The Center for Consumer Information and Insurance Oversight (CCIIO) has released an update for insurers and consumers on new healthcare.gov functionality to allow consumers to report life changes, qualify for a special enrollment period, and switch plans. For consumers, and those charged with assisting them, there are some helpful changes. Below are a couple top takeaways.
Improved IT functionality for reporting life changes
The ACA recognizes that people experience work and life changes throughout a year, and thus allows changes in circumstances to qualify people for a special enrollment period to enroll in coverage or change plans (a full list of reportable changes is available here). However, until now healthcare.gov did not have the functionality to allow consumers to report those changes. For example, if someone moves to a new area, they can now report their move to healthcare.gov and gain a 60 day special enrollment period to sign up for a new plan that services their area.
However, the new bulletin reports that functionality is not yet available for all the changes a consumer might face. Specifically, if a consumer becomes newly eligible for premium tax credits or cost-sharing reductions, the website allows for reporting a change in income and will recalculate tax credits or cost-sharing reductions, but it does not allow the consumer to gain access to a special enrollment period. CCIIO reports that “in the near future” this functionality will be available.
Switching plans after the effective date
Until now, once a consumer paid their first premium and passed their plan’s effective date, they would have to wait until next year’s open enrollment period to switch plans. But some people have enrolled in a plan only to find out to their chagrin that a valued provider is not in their new plan’s network.
Now, CCIIO is offering consumers a limited ability to switch plans after their coverage effective date, and after they’ve paid their first premium. But ALL of the below criteria have to be met before the consumer can switch plans:
- The consumer has to be switching to another plan offered by the same insurer.
- The consumer can only switch to another plan at the same precious metal level (i.e., bronze to bronze, silver to silver). If they’re getting cost-sharing reductions, they have to stay at the same cost-sharing reduction level.
- The reason for the change has to be to move to a plan with a more inclusive provider network or for “other isolated circumstances determined by CMS,” and
- The consumer must make the change within the initial open enrollment period (i.e., by March 31, 2014).