Update from Covered California’s Plan Management Advisory Meeting

If we go by recent reports that both the number of uninsured Californians and the premium rate increase have been cut in half, Covered California is off to a promising start. Critical challenges remain (network adequacy, enrollment simplification, engagement of under-enrolled groups, and more), however, and last Friday’s Covered California Plan Management Advisory Committee is grappling with many of these issues.

  • Recertification of Plans: What happens to current enrollees when a health plan does not recertify its products on the exchange? The onus is on the plan to notify enrollees in plenty of time for them to find another plan for 2015, but what if the consumer does not choose a new plan? Based on the fact that 89% of CC enrollees that are getting subsidies, consumer advocates serving on the committee would prefer for these individuals to be auto-enrolled in a subsidized plan. CC officials are looking for some way (a hook in state law, final exchange rules to be issued by the Feds, etc.) to do this.
  • The ‘Renewal Journey’ for Covered California Enrollees: Heading into the open enrollment season, Covered California’s own guiding principles for the renewal journey were as follows:
      • Focus on the consumer experience by offering service options and making the process easy.
      • Engage and leverage our certified delegates, partners, and plans.
      • Maximize retention by providing an automatic renewal option where possible.
      • Encourage consumer self service through the website, Interactive Voice Response (IVR), and others tools.
          Advocates should ask how Covered California meets these goals. With renewal notices scheduled for release this October, advocates and enrollment counselors need to understand that the window for open enrollment (Nov 15-Feb 15) is much narrower than last year, though the deadline for Jan. 1 effective coverage is still December 15.  Current enrollees who miss this December 15 deadline will have to re-apply for 2015 during open enrollment and will have no more than a one month interruption in coverage. As always these issues highlight the tensions or trade-offs between wanting consumers to actively shop with thoughtful choices and wanting to maximize enrollment for the sake of risk management.   As organizational partners, including navigators and application assisters, set about to recalibrate strategy for the next enrollment cycle, it will be important to consider this tension. See the

    full powerpoint presentation

        for a handy list of key dates in the renewal process. There you can also find content summaries for each of the renewal notices.
  • APTC (Advanced Premium Tax Credit) reconciliation. Paying Uncle Sam at tax time is complicated enough for many consumers; for some, the addition of APTC reconciliation is simply another factor to calculate at tax-time, along with the employer withholding, and/or various deductions; for others, this will be a new complication to deal with. An example of particular note: anyone who has a Covered California subsidy to help afford their premium will no longer be able to use the 1040EZ form. It’s not too soon for advocates and assisters and members of the media to prepare to help consumers through this process and to encourage Covered California to simplify the process even further (check out what they have planned so far in the powerpoint).