth Carpenter, senior vice president at Avalere.

This isn’t a death blow for the Affordable Care Act. Many states and counties will be trying to lure new insurers to their underserved areas up until Obamacare’s enrollment period begins on November 1, potentially improving the competitive picture. By the same token, other insurers may also announce they are dropping out.

Here’s what you can do if your insurer is abandoning Obamacare.

Talk to your doctor -- now.  Your physician is most likely in the midst of negotiations with various networks right now. He or she knows how things will play out during open enrollment. Find out now if you may need to change  health plans to stick with your physician or if he or she will be staying with the remaining carrier(s) in your area, Carpenter advised. 

Remember, you still have options.  Even if you only have one choice of exchange insurance carrier, keep in mind you still have a choice of plans from that carrier. Insurers offering plans on exchanges are required to offer both “silver” and “gold” coverage, and most offer a “bronze” plan as well. Even with only one insurer, you’ll need to consider which level of coverage -- high deductible, preferred provider and so forth -- is right for you, said Cynthia Cox, associate director, health reform and private insurance at Kaiser Family Foundation.

Check your subsidy qualification. Be sure to go back online (healthcare.gov) and reenter your financial and household information, Cox said. Your income and family circumstances can change from year to year, and that can affect whether or not you receive financial assistance.

Prepare to incur out-of-pocket health care costs. They are rising for just about everybody. If you find out from your doctor you’ll need to be going out of network to continue care, try to estimate how much more that will cost you in terms of higher premiums for a flexible plan and higher co-pays. Also, take a look at the medicines you take. Will those still be covered by your limited choice of plans? If not, how much will you be paying for prescriptions? Finally, with fewer choices you may need to move to a higher deductible plan, again costing you more out-of-pocket. Budgeting now for these costs can help make the coming year’s health care costs less of a surprise.

Look beyond the exchange.  Some shoppers may find more options in the private market, Cox said. If you know you aren’t eligible for a subsidy, this may be a good idea. Just be sure to make sure the plans you are looking at meet the minimum requirements of the health law, including no exclusions for pre-existing conditions. The compliance terms should be spelled out in plan materials, but if you have questions ask your insurance broker or potential carrier.