For downstate NY self-employed business owners, tomorrow is indeed “Black Friday”…

For years, thousands of sole proprietors and freelancers (or “small groups of one”) in NY had specialized, lower cost health insurance plan options available to them (as compared to small group insurance, which covers 2-50 employees). Offered by Oxford Health Plans, these options included large in-network local provider access (Freedom and Liberty), national in-network provider access (United HealthCare), reimbursements for receiving out-of-network provider services, no referrals needed to see a specialist, and which were Health Savings Account (HSA)-qualified in some cases. Beginning tomorrow, the doorway leading to quality care for the self-employed will close to make way for the new individual high-risk pool markets, as defined by the Affordable Care Act (ACA).

Because the ACA defines sole proprietors as “individuals” starting in 2014, these sole proprietor plans will be considered “substandard”, and must be terminated under the new health care law. As such, the last opportunity to enroll in Oxford sole proprietor options is 12/1/13, with the application submission cutoff date being tomorrow. Beginning 1/1/14, these plans will be closed to new business, and all existing policyholders will have their plans terminated as of their renewal date next year. Once cancelled, sole proprietors will have no choice but to obtain coverage in the new individual markets created by the ACA.

As more and more people are becoming aware, the new individual markets feature health policies that only offer HMO-based options, with no access larger provider networks such as Oxford Freedom. Additionally, none of the new options offer national in-network coverage, nor do they offer reimbursements for services received from out-of-network providers. Moreover, in an effort to keep costs down due to the new Essential Health Benefits as mandated by the ACA, carriers are being forced to scale down their HMO networks (fewer doctors and hospitals to receive services from) as compared to their pre-ACA plans. So while some uninsured individual business owners will be able to take advantage of Advanced Premium Tax Credits to help foot the bill for a new ACA-compliant individual health plan (those living under 400% of the Federal Poverty Level), existing (pre-ACA) policyholders will see their access to quality health care providers diminish in 2014.

As an insurance broker in New York, it is a very sad day for me that I will no longer be referring to the attached benefits/rate sheet below. However on this Thanksgiving Day, I am very thankful that I was able to help so many business owners secure access to the quality care providers they needed over the years.

Oxford SP Plans – Q4/2013 Benefits & Rates