Marketplace enrollees may discover that their health coverage for 2017 differs dramatically from their 2016 plans. An estimated 2 million people who enroll using state and federal health insurance exchange sites will be forced to choose new coverage for next year. This is due to several major and minor insurance providers dropping out of the exchanges. United Healthcare, Humana and Aetna — three major national insurers — have already announced that they will not be participating in many or all of the markets where they currently offer coverage. In some states, smaller issuers have also dropped out, citing financial loss as the primary motivator.
Under the Affordable Care Act, consumers have the option to let their health plans “auto renew,” which essentially means that a person’s health insurance coverage will simply renew each year unless changes are made. During open enrollment each year, enrollees can also make changes or sign up for a new health plan altogether. Unfortunately, many consumers allow their plans to renew automatically.
Auto renewal can be a risky option since health plans change from year to year. In a competitive marketplace, health insurers offer newer plans with better features. Consumers who shop for coverage are more likely to find a better deal in terms of plan benefits and monthly premiums. For 2017, shopping for coverage is not only beneficial but essential for some consumers. With several major providers bowing out of the marketplaces, enrollees could find themselves forced into different plans, a situation known as “health plan mapping.”
Plan mapping occurs when a carrier moves an enrollee to a similar plan because the person’s current plan has been discontinued. It’s not a new practice, but it has become more common thanks to the competitive nature of a post-ACA insurance market. When carriers innovate or update their plans from year to year, they simply map enrollees to a similar policy if those enrollees allow their plans to auto renew.
The practice itself isn’t necessarily a bad thing, but for some consumers, plan mapping may mean a higher monthly premium, a narrower network or different health care options. Next year, the marketplace may look very different due to the absence of major insurers like Aetna and United Healthcare. People who have plans with insurers that have cut ties with the exchange sites will be forced to choose a new policy — or have it chosen for them.
Under the Notice of Benefit and Payment Parameters for 2017 issued by the Department of Health and Human Services (HHS), the exchange sites will determine health insurance coverage for anyone whose plan no longer exists provided that the enrollee doesn’t come back to the site to select a plan. In other words, if you have a plan with one of the carriers that isn’t participating in the exchanges and you don’t choose a new plan during open enrollment, then the exchange site will choose one for you.
The wording used by the HHS makes it clear that the exchange site will do its best to find similar health plans, but this is no guarantee that a consumer will have comparable coverage — or a comparable monthly premium. In some instances, enrollees may be mapped onto different carriers entirely, which could impact network and availability. Prior to 2017, mapping consumers onto a different carrier was not allowed. This has changed for next year.
ACASignUps.net estimates that about 2 million exchange enrollees will be affected by insurer dropouts in 2017, most of whom have plans with United Healthcare and Aetna. Open enrollment begins Nov. 1 and runs through Jan. 31, 2017. Shopping for a new plan can result in lower premiums or better features. Consumers are encouraged to check the status of their health plans and browse for new coverage next year.
Resources:
http://acasignups.net/16/08/29/update-x2-ok-how-many-people-will-have-shop-around-fall
https://www.healthinsurance.org/obamacare/how-to-avoid-the-surprise-of-health-plan-mapping/