Dr. Brenda Ernest is searching for new medical insurance after carrying a policy for 27 years with the American Veterinary Medical Association's Group Health and Life Insurance Trust (AVMA GHLIT).

The 55-year-old veterinarian from Temple Terrace, Fla., is one of 17,000 or so veterinarians and their families impacted by federal health care reforms that force associations to open medical coverage to the general public, not just association members. The prospect of doing that has caused New York Life Insurance, the GHLIT's longtime underwriter of its medical insurance offerings, to terminate its medical coverage with GHLIT after Dec. 31.

GHLIT officials looked into switching underwriters but couldn't find one, mainly because companies are exiting the association business.

Now Ernest is struggling to find alternate coverage by Jan. 1, 2014, and discouraged by unexpected hurdles to landing a new policy. In a discussion on the Veterinary Information Network, an online community for the profession, she explained that her weight is five pounds over the limit imposed by most health insurance plans, which disqualifies her even though she has no major medical issues.

“I paid in (to GHLIT) all this time, and now I need insurance and I can’t get it,” she said.

Many of her colleagues could face the same situation. The GHLIT reports that approximately 17,000 medical policies were in place as of March 31. That figure represents a gradual decline from years past, likely sparked by correspondence between GHLIT officials and policyholders informing them that they would soon need to seek medical insurance elsewhere.

(The GHLIT's other insurance programs, such as disability and life insurance policies, will continue unchanged.)

GHLIT officials urge veterinarians to keep their current medical insurance policies until the Jan. 1 expiration date. To assist members in securing medical coverage for 2014, the GHLIT has created a private insurance exchange designed to provide member veterinarians with an online marketplace to compare and buy health insurance policies, much like the state-based exchanges that are slated to open this fall as part of the Patient Protection and Affordable Care Act, or PPACA.

The first phase of the AVMA GHLIT C.A.R.E. Insurance Exchange/Marketplace launched in March and promoted Medicare products for members aged 65 years and older. Phase two of the project was completed last month, opening the exchange to all AVMA members.

AVMA members can peruse 2013 medical plans on the GHLIT exchange for now. Veterinarians can't start buying 2014 medical insurance on the exchange until Oct. 1, when state-based exchanges are slated to open to the public.

However, veterinarians who qualify for Medicare already may purchase plans through the new GHLIT marketplace. GHLIT CEO Libby Wallace counts 120 enrollees so far. She expects more veterinarians will show an interest as the first of the year approaches. She explained that any changes members make to a GHLIT medical plan before it expires on Dec. 31 would require new medical insurance underwriting and force the policyholder to start over with new annual deductibles.

Despite the changes, pockets of the profession will continue to not have access to policies the GHLIT offers, even on its exchange. For veterinarians such as Dr. Amanda Rizner, looking for coverage outside of AVMA is nothing new. That's because a handful of states — Rizner's home state of Maine included — do not allow the AVMA GHLIT to offer insurance to its residents. One caveat: If a GHLIT policyholder moved to such a state (ex. Massachusetts, North Dakota, New Hampshire, Vermont or Washington), he or she would be permitted to retain the policy.

Rizner, president of the Maine Veterinary Medical Association, said she received an email stating the AVMA private exchange was up and running but couldn’t find any products offered in her area. She also hasn’t had luck purchasing disability and life insurance products through GHLIT.

The lack of resources available to her through AVMA is frustrating, she said. “When I started looking to open my own practice, I contacted AVMA insurance brokerages, and there were no options available to me."

Rizner suffers from fibromyalgia and rheumatoid arthritis, making health coverage necessary and expensive. She pays roughly $800 a month.

“We just have to suck it up,” she said.

The GHLIT's Wallace sympathizes and anticipates that geographical coverage will get better. “Unfortunately, some of the same issues that precluded us from offering medical policies in Maine still exist,” she said. “We are hopeful that we can add an insurance carrier who offers individual medical coverage in Maine to our private insurance exchange.”

AVMA officials have an incentive to be inclusive. GHLIT leaders told the AVMA House of Delegates in July that while the trust is financially stable, its future is uncertain due to the loss of premiums tied to terminating the traditional medical insurance programs. Some also wonder whether AVMA will lose members once the GHLIT's brand of medical insurance ends, given that AVMA membership is required to access GHLIT programs.

“Other than disability insurance now, I don’t really see any benefit to belonging to the AVMA,” said Ernest, the practice owner in Florida. “I just don’t know where I’m going to get insurance now and what it’s going to cost.”

Wallace says that despite such uncertainties, the ability to purchase insurance through GHLIT is advantageous to members. GHLIT, in addition to offering medical insurance via its exchange, will continue to provide customized disability and life insurance, hospital indemnity plans as well as dental and vision coverage to AVMA members.

She adds that it's worth exploring the GHLIT medical insurance exchange. To veterinarians holding out for the public state or federal insurance exchanges set to open in October, Wallace warns that families earning more than 400 percent above 2013 poverty guidelines will not qualify for certain tax advantages that otherwise would make participation in public exchanges economically beneficial.

That's not to say veterinarians will receive special discounts through the GHLIT's marketplace. What they'll get, Wallace says, is customer service.

“By utilizing the GHLIT insurance exchange/marketplace, veterinarians can see alternative plans available in their geographic area," she said. Users also will have "the advantage of a live chat online or a live customer service person available.

“And they can continue to work with their GHLIT insurance agent if they would like to. In addition, members will be able to purchase other non-medical insurance products from the exchange. So it really creates a one-stop shopping experience," she added.