Monday, December 22, 2014

Anticipated Government Tricks

This particular story has been making the rounds lately:

"New rules being proposed by the Centers for Medicare and Medicaid Services will give that agency enormous new powers ... the government will choose and force you to pay for a policy that they think works best for you."

At issue is the fact that many (most?) folks who use the Exchange are going solo, or relying on the "expertise" and/or good will of the anonymous folks on the other end of the phone line. So when renewal time rolls around, they may (or more likely, may not) pay any attention to the notice from the insurance carrier, and be "renewed" into a completely different plan.

So what?

For one thing, this has been SOP in the health insurance market for as long as I can remember: plans come and go, and carriers transition their insureds to what they they consider the closest alternative. If the client doesn't like it, they're free to choose a different plan, or even - gasp! - shop around for another carrier altogether.

It's called "Personal Responsibility," and it means paying  attention to things like renewal notices and plan changes. Now, it's likely that these kinds of changes will become more commonplace as the Actuarial Value rules mandate the limitation or deletion of certain plan designs. Not to mention, carriers themselves seeing the writing on the wall:

Recently, one of my clients, who had a Medical Mutual of Ohio "Gold" plan learned that it was no longer being offered, and he was being transitioned to a "Silver' level policy (MMO has discontinued all of their Gold plans in this area, no doubt due to horrendous claims experience). We took the opportunity to shop around and compare prices and plans, and he was able to find a new one that fit his needs and budget. And notice, this wasn't an Exchange-based plan at all, and yet the experience matches what's being anticipated on it.

There's just no there, there.
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