Since the Patient Protection & Affordable Care Act, also referred to as “Obamacare”, was passed into law in 2010, this is a common question that has been on the minds of many Americans. While Selected Benefits only provides services for those who need Texas health insurance policies, the problem is certainly nationwide.
As the health insurance carriers have continued to lose money since the ACA was enacted, they have attempted to balance the losses by shrinking the networks of doctors and/or hospitals by offering more HMOs and EPOs. Many of the better physicians and hospital systems do not accept these plans since their reimbursement rates are much lower than with a PPO.
Fortunately, there is a solution. If you own your own company, have at least two employees (or two owners) and are structured in the proper way, meaning you have an actual entity such as a Partnership, LLC, C or S Corp, you are good to go. This can even work for a family that runs their business through an LLC. As long as the Husband/Wife are both Members of the LLC, the kids can be added as dependents on the plan and you have a small group. Now, not all Texas health insurance carriers will write a 2 person group plan, but we at Selected Benefits know the ones that will.
A small group health insurance plan is the easiest solution. Employer group insurance generally offers numerous PPO network choices as well as HMO and EPOs. The plans can be a little more expensive than an individual health policy, but the benefits will be far richer and you will regain access to those good PPO networks. Remember when your preferred doctors were actually “in-network”!
Quite a few of our clients have been converting from their current individual/family policy to a small group policy in 2016. As the networks have shrunk over the past 5 years, this has become a much more popular option.
As an example, our Houston health insurance clients did not have a single PPO plan they could purchase for 2016. Two very popular hospitals systems, MD Anderson Cancer Center and Texas Children’s Hospital, were excluded from the HMO/EPO networks. This leaves the client with a choice of either changing doctors or using a subpar facility in certain circumstances (such as cancer treatment). A small group health insurance policy linked to a PPO network would have solved this issue.
This is not a perfect solution in that some families with small businesses, who are insured through the Marketplace, would lose their federal subsidy by forming a small group plan. In this situation, the benefit of receiving a subsidy would normally outweigh the benefit of access to a PPO network.
If you purchased either a non-subsidized Marketplace policy or an “off exchange” policy, this strategy will work quite well as there are tax benefits by running the insurance through your business including the intangible benefit of being able to provide your eligible employees with solid coverage which enhances your employee retention and recruitment.
If you’re interested in exploring this route, please reach out to us at 866.270.6209 or fill out the Request Form for a Texas small group health insurance policy for your business.