Nashville, here are your Affordable Care Act options

Cigna and Oscar Health are the only two insurance companies offering Affordable Care Act health plans in Nashville next year. While it might seem like options are limited, it’s worth bearing in mind that Nashville was at risk of having no carriers offering 2018 plans. Thanks in part to the leadership of government officials, Middle Tennessee is fortunate to have two, given the turmoil in healthcare today.

Here are a few things consumers should know about this year’s options. 

The good news 

Let’s start with the good. There are two carriers, when it could have been one or even none. According to the Society of Actuaries, Tennessee had the second-sickest marketplace enrollees in the country, following only Arkansas for the top position. This means covering Tennesseans is expensive, and our health status is a driving factor for why we have fewer choices than other states. 

But we have two carriers, and they are each offering numerous plans to choose from. Specifically, Cigna is selling five ACA-compliant plans, and Oscar Health is selling eight. All TriStar and Saint Thomas facilities are in-network with both carriers, which encompasses a broad geographic footprint in the greater Nashville area. 

More good news: Earlier this month, Vanderbilt University Medical Center worked out a deal to be included in Cigna’s network. Initially, the academic medical center was out-of-network with both carriers. Because neither carrier is offering out-of-network benefits, marketplace consumers would have been effectively uninsured at Vanderbilt — but more on that later. 

Last, Nashville is one of just a few cities in the country with access to Oscar Health, a new carrier that was founded in 2012. Oscar Health offers a tech-oriented experience in its insurance plans, including free, 24/7 telemedicine anywhere in the country. This new carrier could be a good fit for some consumers. 

Now for the bad news

There are a few points of concern. Neither carrier is offering any HSA-eligible options. This means that marketplace consumers in Nashville will not be able to contribute to their Health Savings Accounts next year. However, you will still be able to spend any HSA funds you have already saved tax-free on qualified medical expenses.

If you currently have an HSA-eligible plan, it might be a good idea to max out your annual contribution — $3,400 for an individual and $6,750 for a family — before the year ends. You can use these funds next year and beyond, but you cannot contribute if you aren’t signed up for an HSA-eligible plan.

The second big point of concern is that neither carrier is offering out-of-network benefits with any of its plans.

Out-of-network benefits

What are out-of-network benefits? Sometimes, carriers offer “better” coverage at in-network hospitals, but still provide some benefits out-of-network. In these cases, being “out-of-network” can mean having a higher deductible, or being billed for whatever your insurance didn’t cover. 

This is not the case with any of Nashville’s marketplace plans next year. Neither Cigna nor Oscar Health are offering any out-of-network benefits, which means consumers will have no coverage at all out-of-network.

If a consumer were to receive care out-of-network, they would effectively be uninsured, and responsible for the entirety of their medical bills. There are two exceptions. Consumers would be covered in the case of emergencies, or if the treatment they needed could not be provided in-network.

Initially, Vanderbilt was out-of-network with both carriers, and this was likely to cause a lot of problems. Consumers would have had to change doctors or incur large medical bills that their insurance plan would not cover. Patients who couldn’t receive their treatment at TriStar or Saint Thomas facilities would have had to be approved for an exception, but it wasn’t clear which patients would be eligible.

This created a lot of confusion and anxiety for consumers. But a week after the plans were announced, Cigna and VUMC worked out a deal, and Cigna consumers will be able to visit Vanderbilt in-network. 

So should you choose Cigna? Does every consumer need Vanderbilt in-network? In the next column, we’ll cover how to compare the Cigna and Oscar Health plans, and provide information on where consumers can find enrollment help and advice.

Alex Tolbert is the founder of Bernard Health, a company that provides noncommissioned, expert advice on health, Medicare and COBRA insurance and medical bill consulting. To learn more about Bernard Health, visit www.bernardhealth.com.