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You are here: Home / Anderson On Health Insurance / Beware of bad maps

Beware of bad maps

by David Anderson|  November 17, 20156:51 am| 9 Comments

This post is in: Anderson On Health Insurance, Jump! You Fuckers!

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Insurers routinely discontinue plans.  For instance Mayhew Insurance filed five distinct networks for the Exchanges.  We had a network/plan design combination which we sold literally dozens of policies.  It was overpriced for a relatively narrow and restrictive product.  So we dumped that combination for 2016.  The dozens of people were told at least ninety days before open enrollment that their plan was being dropped and that a similar, slightly broader network and less restrictive  Mayhew Insurance product would be their default auto-enrollment option.

This is common.  Insurers are allowed to map their members to similar products if the original policy is being dropped.  This is also a point of awareness as some times the mapping leads to extremely painful default outcomes.  There was a recent article with a good example of this problem:

The 60-year-old Southmont man discovered that his current plan, the Highmark Shared Cost Blue PPO 1000, which was eligible for premium tax credits on the Health Insurance Marketplace, was being discontinued — and that he automatically would be enrolled in another plan not on the marketplace if he didn’t take action before Dec. 15….

The company is “mapping” some customers on plans that are being discontinued into new plans, he said.

Factoring in the tax credit, the new plan would have cost Ross $481.02 more a month. It didn’t come close to offering similar coverage, Ross said.

“It’s not even comparable,” he said.

“It’s vastly inferior.”

The new plan to offer family coverage for Ross and his wife, he said, included higher deductibles — $5,000 more per individual and $10,000 more for family — thousands higher in maximum out of pocket in-network, triple his current copays for primary care physician visits and 40 percent coinsurance.

Ross said he’s shocked that he wasn’t at least being rolled into another marketplace plan, where he could have taken advantage of premium tax credits [my emphasis]

The original plan looks to be a narrow network Gold plan.  Given the $6,000 deductible and even higher out of pocket maximum, the mapped plan probably is a Bronze plan.

And since the plan is listed as an Off-Exchange plan, the plan does not have any advanced premium tax credits to reduce the high monthly premiums.

This is a travesty.

CMS, the federal regulating entity needs to improve the regulation on how mapping can occur.  The principle should be the mapped default auto-renewal plan option should be substantially similar to the current plan.  The following criteria should be met as substantially similar:

  1. If On exchange, the mappped plan must be on-exchange if any On-exchange plan is available.
  2. If Off-exchange, the mapped plan should be on-exchange if possible
  3. The same actuarial value band shall be chosen if possible.
  4. If not possible, the default shall be one band higher unless platinum, and then it shall be gold.
  5. Network shall be no smaller if possible.  If all remaining mappable networks are smaller, then choose the broadest remaining network that meet the above criteria.
  6. Members shall be notified in writing of the significant changes in plans
  7. Members who are mapped to plans that fail to meet the above criteria shall have their information passed to CMS/Healthcare.gov for targeted outreach and navigation assistance.

Do that and the mapping effort won’t be an attempt to drive sick people off of high actuarial value coverage plans.

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9Comments

  1. 1.

    Pseudonymous Bosch

    November 17, 2015 at 7:46 am

    [T]he [mapped] plan does have any advanced premium tax credits to reduce the high monthly premiums.

    Why would the insurance company do this? The premium support really puts money in their pocket. Looks to me like they are intentionally trying to make him move companies.

  2. 2.

    richard mayhew

    November 17, 2015 at 7:59 am

    @Pseudonymous Bosch: bingo

  3. 3.

    dr. luba

    November 17, 2015 at 10:58 am

    Insurance companies accidentally sticking you with higher premiums and profiting by their “mistakes”? Color me surprised.

    I’ve had my insurance plan cancelled annually since the ACA went into effect. I can only assume I am too good at choosing plans, and pick the best value ones which prove unprofitable for the insurer in the long run.

    Last year I chose a different plan from the one suggested. This year I compared plans, and the suggested one was the best value, but I still had to go through the HSA website to sign up. Last year I tried to sign up through the insurance company instead, since I don’t get a subsidy, only to have a cascade of troubles……

  4. 4.

    smintheus

    November 17, 2015 at 11:31 am

    Whatever Highmark’s motives, this looks like a case of out and out fraud. What is the chance they’ll be prosecuted?

  5. 5.

    richard mayhew

    November 17, 2015 at 12:20 pm

    @smintheus: Call the AG’s office, I don’t know Pennsylvania well enough to give you a probability assessment

  6. 6.

    Mnemosyne (iPhone)

    November 17, 2015 at 1:33 pm

    This kind of stuff is why I keep urging people to file complaints with both their state consumer affairs department and with HHS rather than shrugging it off as, “Obamacare sucks.” If state and federal regulators don’t know insurance companies are playing these games, they can’t do anything to stop them. So be the squeaky wheel!

  7. 7.

    ACTSCI

    November 17, 2015 at 5:37 pm

    Actually, HHS does have the regulation enforcing the Plan Crosswalks. As indicated in the Letter to Issuers, they must follow 45 CFR 155.335(j)(2).

  8. 8.

    J R in WV

    November 17, 2015 at 6:45 pm

    @richard mayhew:

    The Pennsylvania AG has had her law license suspended, is perhaps going to lose her office, and is fighting back by releasing emails between highly ranked state employees which are extremely embarrassing, to put it mildly.

    Judge upholds perjury charge

    She’s also started divorce proceedings against her spouse of 14 years.

    This doesn’t mean that people in her office aren’t doing their jobs, of course, only that major cases are probably going to take a while.

    ETA: getting that link right the first time wasn’t easy as the “link” button only did about half of what was needed. I don’t type HTML every day, and so had to look it up. Google is my friend!

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Trackbacks

  1. Balloon Juice | More on mapping says:
    November 18, 2015 at 8:21 am

    […] yesterday’s post concerning a very odd mapping of an auto-renewal option from what looked like a Gold plan to a […]

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