ANOTHER important reason NOT to passively "auto-renew" this fall!!

Highmark canceling some ACA plans

Nov. 15--As a licensed health insurance agent, Sam Ross was used to seeing changes slipped into customers' plans during open enrollment season.

But he was surprised this month when he opened a letter from Highmark. The 60-year-old Southmont man discovered that his current plan, the Highmark Shared Cost Blue PPO 1000, which was eligible for premium tax credits on the Health Insurance Marketplace, was being discontinued -- and that he automatically would be enrolled in another plan not on the marketplace if he didn't take action before Dec. 15.

A Highmark representative said the company mailed letters to some customers -- though he wouldn't say how many or provide a list of plans being discontinued.

The company is "mapping" some customers on plans that are being discontinued into new plans, he said.

Factoring in the tax credit, the new plan would have cost Ross $481.02 more a month. It didn't come close to offering similar coverage, Ross said.

"It's not even comparable," he said.

"It's vastly inferior."

The new plan to offer family coverage for Ross and his wife, he said, included higher deductibles -- $5,000 more per individual and $10,000 more for family -- thousands higher in maximum out of pocket in-network, triple his current copays for primary care physician visits and 40 percent coinsurance.

Ross said he's shocked that he wasn't at least being rolled into another marketplace plan, where he could have taken advantage of premium tax credits, and he worries that consumers who don't pay attention to notices may find themselves in a financial bind when new policies take effect.

"I get it," he said. "(Highmark is) trying to find their way through a brave new world of healthcare. I don't understand, though, why Highmark wouldn't have automatically put me into an (Affordable Care Act) policy."

Let's step back a moment here.

The way that ACA exchange auto-renewals are supposed to work, as I understand it, is as follows: If someone currently enrolled in an ACA exchange-based policy fails to actively renew their policy (either sticking with the exact same policy or switching to a different one), then if that policy is still offered for 2016, they're supposed to be automatically renewed in it on or around December 17th (for most states) or around December 24th (for 4 states which have 12/23 enrollment deadlines).

However, for some people, their current policies won't be available next year. In some cases their insurance carrier may be dropping one particular policy. In other cases they may be dropping all PPO plans, or even pulling out of the individual market in that state altogether. In the case of a dozen ill-fated CO-OPs nationally and at least one private carrier in Wyoming, of course, they're going out of business altogether and therefore aren't in a position to offer any plans for 2016.

In those cases, the current enrollees are supposed to know to shop around on the exchanges to find a different plan--either via the same carrier or a different one. The new plan may be better or may be worse, but at least a) it's the one they choose, b) it's not gonna surprise them with sticker shock and c) assuming they qualify for tax credits/subsidies, they'll continue to receive them.

Unfortunately, in situations like the one laid out in the article above, some people who don't take action before December 15th may find themselves automatically enrolled not just in a policy they don't like, they may also find themselves being screwed out of the tax credits that they're eligible for because they'd be enrolled off-exchange.