Can’t Find a Plan on HealthCare.gov? One May Be Picked for You.
By: Robert Pear, NY Times, October 2016
WASHINGTON — The federal government will choose health plans for hundreds of thousands of consumers whose insurers have left the Affordable Care Act marketplace unless those people opt out of the law’s exchanges or select plans on their own, under a new policy to make sure consumers maintain coverage in 2017.
“Urgent: Your health coverage is at risk,” declares a sample “discontinuation notice,” drafted by the government for use by insurers. It tells consumers that “if you don’t enroll in a plan on your own, you may be automatically enrolled in the plan picked for you.”
That may make for a jarring start to the health law’s fourth annual open enrollment period, which starts Nov. 1, a week before Election Day, and runs through Jan. 31. While the administration says 20 million people have gained insurance through President Obama’s signature health law, it has suffered setbacks: Nonprofit health insurance co-ops created by the law have shut down; major health insurers have withdrawn from its marketplaces; and the ones that remain have raised premiums sharply.
Now, as the administration struggles to adjust to those changes, consumers may be surprised to learn that they have been placed in a health plan offered by a different insurance company, which is likely to have different doctors, benefits and drugs that are covered.
Consumers in discontinued plans will often receive a welcome kit from the new company, with a bill for the January 2017 premium.
“Without health coverage or an exemption,” the discontinuation notice says, “you may have to pay a penalty of $695 or more when you file your taxes.”
Assigning consumers to alternate plans, the Obama administration says, will protect them from coverage lapses. And, it notes, consumers are free to choose another plan if they do not like the one chosen for them. But the alternatives may be limited. In Maricopa County, Ariz., which includes Phoenix, the number of insurers in the public marketplace may drop to one, from eight this year.
Brett Barry, 51, of Phoenix, had coverage last year from a nonprofit co-op, Meritus, but it closed, forcing 59,000 Arizona residents to shop for another plan. Mr. Barry is covered now by UnitedHealth, one of the nation’s largest insurers, but he recently received a notice that it would no longer be available.
“It’s really frustrating,” Mr. Barry said. “The marketplace here is in a meltdown.”
UnitedHealth is pulling back from Affordable Care Act marketplaces, saying it has lost hundreds of millions of dollars.
Kevin J. Counihan, the chief executive of the federal insurance exchange, said the administration’s policy on automatic re-enrollment would promote “continuity of coverage and the availability of subsidies through the marketplace.”
“We expect most enrollees to actively select a qualified health plan via HealthCare.gov, as they have in prior years,” Mr. Counihan wrote in a letter to the Wisconsin insurance commissioner, Theodore K. Nickel.
Mr. Nickel objected to the federal policy, saying it could “sow chaos” and confusion among consumers, obliging them to pay for insurance chosen by the government. Consumers may be confused when they receive bills from a different insurance company, Mr. Nickel said.
Ben Wakana, a spokesman for the Department of Health and Human Services, said consumers would not be enrolled in any plans without their consent since they would generally have to pay the first month’s premium to activate coverage.
Federal officials say consumers should actively shop for a plan in the marketplace and update their income information so subsidies can be properly calculated. In the last open enrollment period, they said, 43 percent of consumers returning to HealthCare.gov switched plans.
Fighting for passage of the Affordable Care Act in 2009-10, President Obama promised that “if you like your health care plan, you can keep your health care plan.”
But that promise may be difficult to keep in 2017 as major insurers like Aetna, Humana and UnitedHealth leave the public marketplace in many counties and as most of the nonprofit co-ops have collapsed, leaving consumers with fewer choices.
In prior years, if consumers with marketplace coverage did not return to the exchange, they could be enrolled by default in the same plan or a similar plan from the same insurer. Next year, if consumers take no action and no plans are available from their current insurer, they can be placed in a plan from a different insurer.
In reassigning a consumer, the government will try to select a plan similar to the person’s current one, but that may not always be possible. Even if a similar plan is available, the insurance company may not have the ability to absorb all of the people being dropped by insurers leaving the market.
Accordingly, federal officials told insurers last month that they would not take enforcement action against health plans that could not meet certain customer-service standards because of a surge in enrollment in 2017. However, they said, health plans must still make reasonable efforts to address consumers’ complaints.
Blue Cross and Blue Shield of Minnesota is terminating health plans that cover 103,000 people. Those consumers can shop for coverage, but most of the other carriers are limiting enrollment for 2017. Medica, for example, says it will accept about 7,000 people, in addition to the 43,000 it now insures.
The limits were negotiated with Minnesota’s top insurance regulator, Commerce Commissioner Michael Rothman, who wanted to be sure carriers had the capacity to serve new customers.
Molly K. Eckley, 32, of Otter Tail County, Minn., said her family paid $1,100 a month for a Blue Cross and Blue Shield policy covering her, her husband and their two children, ages 5 and 8. With Blue Cross pulling out, she said, “I am scared for next year.”
Minnesota officials have approved rate increases averaging 50 percent or more for other insurers, and because of the enrollment caps, she said, she felt compelled to choose a plan as fast as possible, before insurers reached their capacity limits.
The Obama administration has developed two new tools to help consumers pick plans, but they will be available in only a few states, as part of a pilot project. Federal officials will try to determine the size of the networks of doctors and hospitals available through health plans in Maine, Ohio, Tennessee and Texas. Provider networks will be labeled “larger,” “smaller” or “medium.”
In a separate test, federal officials will assess the quality of health plans in Virginia and Wisconsin, using clinical data and surveys of patients. The quality ratings, on a five-star scale, will be displayed on HealthCare.gov.
