Home Health Insurance Open Enrollment: Growing Pains & Significant Gains

Open enrollment is almost over… so how did it go for you? This year, open enrollment brought a whole new set of obstacles, as individuals who purchased insurance on the exchange last year had the opportunity to renew for the first time. While things were much improved over this same period last year, successfully integrating their user experience with the exchange presented a significant challenge to health insurers.

For members who purchased a plan on the exchange last year, until the 834 was received, there was no indication whether they had chosen to auto redetermine their eligibility for this year. If they had, the guidance was that their 2014 subsidy and plan would automatically be renewed for 2015 by the exchange if the member took no action. However, if the member had elected not to auto redetermine, they would lose their subsidy if they took no action. This made the job of communicating with members complex; you want to encourage members to auto renew, but at the same time, not risk them losing their monthly subsidy.

The second hurdle facing insurers was the ease with which consumers could shop other plans on the exchange – even when directed to the exchange through the issuer. Last year, when entering the exchange through an issuer, shoppers’ only option was returning to that insurer. This year, they had the option to shop for other plans as well. This was in the best interest of the consumer, but from an insurance company perspective, it made it difficult to determine which members should be directed to the exchange.

Another ongoing challenge was the inability of the exchange to support special enrollment through issuers. When an individual with a special enrollment life event chose to purchase an on-exchange plan and went to the exchange, they either didn’t return – or if they did, they no longer had the special enrollment date available to them.

The exchange has had its share of growing pains, but there were certainly significant improvements over last year. The first was reliability and uptime. While there were some glitches, we did not see major issues like last year. Further, there were no eleventh hour crises. CMS could have done a better job of communicating some of the details, for example, how it would handle renewals. However, they successfully avoided the kind of major last-minute changes that create marketing and communication nightmares for insurers.

Working and integrating with a large bureaucratic entity always presents its own set of challenges. However, two years into the implementation of the federal exchange, the road is looking significantly less bumpy. Our vision for the future: the FFE stabilizes its platform, 2015 brings further improvements, and insurance companies are able to provide a clear, seamless experience for consumers.

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As Manager of Healthcare Strategy, Mukesh helps our clients develop and execute digital strategies to attract new customers and keep current ones engaged. When not delving into healthcare and technology, Mukesh is usually out running or occasionally writing about running.

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