It’s official: we’re lowering rates by an average of 5.5 percent for 2020 Affordable Care Act (ACA) plans offered to individuals.
The North Carolina Department of Insurance has approved our reduction, making this is the second year in a row that we have decreased average rates for individual ACA members. Our average rate reduction for individual members totaled nearly 10 percent over the last two years. But it’s more than just a statewide average.
The individual market decrease will reduce consumer health care costs by $230 million in 2020 and is primarily due to our industry-leading shift to value-based care, marketplace expertise, greater stability, internal savings, our continued work with providers to improve quality and lower costs.
Today we made history: for the first time since we entered the current individual market more than 25 years ago, all 100 counties will see a decrease.
To help you understand this shift, we’ve put together answers to some of the most commonly asked questions
If your answer isn’t here, our customer service professionals are available to answer additional questions.
Will I see a 5.5 percent decrease in my premiums next year?
Not necessarily. The 5.5 percent reduction is an average for individuals. Regional rate decreases range from an average of -1 percent to -14.2 percent for the individual market. As always, rates vary based on location, age, and plan. And since the percentage changes we are presenting are changes to rates prior to subsidy, keep in mind that your share of premium subsidy (if you qualify for one) will be determined by the federal subsidy calculation – which changes each year. In some cases, a person’s change in premium after subsidy can increase even when the premium without subsidy has decreased.
Will some ACA customers see a rate increase in 2020?
Although most members will see a decrease in their rate (pre-subsidy), some may have a rate increase. Rates vary based on location, age, and plan. And for those who qualify for a subsidy, the yearly change in subsidy calculation will have an impact on the percent change in the amount of premium paid after subsidy. Individual premiums will be available in October.
Why is Blue Cross NC’s approved decrease of 5.5 percent different than its filed decrease of 5.2 percent?
Blue Cross NC was able to achieve an even lower rate than what it originally filed due to continued progress on provider collaboration.
How will ACA customers in the Triangle be impacted?
Last year, Blue Cross NC announced an agreement with UNC Health Alliance that made UNC Health Alliance Blue Cross NC’s in-network provider for the greater Triangle region. This agreement was the foundation for Blue Value with UNC Health Alliance and helped lower pre-subsidy costs by $140 a month in 2019.
Members in the Triangle will now have access to ‘Blue Home with UNC Health Alliance’ for 2020. ‘Blue Value with UNC Health Alliance’ will not be offered in 2020.
Through our work with UNC Health Alliance we will be reducing rates for Triangle customers by an average of more than $200 a year before subsidies, or an average of nearly $1,900 a year before subsidies for the last two years.
In 2020, Blue Home plans will be available in Wake, Johnston, Franklin, Lee, Chatham, Alamance, Orange, Durham, Caswell and Person counties.
What will be in-network for Blue Home with UNC Health Alliance?
Blue Home members will have access to the full UNC Health Alliance network.
The UNC Health Alliance network includes:
- More than 5,000 UNC Health Care and independent providers in 48 counties throughout the state of North Carolina.
- More than 850 primary care providers and 3,300 specialty providers.
- More than 500 locations in the 10-county region that Blue Home will be offered.
In-network hospitals: UNC Hospitals at Chapel Hill, UNC REX Healthcare in Raleigh, Chatham Hospital, Johnston Health Services, Pardee Memorial Hospital, Caldwell Memorial Hospital, UNC Lenoir Hospital, Nash Hospitals, Wayne Memorial Hospital, and UNC Rockingham Health Care.
Will coverage change for those with Blue Home?
More than 85 percent of the primary care and specialist providers who cared for Blue Value Triangle members in 2019 will remain in-network for 2020. Some non-UNC Health Alliance providers who were in-network with ‘Blue Value with UNC Health Alliance’ will no longer be in-network with Blue Home with UNC Health Alliance. In-network providers include the full UNC Health Alliance network, plus some additional providers, selected by Blue Cross to ensure members have access to the care they need.amount
We urge members to use the “Find a Doctor” tool beginning in October to see if their provider is still in-network.
How will ACA customers in the Triad be impacted?
Through a new arrangement with Wake Forest Baptist Health, Blue Cross NC will be able to reduce rates for individuals in the Triad by up to 40 percent – or $3,400 less a year before subsidies for individuals.
The decreases will be available through a new product called Blue Local with Wake Forest Baptist Health and could result in $60 million reduction premiums for the region.
Blue Advantage and Blue Value plans will continue to be offered, but those who stay with these plans will see a subsidy decrease due to the lower cost of the Blue Local product.
Blue Local will be available in Stokes, Yadkin, Forsyth, Davie, Davidson, Guilford, Randolph and Wilkes counties.
What will be in-network for Blue Local with Wake Forest Baptist Health?
Blue Local members will have access to a high-quality, coordinated network.
The Blue Local network consists of:
- Wake Forest Baptist Health, an academic medical center which includes
- Four community hospitals
- Brenner Children’s Hospital
- New leading-edge labor and delivery and high-risk infant care at The Birth Center and Dale & Karen Sisel NICU
- One of only 49 National Cancer Institute-designated comprehensive cancer centers in the country
- More than 300 primary care and specialty clinics
Beginning in October, the “Find a Doctor” tool can be used to see if your provider is in-network.
Will customers still be able to get premium subsidies from the federal government in 2019?
Yes. Federal tax credits, also known as premium subsidies are still available for customers with household incomes between 100 and 400 percent of the Federal Poverty Level. About 85 percent of our current customers with ACA plans qualify for subsidies this year. Subsidies vary by plan and household income.