The Centers for Medicare & Medicaid Services (CMS) finalized a policy that provides current Health Insurance Marketplace consumers with a way to keep their current health plan. Generally, individuals enrolled in coverage through the Health Insurance Marketplace will be automatically enrolled unless they opt to enroll in a new plan.  Accordin
g to a CMS news release, Consumers in the Health Insurance Marketplace will receive notices from the Marketplace shortly before open enrollment begins on November 15, 2014 explaining the auto-enrollment process and how they can return to the Marketplace to see if they qualify for additional financial assistance and shop for plans.  Consumers will also receive notices from their insurance company about their new 2015 premium and the amount they may save on their monthly bill with a premium tax credit.

As part of the renewal process in the Health Insurance Marketplace, generally, if consumers do nothing, they will be auto-enrolled in the same plan with the same premium tax credit and other financial assistance, if applicable, as the 2014 plan year.  Consumers are encouraged to return to the Marketplace to make sure they are getting all the financial assistance they qualify for, and to shop for the plan that best suits their needs. Consumers whose 2013 tax return indicates that they had very high income, or who did not give the Marketplace permission tocheck updated tax information for annual eligibility redetermination purposes will get auto-enrolled without financial assistance if they do not return to HealthCare.gov.  According to CMS, this process will help provide continuity of coverage and safeguard taxpayer dollars.

We include the following highlights from the final regulations:

• Consumers who do not denote otherwise will be re-enrolled in their current exchange plan on December 15, 2014, rather than right away.
• Those who are re-enrolled will be able to keep their 2014 subsidy as long as their income has not changed dramatically and if they checked the box on their original application that allowed the IRS to view their tax returns (a reported 90% of consumers checked the box).
• If a consumer is enrolled in a plan that has been cancelled on the exchange, but offered outside of the exchange, they’ll be automatically enrolled in the plan off the exchange.
• If the plan has been cancelled altogether, the consumer will be enrolled in a plan of the same metal tier. If a similar tiered plan is not available, they will be automatically enrolled in a different plan of the same carrier and metal tier. If the carrier does not offer a different plan of the metal tier the consumer was previously enrolled in, the consumer will be enrolled in a plan one metal tier higher or one metal tier lower that they were previously enrolled in. If that still is not an option, then the consumer will be enrolled in “any other plan offered under the product in which the enrollee’s current QHP is offered in which the enrollee is eligible to enroll.”
• If plan premiums increase, the consumers who are automatically re-enrolled will be liable for the price of the premium increase.
• The issue of consumers getting larger subsidies than they deserve still remains to be an issue and an industry-wide concern, despite the finalization of this rule.

If you have any questions regarding the process for enrolling in health insurance coverage through the Health Insurance Marketplace, please contact me or give me a call – I’m happy to help!