Just as a reminder for people who bought policies on the Exchanges for 2014 and plan to continue those policies in 2015 — please manually re-enroll at some point during the open enrollment period.
Healthcare.gov is preparing an automatic re-enrollment as te default mechanism. The default re-enrollment will be the same person going to the same exact plan that they had in 2014 for 2015. If that plan does not exist because the offering insurer is pulling the plan, the buyer will be defaulted into a similar plan from the same insurer. If the insurer is pulling out of the market, the individual will receive a nice e-mail telling them about the problem.
There are several significant problems with this default (there are always problems with defaults, it is a matter of choosing which ones to embrace and which ones to avoid).
The biggest problem is the subsidy level is not being automatically calculated and adjusted, so if your 2014 post-subsidy premium was $93 a month for Mayhew Silver Super Duper, and you default into Mayhew Silver Super Duper for 2015, your subsidy would be the same even if your income changes but your premium would now be $129.
The next big problem is also premium related. As Kaiser has pointed out, the cost of the 2nd lowest Silver which sets the subsidy benchmark is moving around all over the place. Subsidy values will change dramatically if you make no change. It is highly likely that the 2014 plan which was the second Silver is now the market’s 5th cheapest Silver, and the #7 2014 Silver is now the #2 Silver. Remember, 2014 was basically a beta test year. The cheapest Silver plans were often created by insurers that either had overly optimistic pricing models, or were deliberately engaged in loss-leader strategies to build membership. The three Rs of risk adjustment, reinsurance and risk corridors have insulated insurers from being overly optimistic and overly aggressive on pricing. So some insurers who had low 2014 enrollment will slash prices to get a bigger slice of membership for 2015 while overly optimistic insurers will raise prices.
Thirdly, incomes and circumstances change. People are supposed to report major qualifying life events as well as significant income changes to the Exchange in a timely manner but not everyone does. Subsidies and appropriate plan choices vary greatly if the assumed family size is five people while the actual covered family is four people.
Finally, we have good evidence from Medicare Part D that people often choose a plan in the first year that is not a really good fit for them and their circumstances. Medicare Part D has far fewer moving parts than major medical health insurance, so I am betting that even more people chose sub-satisfactory much less sub-optimal plans in 2014, and they want the chance to make another choice in 2015.
I implore any readers who are on the Exchanges to block out an hour or two this November and manually review what is available to you. You might be totally happy with what you have — if so, great. If not, make a new choice.
West of the Cascades
I’ve got this on my calendar, but am not clear whether CoverOregon will continue to be the exchange or whether Oregon has turned our exchange over to Healthcare.gov. I’ve seen conflicting stories.
CoverOregon was such an unmitigated disaster, but I was determined to enroll through it just to be a statistic … hoping whatever exchange is operating in Oregon this year is an improvement!
Keith G
My insurance provider is a community-based non-profit (in Houston TX) who will be running outreach programs for current and future customers during this first renewal process. They have been really good at maintaining contact during this first year. They thoroughly blow away the bromide that there must be a profit motive for things to work correctly.
MomSense
Thanks, Richard.
So my youngest was briefly enrolled in cub care for two months until my income changed at which point I reported the change to healthcare.gov and he was added to my plan and my subsidy decreased.
Well, months later I am still getting these letters and forms from cub care (MaineCare) asking me if he has primary insurance. I have spoken with them several times but I honestly cannot fill out the form they sent because it doesn’t have appropriate answers. I know that sounds strange but there is no way to indicate that I no longer have cub care for him and he is only covered by private insurance. If I fill out the form the way it is designed I would be keeping him enrolled in something for which he is not eligible. They also sent out this really misleading letter in the beginning saying that there were delays in receiving cards, and some people would no longer be eligible for MaineCare because of the ACA. They totally left out the part where the governor decided to make people ineligible and that the ACA would have helped them.
Oh well. I am going to call again today and try and straighten this out.
cosima
Thanks for the information. Living overseas with NHS and as local hires we’ve had to purchase insurance for our daughter, soon to be 24, through the plans offered in her R state that did not opt into the expansion. Expensive, but not as expensive as the COBRA plan that we had her on. Now, though, she has just graduated from uni, and is moving to Vermont to be with her BF where he is attending law school. We are very excited about the prospect of lower premium! So, if anyone here has experience with Vermont’s program &/or insurers, I’d really appreciate hearing about it.
For now, though, will add it to the electronic calendar so that we can discuss with her when she comes to visit for a few months.
currants
@cosima: Don’t know about VT’s programs/insurers but they have an EXCELLENT community health system.
JaneE
Thank you for making people aware of all the things they need to consider when renewing insurance. One of my friends has prescription coverage through AARP, selected a coverage level that kept their out of pocket costs fairly low, bought the policy several years ago, and has been renewing it ever since. Last year most of the medications they take went off patent, and they now receive the generic versions. What was a good policy that kept them from paying an arm and a leg is now a clunker. Their total out of pocket costs, even without a co-pay, are now less than their premiums, and they will be looking at the other options when it is time to renew.
Linnaeus
I’m thinking of upgrading. I could only afford a bronze plan at first, but I’ve been using my insurance more than I expected to and my out-of-pocket costs keep growing.
Santa Fe
Thanks Richard! Bookmarking this, as way of reminder. Hopefully I made a smart choice going with BCBS Silver here in New Mexico, and won’t have much pain with the re-enrollment. I purchased the plan early this year, but I guess I don’t get a full year before I need to re-enroll.