New Mexico: You Snooze, You Lose: NM Residents who didn't sign up early just missed a shot at extra savings.
Insurers That Filed Wrong Rates Told By CMS They Can't Sell Plans Through Mid-November
An issuer whose final CMS-approved rates don’t account for the loss of cost-sharing reduction payments is being told by the agency that they won’t be able to sell plans until healthcare.gov data is refreshed– even though this would mean the carriers are even more crunched for time to sell their plans during the shortened open enrollment period.
Insurers are being told rates will be “suppressed and not able to be viewed or purchased” until that refresh is completed, officials said according to an email obtained by Inside Health Policy. Originally CCIIO told plans they would have to wait until the end of November for the refresh, but according to one source officials will move that date up to the middle of the month instead. But an agency official said these plans have no recourse. “CMS provided a limited data correction period this year to give issuers an opportunity to submit updates to final rate filings. Plans will not have additional recourse to change rate filings,” the official told IHP.
As Wesley Sanders later tipped me off, to the best of my knowledge, this situation is only impacting a single insurance carrier (Christus) in a single state (New Mexico):
ATTENTION CHRISTUS HEALTH PLAN MEMBERS:
Due to a technical error with CMS, CHRISTUS Health Plan’s Health Insurance Exchange plans in New Mexico may not currently appear on healthcare.gov. We are actively working with CMS to resolve the issue. If you have any questions, please feel free to contact the CHRISTUS Health Plan Customer Service Department at 844-282-3025.
As I noted at the time, this is causing a lot of confusion for NM residents, not just in terms of their options but also regarding how much they'll qualify for in tax credits:
So what is this gonna mean? Well...I'm not sure.
For one thing, it means that from 11/01 - 11/15, a bunch of people will shop around without seeing some options which will pop up on HC.gov after the 15th.
For another, it could play havoc with the benchmark plan pricing, which in turn could potentially make a mess out of the Advance Premium Tax Credit (APTC) subsidy formula.
For instance, let's say that the following Silver plans are available in a given market:
- Carrier A: $300
- Carrier B: $325
- Carrier C: $350
- Carrier D: $375
In this lineup, Carrier B is the 2nd lowest-cost Silver plan, so it's the benchmark plan, and everyone's subsidies in that rating area will be based on it.
However, what if Carrier B is one of the companies which had to scramble to refile at the last minute? What if the CSR-loaded premium for Carrier B's Silver plan is, say, $360?
In that case, Carrier C now has the 2nd lowest-cost Silver at $350...which means that everyone's subsidies is higher (preumably to the tune of $25/month or $300/year). Plus, anyone who was less than $300 over the 400% FPL APTC income threshold will suddenly be eligible after all...and that could mean up to several thousand dollars in savings!
OK, great...but is the benchmark plan during the first two weeks going to be based on the $325 rate or the $350 rate? The $325 plan isn't technically listed/available, so it technically isn't the "2nd lowest-cost Silver plan available"...but then what happens after 11/15? Does the benchmark plan stay at $350, or does it nudge up a bit more to $360? If so, that presumably means subsidized enrollees end up with another $10/month in APTC, or an extra $120 for the year, right?
For that matter, what if Carrier B only adds a small CSR load...instead of repricing their plan at $360, they price it at $340? Now it's still the 2nd lowest-priced Silver plan, and it's available after 11/15, meaning the APTC formula dropsslightly (from $350 to $340), costing everyone $10/month.
Either way, what does that mean for someone who selects their exchange policy during the first two weeks? Will they receive the pre-11/15 APTC or the post-11/15 APTC amount?
...and so on.
Well, it turns out that sure enough, Christus does have the benchmark Silver plan in at least some areas of New Mexico. Since the Christus plans were "suppressed" until last night, a different benchmark Silver plan was used to calculate tax credits. Since the other benchmark is priced higher, that means anyone who qualifies for tax credits in those regions was given a substantial boost in financial assistance.
However, it now appears that Christus' lower rates have been added to the NM exchange...which, indeed (according to Ken Krasity via Facebook) appears to already be lowering the APTC calculations for subsidized enrollees who sign up starting today:
NM folks just missed their chance for uber-uber-cheap policies. Christus re-entered the exchange last night, with its cheaper Silver replacing the more expensive Molina silver plan as the benchmark thereby reducing advanced premium tax credits a lot. My credits dropped $190/mo overnight, but fortunately I'd already signed up and locked in the higher credits.
Ouch. That's $2,280 in potential tax credits lost for New Mexico residents who failed to sign up before midnight last night...
The problem here is that I still have no idea what will actually happen to anyone who did enroll in the first 18 days. Are their higher subsidies locked in contractually? Or will they be subject to a bait 'n switch by the federal government, seeing their tax credits plummet after all?
The closest thing to an answer on this was provided by Emily Gee of the Center for American Progress, who found this official CMS bulletin from last year ("SLCSP" = "Second Lowest-Cost Silver Plan"...aka the Benchmark Plan):
— Emily Gee (@EmilyG_DC) November 1, 2017
7. At what point in time is the SLCSP determined?
The SLCSP is determined at the time of enrollment, and only plans that are available to the tax household are considered in the SLCSP determination. As an example, a plan under an enrollment freeze, or in a “suppressed” status, is only included in the SLCSP determination for families to whom the plan is available, such as because they are renewing coverage in that plan. If the lowest cost silver plan or SLCSP for a tax household becomes decertified or closed to new enrollment after a family enrolls, the SLCSP for that tax household is not re-determined unless the tax household completes a new enrollment, such as during a Special Enrollment Period.
If I'm reading this correct, this is good news for anyone who enrolled before midnight yesterday...but bad (or at least disappointing) news for anyone who's enrolling from today forward.
So how many people grabbed several thousand dollars in extra savings, and how many are gonna lose out on it?
Well, to the best of my estimates, I figure roughly 8,322 New Mexico residents enrolled as of 11/11, and probably around 13,000 as of last night. Assuming the vast majority of them qualify for tax credits at all, that's perhaps 12,000 who grabbed the "No-Christus" bonus APTC assistance while they could.
As for how many more will enroll between now and December 15th, that's entirely unknown, of course, but last year around 54,000 New Mexico residents enrolled total, of which around 39,000 received tax credits. Since I'm assuming a lower total number but a higher percent receiving credits, I figure around 42,000 total subsidized enrollees, which means around 30,000 should receive some assistance...but lose out on the "bonus" financial help available prior to today.