Monday , November 13, 2017 - 5:00 AM1 comment
OGDEN — Thanks to a practice called “crosswalking,” people insured by Molina Healthcare in 2017 under the Affordable Care Act will automatically be enrolled in a comparable SelectHealth plan on the federal marketplace exchange. But for some consumers, that convenient switch could cost them more and possibly cause other problems.
In August, Molina announced its exit from Utah’s exchange at the end of 2017, which left just two insurers for the entire state — SelectHealth and University of Utah Health Plans. The latter began offering marketplace plans to certain counties in 2016 and expanded to statewide coverage for 2018.
In late October, SelectHealth sent letters to Molina policyholders notifying them of their automatic enrollment in a default plan with SelectHealth and also asking for payment of the first month’s premium. By email Tuesday, SelectHealth spokeswoman Jamee Wright said their intent is to protect consumers.
“As a result of Molina’s withdrawal from the Individual federally facilitated marketplace in Utah, the Centers for Medicare & Medicaid Services (CMS) crosswalked the affected members to a new plan,” Wright said. “The action, which occurred in October, took into consideration geography, the former plan’s medal tier (bronze, silver or gold), and the lowest premium.”
According to Wright, CMS provided SelectHealth with a list of people who would be crosswalked to their plans, and those individuals should also have received letters from Molina and CMS stating they would be passively enrolled with another carrier if they took no action on their own.
The open enrollment period for 2018 health insurance under the ACA (commonly called Obamacare) — trimmed from 12 to six weeks by the Trump administration — began Nov. 1 and ends Dec. 15. Utah’s 70,000 Molina policyholders who could be affected by crosswalking still have time to check out alternatives, which the SelectHealth letter encouraged them to do.
“When other carriers have left the marketplace, we utilized a similar approach to notify consumers. We recognize that health care is constantly evolving, and there is confusion surrounding choosing a health plan,” Wright said. “We encourage people to explore their options — they can call their agent or SelectHealth for help understanding what plan would work best for them.”
But the SelectHealth letter also appeared to be an invoice requesting payment for the first month’s premium by Dec. 31.
“We wanted to help make the transition as smooth as possible . . . and due to the condensed open enrollment period, we chose to consolidate the notification letter with a premium statement,” Wright said.
But Ogden resident Karen Thurber, insured by Molina this past year, objected to the letter’s lack of details on the default plan other than it being “comparable” to the one she had. It also asked her to pay $1,082.88 by year’s end to avoid any gaps in coverage.
In Thurber’s case, she’d been paying $604 per month on her Molina silver plan and did not qualify for federal subsidies. But paying an additional $479 per month for a plan she knew little about seemed like a bad deal. And her insurance agent, Lionel Longson of Health Benefits of Utah, also sent out a mass email cautioning his Molina policyholders to not pay the invoice — action that would lock them into a specific plan they might not actually want.
“Please be aware that SelectHealth will be sending you a form letter announcing your ‘default enrollment’ with SelectHealth,” Longson said in his mass email, noting the premium stated in the letter did not reflect tax credits they could receive.
In addition, they might have to switch doctors and networks under a new plan from SelectHealth, which is the insurance division of Intermountain Healthcare. Longson recommended they also look into coverage options under University of Utah Health Plans.
By phone, Longson said that some consumers might value price more than specific doctors. But for those with favorite physicians, they should be aware that out-of-network providers won’t be covered under the new default plan.
Jason Stevenson, education and communications director for Utah Health Policy Project, crunched the numbers and found that someone like Thurber would actually fare better on SelectHealth’s off-market silver plan, which has a higher deductible — $2,250 compared to $1,800, but its monthly premium drops to $890.42. That would save $192.46 per month or $2,309.52 for the year.
The uncertainty caused by Trump’s threat and subsequent action to not cover the ACA’s cost-sharing reductions led to some off-market plans being cheaper for 2018, Stevenson said, explaining that insurers anticipated losing those federal dollars that are used to reduce costs for low-income families and responded by raising marketplace premiums to be able to keep that assistance in place.
Those with incomes between 100 and 400 percent of the federal poverty level who qualify for subsidies under the ACA might do well with their default SelectHealth plan. Most low-income people would not benefit by switching to an off-market plan, Stevenson said, because subsidies for silver plans will eclipse any savings they’d get outside the marketplace.
But for Thurber, who already has a preferred doctor at the University of Utah, choosing a silver U of U Health plan — with a monthly premium of $802 — proved to be the best option, and it also allows her to see Ogden Clinic physicians, she said.
With the help of her insurance agent, Thurber found a better option, but she worries that some might pay the premium requested in the SelectHealth letter and get locked into a plan that might not suit their needs.
“I'm worried about those who might not understand and think they have no other choices,” Thurber said.
According to Steve Gooch, public information officer for the Utah Insurance Department, Molina policyholders will get an extra grace period to choose a new plan, but that delay could also mean risking a month or two without coverage. That special enrollment period begins Jan. 1 and ends March 1, 2018.
“We’re highly recommending that people go shopping now to avoid a lapse in coverage,” Gooch said. “Anything they buy up to Dec. 15 will start Jan. 1.”
To explore available plans online, go to healthcare.gov and follow the prompts.
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