I was getting my pre-professor start hair cut this afternoon. The place I go to plays an urban radio station for background noise. It is usually good background noise but an insurance broker ad really perked my interest. I am going to paraphrase it:
“Do you want free health insurance and a $500 cash card? If you are not on Medicare/Medicaid, earn under $50,000 and are under age 65, call XXX-867-5309 and our agents will check your zip code to see if you qualify for free health insurance and a cash card you can use to pay rent, or groceries or your cell bill…..”
This is an ACA pitch. The criteria of age, income and no other qualified coverage are the give-aways.
Zero premium plans are wicked common in the ACA with the ARPA/IRA enhanced subsidies. The two least expensive Silver plans are zero premium up to 150% Federal Poverty Level (~$22,000 for a single individual) and Bronze plans are typically zero premium well into the 200s and sometimes 300% FPL. Many insurers can plausibly offer zero premium Bronze plans. Typically we assume that marginal enrollees are picking only on price, but there is no price differentiation. These plans will not be substantially differentiated on benefits as the Max Out of Pockets Limits will be $7000 to $9000. Networks will differ but good networks will be attractive to individuals that risk adjust poorly so there is a strong incentive to race to the bottom. A cash card is effectively a price differentiation feature as it effectively makes a zero premium plan a negative premium plan if people know about it.
So I have a lot of questions.
The first one is how common are these cash cards?
If you have heard of an ad that sounds like a cash card for an ACA plan, can you put it into comments with a rough date and city or county and state.
This is interestingly weird. And on first thought, likely dumb.
Frank Wilhoit
My wife and I have a Medicare Advantage plan. She got it long ago because she got SSD; her experience with it has always been excellent, so I signed up when I turned 65. It is a 0-premium plan.
This year, out of nowhere, they sent us each a $1000 prepaid Visa usable for vision and hearing services, any remaining balance forfeit at EOY. I must think that if all of their customers used these to the full, the insurer would suffer a serious loss. I’d bet — maybe not the whole nickel, but three cents — that they will not do this next year. We’ll see.
Brian Blase
we just did a paper on this: Unpacking The Great Obamacare Enrollment Fraud: How the Exchanges Became the Wild West (paragoninstitute.org)
Brian Blase
Unpacking The Great Obamacare Enrollment Fraud: How the Exchanges Became the Wild West (paragoninstitute.org)
lollipopguild
I have not heard the FREE cash card ad but I have heard ads(louisville,Ky) that promise FREE groceries! The ads I heard 2-3 years ago promised NO MONTHLY premium! The monthly premium would be added back into your Social Security check.
David Anderson
@Frank Wilhoit: Restricted cards to vision/dental make sense as it allows an insurer to offer a vision/dental service without the pain of creating/managing a network and paying claims.
Yutsano
Nice touch Mayhew.
I haven’t heard anything like this, but the IRS brain in me is screaming “DANGER WILL ROBINSON!!!”. I’m not sure why, but something does sound hinky.
artem1s
My brother and SIL both have some sort of extra cash card for groceries, etc on their Medicaid. Both are over 65 and started taking SS before they maxed out their payout (brother retired before 65, SIL started SS at 66-10mos). This is Ohio.
Anonymous At Work
Are zero deductible plans “wicked common” outside the Boston area?
*Third time today, in South Florida, someone used “wicked” that way to me…
TBone
I am under 65 and on a zero premium plan chosen on our state’s (PA) exchange. Have never been offered any such swag or even heard any ads for it.
Are the insurance companies getting more cash from the government for each enrollee than they are expending paying claims? (Brian’s link indicates that’s the case). Seems like a no brainer, incentive-wise. But a really crappy way to run things.
Instead of a gift card, why don’t they just cover vision and dental?
TBone
@Brian Blase: thanks for sharing.
stacib
I’m in Chicago, and I hear these ads all the time. Additionally, since I’m turning 65 this year, I’m being bombarded with offers from insurers. I’ll pay more attention and let you know.
Frank Wilhoit
@David Anderson: Quite so, but a grand a head? Where is it coming from?