Wyoming renowned for it 3,500 square miles of Yellowstone National Park, is also home to diverse animal species, dramatic canyons, and alpine rivers. The state ranks 1st for least populated, 2nd for most sparsely populated and 10th in terms of area. Both these factors contribute to higher-than-average health insurance premiums that also leads to increasing number of uninsured rate in the state. Thus, when it comes to health and healthcare, Wyoming ranks low in the list and hence there is certainly room for improvement for this cowboy state. The uninsured rate in the state from the last few years is higher than the national average. Even the average individual health insurance premiums in the state are second-highest in the country in 2020, though it was calculated before premium subsidies were applied. Due to the high premiums in the state, the subsidies are large that allow people in many areas to get bronze and even gold plans at no charge. The state seems to have more conservative health insurance market and hasn’t embraced the Affordable Care Act and has also refused to expand Medicaid. The state does not run its own health insurance exchange and has opted for a federally facilitated exchange, so residents of Wyoming enroll in health insurance coverage using HealthCare.gov. For 2020 health insurance plans open enrollment period has ended and only residents with qualifying events can enroll or make changes in their coverage. Health insurance plans that will be effective in 2021, open enrollment period will commence from November 1, 2020.
Highlights & Updates On Wyoming Health Insurance Market
- Residents in Wyoming uses the federally facilitated marketplace, so they enroll through HealthCare.gov.
- Open enrollment period to enroll in health plans that will be effective in 2021 will begin from November 1, 2020.
- Wyoming has done least to preserve the Affordable Care Act’s provisions and its lawmakers generally opposed to the ACA along with Medicaid expansion.
- In Wyoming short-term health insurance plans are sold with initial terms of up to 364 days.
- Currently the state has only one insurance carrier in the state’s exchange i.e Blue Cross Blue Shield of Wyoming.
- Individuals health insurance rate has slightly increased in the year 2020.
The uninsured rate in the Wyoming is higher than the national average.
- Around 111,000 residents of Wyoming are enrolled in Medicare.
- Around 24,574 people enrolled in private plans through state’s exchange during the open enrollment period for 2020 coverage.
Individuals and Family Health Insurance Plans in Wyoming
Wyoming health insurance market has several individual and family health insurance plan offered either by participating private health insurance carriers or through HealthCare.gov, the federal exchange. Individual and family health insurance plans offered by private insurance companies offer the standardized essential benefits that are mandated by Affordable Care Act. However, individual health plans offered by private health insurance companies in Wyoming should meet some additional benefits too such as x-rays, diagnostic imaging, laboratory outpatient, clinical trials and diabetes care management. Different types of individual health insurance plans are available that are designed to meet diverse needs. Some plans restrict the choice of healthcare provider whereas some of the plans encouraged policyholders to avail healthcare from the in-network doctors, hospitals and pharmacies. Some plans also pay a greater share of cost for healthcare providers outside the plan’s network. Some of the individual and family health insurance plans available in Wyoming include:
PPO Plans – PPO or Preferred Provider Organization is a type of health plan having contracts with hospitals, pharmacies and healthcare providers to create a network. Individuals enrolled in this type of plan spend less amount on healthcare if visit in-network doctors and receive services from the plan’s network hospitals. PPO plans are preferred by individuals mainly due to freedom and flexibility, as they are free to see any in- or out-of-network doctor or specialist without any referral. Members of the PPO plan are not required to have a Primary Care Physician. The freedom and flexibility of PPO plans make these plans expensive compared to HMO plans. However, individuals enrolling in the PPO plans should be aware that these plans tend to have higher premiums and there is also a deductible and copay with these plans. While members of PPO plans are allowed to receive healthcare services from the out-of-network hospitals but the cost sharing is higher compared to using in-network doctors and hospitals. Individuals should also remember that no two PPO plans are same and their cost and coverage varies.
HMO Plans – Health Maintenance Organization is a health insurance plan offering a broader range of healthcare services through a network of healthcare providers like doctors, hospitals and pharmacies, who agree to provide medical services to members on a agreed upon rates. Members of HMO plans are required to choose a PCP or primary care physician, who take care of their needs and also provide a referral before visiting a specialist. Members of HMO plans have less flexibility in terms of doctors and hospitals choice and also have lower out-of-pocket health care expenses, as they are not required to pay a deductible before their coverage starts and also have minimal co-payments. Members of HMO plans won’t have to submit any of the insurance claims to the insurance company, as the healthcare provider will submit the claims on their behalf. Policyholders should also keep in mind that they will receive no coverage for the healthcare services which they received from non-network providers and for services that are received without a proper referral from their PCP.
EPO Plans – Exclusive Provider Organization or EPO is a managed care plan offering coverage for healthcare services received from the doctors, specialists, or hospitals within the plan’s network. However, members of EPO plan will not receive any coverage, if they visit doctor or hospital outside the network, except for the emergency coverage. EPO individual health insurance plans require members to select a primary care physician to receive preventive care as well as treatment for minor and chronic illnesses. EPO plan members do not need to get a referral from their PCP to visit a specialist. EPO plans come with lower monthly premiums, since members are restricted to receive healthcare from the in-network providers who have contracts with the insurance company. Individuals seeking insurance coverage with an EPO plan need to pay a monthly premium, which generally depends on the type of EPO pl they have and the area where they live.
