Clear messages shine through the chaos

December 1, 2013

Confused members might opt for the worst choice under ACA

During the scuffle over extending non-grandfathered plans into 2014, insurers were rebuked by Department of Health and Human Services for failing to disclose to members all their coverage options. So the remedy was to insist that plans follow a suggested format when they send out new letters.

If you offer extended policies, you must provide information about exchange products-even if you don’t offer an exchange-based product. In effect, some plans will be encouraging their members to buy from the competition.

The situation doesn’t bode well for member retention.

The choices

Consumers in the individual market with non-grandfathered plans have a few choices for 2014. They can:

  • Keep their plan if their state regulator and their insurance carrier have agreed to provide an extension;

  • Enroll outside the exchanges in a new plan that is compliant with the Affordable Care Act;

  • Enroll in a compliant plan within the insurance exchanges-possibly with a subsidy;

  • Enroll in Medicaid if they qualify; or

  • Skip coverage and pay the $95 penalty.

Many consumers will choose the penalty, however, they won’t actually get anything for their $95. Unfortunately, some of those individuals could be missing out on subsidized coverage that would have cost them less than their old plans.

About 17 million of the 29 million estimated customers that could potentially purchase insurance through the marketplaces will be eligible for tax credits, according to a recent Kaiser Family Foundation analysis. Some enrollees will see premium rates lower in comparison to 2013 thanks to the subsidies, and some will see higher rates. Most will complain regardless of what happens, and several will probably even try to sue you over their discontinued plans or severing ties with their favorite doctors.

Of course, your first instinct is to retain the member, whether in your exchange plan or in your individual policies.

Why you want to keep them

Those who have most recently been covered by an insurance plan are more likely to be in better health by comparison than the uninsured population. Their relatively good health status will make a desirable addition to the risk pool.

And knowing a population’s history is a valuable piece of information. It helps you leverage your big data and predict costs better than if you were only guessing at the population’s needs.

Retaining current members must be at the top of your list. Sending a clear message is the only way to get your message past the confusion and daily political fights. Open enrollment is available until March 31, but plans must act fast to reinforce their brand messages to get through the chaos of the ACA rollout.