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Thursday, November 12, 2015

What to Expect from the Health Insurance Renewal Process

Jessica Kendall

Director of State Partnerships

The third open enrollment period for consumers to buy health insurance through the marketplaces has officially begun! New and returning consumers can shop for and enroll in health coverage through the marketplaces from November 1, 2015, until January 31, 2016. The process of renewing coverage for returning consumers will be a little different than last year, so let’s take a look at what consumers can expect from the process. 

In April, the Centers for Medicare and Medicaid Services (CMS) published guidance on the renewal process for states using the federally-facilitated marketplace. Like last year, there is good news for consumers: The rules and related guidance make it easy for consumers to keep their current health plan and their financial assistance. 

However, there are some important reasons for consumers to be proactive about renewing their coverage: In order for consumers to confirm that they are getting the best plan they can afford and the correct level of financial help, they should shop around in the health insurance marketplace and submit up-to-date income information. (See our infographic: Stop, Shop, and Enroll)

Most consumers will be able to keep the same coverage and tax credit amounts 

The renewal guidance allows most consumers to stay in their existing plans and continue getting financial assistance, even if they take no action. And new for this year, financial assistance will be based on the most recent income information the marketplace has on file for a consumer. 

As we know, income and household circumstances change from year to year, so consumers who do not take active steps to renew their coverage could receive less financial help than they are eligible to receive. 

Or worse: they could receive too much financial assistance and be required to pay some or all of it back at tax time. 

It’s important to note that there are groups of consumers who will be renewed into coverage but will not continue to receive financial help in the form of advanced premium tax credits (APTCs):

  • Consumers who received advanced premium tax credits (APTC) in the 2014 and failed to file taxes and reconcile their APTCs. (Here's an overview of what the process looks like for these consumers.)  
  • Consumers whose income has risen above 500 percent of the federal poverty level (or $100,450 for a family of three). 
  • Consumers who did not authorize the federal marketplace to obtain their updated income information in order to renew them into coverage with APTCs. 

Consumers may be confused or overwhelmed by the amount of information from different sources 

Consumers will receive a few different notices from the marketplace and from their health plan. For families who get coverage from multiple sources or different issuers, the number of notices will be even greater. Consumers should carefully read ALL notices they receive to understand what their options are and what actions to take. Assisters can play an important role in helping consumers understand what these notices mean for their future coverage. 

These notices will come at different points leading up to January 1, 2016. Here are a few of the notices consumers will receive (see models of these notices):

  • Marketplace Open Enrollment and Annual Redetermination Notices that include information about the renewal process, coverage effective dates, and the importance of updating information  
  • Marketplace Eligibility Determination Notice that has information about what a consumer is eligible for, what steps are left in the enrollment process, and coverage effective dates 
  • Issuer Notice, including details about the plan a consumer will be auto re-enrolled in, key changes to their plan, and the level of APTCs the consumer will receive 
  • Enrollment Confirmation Notice

Consumers will still need in-person help

Many consumers will take the “no action” route to renewal, while others who are computer-savvy or who have simple changes or updates will use HealthCare.Gov or the call center on their own. But people with more complex issues and questions and those who sought help from an enrollment assister during the first two open enrollment periods will likely seek in-person assistance again. 

Many consumers have had marketplace coverage for one or two years now, and assisters should be prepared to answer more detailed questions about their plans. Like last year, we encourage assisters to talk with consumers about the importance of working with them to visit the marketplace website, update their information, and discuss their plan options. 

Typical questions from consumers renewing coverage could include:

  • Is a particular provider I need to see still in my plan’s network?    
  • Are there any changes in my plan’s benefits or costs?
  • If my current plan is no longer available, what are the benefits and cost-sharing for the new plan the issuer is offering?  

Consumer education will be crucial

Even though most consumers will not have to do anything to keep their coverage, it is imperative that they hear the message that it is a good idea to actively shop for coverage and submit updated information to the marketplace. Post our infographic in your office: Stop, Shop, and Enroll.

Automatic renewal will help ensure that people who got covered in 2015 stay covered in 2016. But to make sure they are getting the best plan they can afford and the right amount of tax credit, consumers will need to be active shoppers—and many will need help from assisters to make the right decision.