New Renewal Guidance Will Better Position Consumers to Stay Covered

By Zachary Baron

As part of Enroll America’s core mission to ensure that consumers maintain their coverage over time, we remain focused on identifying and promoting best practices related to the renewal process. As we highlighted last month, millions of people who were already enrolled in marketplace coverage took the initiative during the second open enrollment period (OE2) to learn more about their options for 2015. While we were very excited to see marketplace enrollees taking action to find and keep coverage that met their needs and budget, the renewal process was not as streamlined as originally envisioned by the Affordable Care Act.

That’s why we were pleased to see new renewal guidance released yesterday by the Centers for Medicare and Medicaid Services. The guidance describes the improved approach that states using the enrollment platform will use for OE3 to help enrollees stay covered for the 2016 plan year.

Similar to last year, consumers will receive information from the marketplace and their insurance company explaining:

  • Key dates for the renewal process,
  • How their plan may be changing, and
  • How their financial help will be determined for the 2016 plan year

Most consumers can keep their coverage with financial help even if they don’t take action. To find out the most up-to-date amount of financial help they will receive for 2016, enrollees will need to contact the marketplace.

But there are a few key differences for OE3 that enrollment stakeholders should be aware of:

  • The financial help amounts for most enrollees get adjusted based on new income and premium data if enrollees don’t take action (rather than simply carrying over the previous year’s financial help amount, as was done for automatic reenrollments in OE2).
  • Current enrollees receiving financial help that did not appropriately file their 2014 federal income taxes will be unable to continue receiving financial help unless they take action.

This guidance is a step in the right direction, and we are pleased that enrollees will receive a more accurate amount of financial help for the 2016 plan year even if they don’t take action, but more can be done to improve the renewal process for consumers leading up to OE3. For instance, all types of communications consumers receive from their health insurance company and the marketplace should be coordinated and up-to-date to make it even easier for consumers to understand how their plan options and financial help may change for the 2016 plan year. This includes special attention to those consumers that still need to fulfill their tax filing responsibilities.

State-based marketplaces maintain some flexibility in how to design their renewal process, so we’ll keep a close watch over the coming weeks and months for further updates from states.

What does this mean for consumers?

  • Consumers will continue to receive multiple forms of communication from the marketplace and their insurance company at various times leading up to OE3. Health plans, the marketplace, and assisters will need to coordinate in advance to mitigate confusion among consumers.
  • Enrollees still need to actively engage in the renewal process by logging into their marketplace accounts and confirming that the information on their application remains correct to make sure they’re getting the right amount of financial help and avoid surprises at tax time.
  • Auto-renewal remains a helpful safety net to make sure people don’t fall through the cracks if they don’t return to the marketplace during OE3.

Enroll America will continue to work with partners to make sure that enrollees are in the best position possible to maintain coverage that meets their needs and budget. Stay tuned for further analysis of the renewal process from our survey research and recommendations for additional improvements in the coming weeks!

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