With the recent Individual/family rate increases and doctor issues, many families are looking to get back to Employer sponsored health plans.
For good reason!
The ACA law really made it tough for mom and pop companies to enroll in group health.
We'll look at the rules, how to bypass them, and the benefits to this type of coverage.
Let's hit the reasons first for the big interest.
With the most recent rate increases, those differences are almost completely gone and in some cases, group health plans be cheaper.
You can quickly quote the new Small Group rates here:
This is the big reason people are moving.
We hear that all the time.
It's a major issue.
The individual and family networks are roughly 2/3rds the size of the group health plans.
Before 2014, the group and individual market had the same networks of doctors and hospitals.
That's no longer the case.
The hospital difference is especially pronounced.
The carriers signed exclusive deals with major hospital chains.
What if the dominant hospital in your area only contracts with one carrier and your doctors contract with another carrier.
From enrolling 1000's of people in the new ACA plans, this is very common.
Group health plans do not have this issue.
They typically contract with all the major hospitals and a large majority of doctors and other providers.
This is the biggest complaint we hear and now that the rates have risen on the individual/family market, there's no reason to stay there.
The third big reason for families to come back to Employer health plans is the drug formulary.
The list of allowed medications is also quite a bit smaller with new ACA health plans.
The missing meds can be surprising.
We've research rx lists from different carriers for clients and some very basic medications have been missing from one list or another.
In general, there will be less "management" with group health plans and this includes paying for medications.
We're also seeing more management on the "mental health" and "chemical dependency" treatment with individual/family.
So..what's about eligibility?
First we'll discuss what the ACA law did for mom and pop businesses but more importantly, we'll let you know the loopholes!
The ACA law basically gutted the family business market.
Sole proprietorships, Corporations, LLC's, and Parterships.
The ACA law came along and basically forced many of these groups into the individual/family market.
Here's how they did it.
There's a requirement in the law that said a company must have a non-owner or spouse on payroll and enrolling to qualify.
Translation...you can't just enroll with two spouses. Potentially, they could enroll their children if they're old enough to work but really hit a lot of family businesses.
Here's what we can do with some of the major carriers to still qualify:
We need one person on payroll to get a small business plan.
The person can be part time or full time but keep in mind that outside of Special Enrollment (Nov 15th-Dec 15th most years), we need a certain % of eligible people to go with the plan.
We can help you navigate all the rules to see if there's a way in.
The first step is to see if the group health plans are priced well to begin with.
You can request your group health quote for families here:
You can quote Small Business Plans for
Family Business plans here:
Or course, we're happy to walk through your situation to see what works best.
Our services are 100% FREE to you as licensed health agents with 20+ years of experience in California.
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