The Affordable Care Act (ACA) marketplaces are still relatively new. Consumers are still becoming educated about the health plan types and network designs available in their areas. Insurers are still learning how to educate and incent newly covered enrollees on how to use their plans properly and participate in their healthcare decisions.
Its been reported recently that major insurers like UnitedHealthcare, Aetna, and BCBSA have lost hundreds of millions of dollars on health exchange plans in the fourth quarter of last year alone. To keep the exchanges alive and well in their infancy, the Centers for Medicare & Medicaid Services (CMS) is agreeing to make some changes.
As noted in February articles in Healthcare Financial Management, one of the main points of contention for insurers is the special enrollment periods (SEPs). Health plans are finding that the people who sign up during the SEPs are usually sick and using up to 55 percent more services than their open enrollment counterparts, according to BCBSA. Additionally they then drop their insurance after they receive their healthcare services.
The CMS announced they will eliminate some SEPs, clarify others and have established an enforcement unit to ensure proper usage of this provision. In addition, they are looking to help ACA marketplace plans in terms of risk adjustments. The CMS plans to provide earlier estimates of health-plan-risk-adjustment calculations and have a public conference seeking input from insurers of the methodology.
The CMS must continue to work with insurers to help the evolution of the marketplace. There was a decline of marketplace health plans from 2015 to 2016. To stop that decline insurers concerns need to be heard and addressed and health plans need to continue looking for ways to provide care coordination and cost-effective choices.
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