U.S. Says Consumers Must Renew Health Insurance Policies

The Obama administration began notifying consumers on Wednesday that they should return to the federal health insurance marketplace to renew coverage for next year.

In addition, the officials said, consumers should update information on their income and family size and should compare their current insurance with alternatives, which could offer better coverage at a lower cost.

Kevin J. Counihan, the chief executive of the federal marketplace, said the notices were being sent to 7.3 million people enrolled in health plans purchased through the exchange, HealthCare.gov, which serves three dozen states. Mr. Counihan, speaking at a conference of insurance executives and consumer advocates, outlined what he described as five easy steps for consumers.

“Step 1 — review your coverage,” Mr. Counihan said. “Plans change, people change. Step 2 — starting Nov. 15, log in and update your application. Make sure your household income and other information is up-to-date. Step 3 — compare your current plan with other plans that are available in your area. Step 4 — choose the health plan that best fits your budget and health needs. Step 5 — enroll.” The open enrollment period runs from Nov. 15 through Feb. 15. But, Mr. Counihan said, “for coverage starting Jan. 1, the consumer must enroll in a health plan by Dec. 15.”

Consumers who have already signed up and who take no action will, in most cases, have coverage automatically renewed in the same or similar health plans. Federal subsidies will also be the same, though premiums are likely to change, and consumers will not always be able to stay with their current doctors because health plans can change their provider networks.

“There is going to be a lot of confusion,” said Rachel Klein, director of the enrollment program at Families USA, a consumer group. But she said, “The uninsured want health insurance and will persevere to get it.”

Insurers expressed concern about consumers who choose to leave one health plan and sign up for another offered by a different insurance company. The federal government is not planning to send a notice to the first insurer terminating the consumer’s enrollment. As a result, consumers may receive bills or invoices from both companies. And conceivably, insurers said, if premiums are paid from bank accounts by electronic funds transfer, the money could be deducted twice.

Katie Dzurec-Dunton, the director of compliance and regulatory affairs at Maine Community Health Options, the state’s most popular plan on the exchange, said she worried that “we will get no notification of any kind” in these cases. Insurers will hesitate to shut off coverage for consumers if the companies do not receive explicit instructions to do so, she said. Mr. Counihan said the renewal process would work well for most consumers, but might not be “perfect for every enrollment transaction.”

Aaron Albright, a spokesman at the federal Centers for Medicare and Medicaid Services, said that insurers would not receive termination notices, but could assume that an individual’s coverage ends on Dec. 31 unless the insurer is told otherwise by the government. In late December, the federal marketplace will send enrollment files to insurers indicating whose coverage has been renewed for 2015.

Esther Krofah, a health-policy specialist at the National Governors Association, voiced another concern. “Consumers,” she said, “will receive multiple notices from the marketplace and insurers and will need to pay careful attention to the complex messages.” The notices could differ because enrollment records kept by insurers and the government differ in many particulars.

The Obama administration began notifying insurers this week of its preliminary decisions to approve health plans for sale in the federal marketplace this fall. But insurers cannot begin sending renewal notices to customers until they receive signed contracts from the government in November. This conflicts with rules and laws in some states, which require insurers to inform consumers two or three months before the renewals take effect on Jan. 1.

Paul D. Wingle, the exchange strategy chief at Aetna, asked federal officials how to reconcile the federal and state requirements. Michael Adelberg, a senior official at the Centers for Medicare and Medicaid Services, said that federal officials were in discussions with state insurance regulators and would probably issue guidance on the question.

Source Link