Beware of bad maps

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.