POS Plans – A Point of Service or POS plan is a manged care health plan having qualities of both the HMO and PPO plans. Though plan’s benefits level vary depending on whether member receives medical care from in or out of the health insurance company’s network of providers. In POS plan, members just like HMO plan are required to designate a primary care physician to manage their health care and to provide referral when required to visit a specialist. However, POS plans have quite a small share of the health insurance market because most of the individuals either have HMO or PPO plans. In some of the POS plans healthcare services received from PCP are not subjected to a deductible and preventive care services are included in the plan. Members of POS plan just like a PPO plan are eligible to receive healthcare from non-network providers though they have to bear greater out-of-pocket costs. The plan members are also responsible to pay for co-payments, coinsurance and an annual deductible.
Indemnity or Fee-for-Service Plan – Fee-for-service plans members have freedom to choose any doctor and hospital of their choice and are liable to directly pay their healthcare bills and later on file the paperwork with their insurance carrier to avail reimbursement. Thus, indemnity plans are exceptionally convenient but at the same time expensive too. These are considered as the most expensive type of health insurance plan that individuals can purchase if they are not covered by their employers. Indemnity plans basic coverage includes the cost of doctor visits, hospitalization, surgery along with other medical expenses. When these benefits are over then the major-medical part or the policy takes over that covers the bulk of the medical bills in case if the policyholders have serious injury or a prolong illness. Thus, this plan protects the insured against hefty medical bills that climbs to exorbitant amount. However, like other health insurance plans, this plan also require members to pay deductible and co-payments for their medical services, which is based upon premium rates and plan coverage.
Short-term Health Insurance Plans in Wyoming
Wyoming on short-term health plans defaults to federal guidelines and does not have state-specific regulations for short-term plans. Earlier in 2018, short-term plans were not available for more than three months, as per federal regulations but Trump administration has relaxed those rules and now short-term plans are available for an initial duration of up to 364 days and renewals are permitted as long as the total duration of the coverage doesn’t exceed 36 months. Consumers in Wyoming has been warned by the insurance commissioner to carefully scrutinize the short-term plan they are considering to buy outside the HealthCare.gov. Consumers are advised to carefully read the plan details when shopping for short-term plans to understand that this is a temporary coverage and is quite different from the typical ACA-compliant coverage. People shopping for short-term plans should remember that these plans do not cover pre-existing medical conditions or several other benefits that are generally covered under more comprehensive plans. In Wyoming just like other states, short term plans do not guarantee renewal, so any conditions that insured develop while being on a short term plan may prevent them from renewing the plan or they may even be excluded from their plan.
Dental Insurance Plans in Wyoming
Different dental insurance plans in Wyoming are available that offer coverage on many dental care procedures like teeth cleanings, checkups, root canals, x-rays and more. Whether individuals are looking for the best, cheapest or preventive dental insurance plan, the good news is that the state has every type of dental insurance to provides coverage specific as per the needs of the people. In Wyoming, there are three types of dental insurance plans available:
Preferred Provider Organization Dental Plans – PPO dental plan members are required to visit the in-network dentists of the plan to receive any of the covered dental care. This plan has a specific network of participating dentists, who agree to render dental care services at pre-negotiated rates with the insurance company. This further helps to keep the costs down for the members of the plan. Though, members are allowed to go out-of-network dentists for a dental care but out-of-pocket costs will steeply increase for the members.
Indemnity – Indemnity or Fee-for-Service plans have no network of dentists so the members of the plan are free to visit any dentist of their choice. Though, members are free to visit any dentist but they will not be entirely covered. The dental insurance companies will only pay the Usual, Customary, and Reasonable amount, which means that when the dentist will claim for the reimbursement to the dental insurance companies, they will verify the dental care cost with their in-network dentist and will reimburse only that amount, which they would have charged for the same service. Members of the plan are responsible to pay the remaining amount to the dentist.
Dental Discount Plan – These are not dental insurance plan but members of dental discount are provided with a card in which several dental care services along with its discounted rates are given. Dental discount also maintain a network of dentists who agree to serve the members at a special discount rates. Members in order to receive the discounts on dental care cost should visit the in-network dentists. Members are liable to pay the dentist the amount specified in the card after receiving the dental care service. The best thing about this plan is that there is no billing and members are not required to fill out any form.
Vision Insurance in Wyoming
There are very few health insurance plans in Wyoming that offer vision insurance to adults. However, people need to ask their insurance adviser or search online to find a stand-alone vision insurance in Wyoming. Vision insurance is a type pf supplemental health insurance that is designed to manage the costs related with routine eye care like annual eye exams, eyeglass lenses, frames and contact lenses. Individuals having vision insurance will be provided a specified amount to purchase eyeglasses, contact lenses and to make payment for some eye exams. Some vision insurance plan may even provide discounts on refractive surgery.
Insurance Carrier in Wyoming
Blue Cross Blue Shield of Wyoming is the only health insurer carrier operating in the state’s exchange to offer coverage in 2020.