Department of Health and Human Services, June 19, 2014
This proposed rule would specify additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, beginning with annual redeterminations for coverage for plan year 2015.
In paragraph (j)(1), we propose that if an enrollee remains eligible for enrollment in a QHP through the Exchange upon annual redetermination, and the product under which the QHP in which he or she was enrolled remains available for renewal, consistent with 45 CFR Ā§147.106, such enrollee will have his or her enrollment in a QHP under the product renewed unless he or she terminates coverage, including termination of coverage in connection with voluntarily selecting a different QHP, in accordance with Ā§155.430. In this situation, we propose that the QHP in which the enrollee will be renewed will be selected according to the following order of priority: first, in the same plan as the enrolleeās current QHP, unless the current QHP is not available; second, if the enrolleeās current QHP is not available, the enrolleeās coverage will be renewed in a plan at the same metal level as the enrolleeās current QHP; third, if the enrolleeās current QHP is not available and the enrolleeās product no longer includes a plan at the same metal level as the enrolleeās current QHP, the enrolleeās coverage will be renewed in a plan that is one metal level higher or lower than the enrolleeās current QHP; and fourth, if the enrolleeās current QHP is not available and the enrolleeās product no longer includes a plan that is at the same metal level as, or one metal level higher or lower than the enrolleeās current QHP, the enrolleeās coverage will be renewed in any other plan offered under the product in which the enrolleeās current QHP is offered in which the enrollee is eligible to enroll.
http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/508_CMS-9941-P-OFRv-6-26-14.pdf
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Exchange Plan Renewals: Many Consumers Face Sizeable Premium Increases in 2015 Unless They Switch Plans
By Elizabeth Carpenter
Avalere, June 26, 2014
Under the Affordable Care Act, federal premium assistance is tied to the second lowest cost silver plan (ābenchmark planā) in a given region. Subsidized exchange enrollees who select a more expensive plan must pay the differenceādollar for dollarābetween the benchmark plan premium and their selection. In six of nine states analyzed by Avalere, the 2014 benchmark silver plan will lose benchmark status in 2015. Further, in seven of the nine states, the lowest cost silver plan will also change in 2015.
āMost enrollees in 2014 chose a plan based on the monthly premium. However, the lowest cost plans in 2014 may no longer be low cost in 2015,ā said Elizabeth Carpenter, director at Avalere Health. āBefore consumers renew their 2014 plan, they should consider the tradeoff between continuity of care and lower monthly premiums.ā
āTwo-thirds of people enrolling in silver plans are choosing one of the two lowest cost silver options,ā said Caroline Pearson, vice president at Avalere. āThe competitive landscape for plans is changing in 2015. However, the premium subsidies are tied to the benchmark plan and a percentage of income. Consumers have to pay the difference if they enroll in a plan more expensive than the benchmark. Those receiving federal premium subsidies may need to switch plans in 2015 to avoid paying more than the limits established by the ACA, and the impact will be more profound for lower-income consumers.ā
http://www.avalerehealth.net/expertise/managed-care/insights/exchange-plan-renewals-many-consumers-face-sizeable-premium-increases-in-20
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Comment:
By Don McCanne, MD
Acknowledging the complexity of the administration of the exchanges under the Affordable Care Act, HHS has decided to simplify the process by making renewal of plan enrollment automatic unless the enrollee decides on a different option. It is estimated that about 95 percent of enrollees will qualify for automatic renewal, and undoubtedly many will passively accept this hassle-free option. That may not be a wise choice.
The Avalere report indicates that the benchmark silver tier plan – the plan with the second lowest premium in the silver tier – will change in many of the exchanges since premium bids are changing for most plans. Since the enrollee is responsible for the full balance of the premium above the benchmark plan, net premiums for the enrollees could increase significantly unless the person opted to change to next yearās benchmark plan or a plan close to it.
As Avalere director Elizabeth Carpenter states, ā(consumers) should consider the tradeoff between continuity of care and lower monthly premiums.ā This means that those current enrollees who do not passively accept higher premiums will be forced to choose between higher premiums or a change in their narrow provider networks, the latter likely resulting in disruption of continuity of care.
Further, according to the HHS rule, the individual could be transferred to a different metal tier, thereby losing eligibility for the subsidies for cost sharing, though that would likely occur only in exchanges that have few choices.
Even something as simple as āautomatic renewalā becomes complex when you try to rely on market dynamics to satisfy private insurers. Imagine if at renewal time you didnāt have to make a decision on what premiums you could afford, or on what provider networks you would choose when none of them quite fit, or where you might fall based on subsidy eligibility redetermination.
Imagine instead if the concept of renewal did not even exist – you were simply automatically enrolled for life. We really do need to replace this boondoggle with a single payer national health program – quality health care for everyone at a price we can afford.