Keeping Consumers Covered

Source: CMS
Keeping Consumers Covered

By Health Insurance Marketplace CEO Kevin Counihan

The latest open enrollment period exceeded our expectations, with more than 12.7 million people signing up for coverage or automatically renewing their plans for 2016. To me, this success is confirmation that the Health Insurance Marketplace is providing a needed service to connect people to quality, affordable health care coverage. This year’s progress is also confirmation of the hard work that went into improving the consumer experience on to help people shop for the coverage that is right for them and their families.

Consumers are more engaged, savvier and better informed. New customers came in earlier, allowing them to have a full year of coverage, and 70 percent of returning customers actively selected a plan. And because of operational improvements, we have more precise enrollment data, so the 12.7 million already takes into account a larger share of cancellations that took place during Open Enrollment.

These are all good signs for consumers retaining coverage for the year to come. And now that Open Enrollment is over, we are focusing even more of our energy on helping consumers stay covered.

There are many reasons consumers choose to leave the Marketplace – perhaps the most common is that the consumer finds a new source of coverage outside of the Marketplace, including getting a job with employer coverage or becoming eligible for programs like Medicare and Medicaid. What we don’t want is for eligible consumers to lose their coverage because they have trouble navigating our processes. Below are some of the things we’re doing to make sure that consumers who are eligible for and need coverage throughout the year are able to stay covered.

Consumer Payment Experience

Some consumers who are just entering the Marketplace don’t pay their first bill. In some cases, a consumer changes their mind or has had a life change and no longer needs Marketplace coverage. But in others, it’s because they have trouble navigating the payment process, aren’t clear on when their payment is due, or simply forget to pay before it’s too late. If a consumer doesn’t pay their first bill, or what’s called their binder payment, their coverage is terminated by their insurance company.

We’re working to improve the consumer payment experience this year in a couple of different ways:

  • We’ve made improvements to our Marketplace outreach, reminding consumers to make their first payment. We’re sending consumers additional reminders, sending them earlier in the process and providing clearer guidance on when their payment is due.
  • We’re also working closely with insurance companies to reinstate consumers who had trouble during the payment process.

Data Matching

Another reason consumers may lose their coverage is if we don’t receive the information we need to confirm their eligibility. The law specifies that when we can’t verify key information like a Social Security number or income immediately through automatic checks against other Federal data, consumers can enroll in coverage for 90 or 95 days while we work with them to verify their eligibility. But after that, their coverage is cancelled or their financial assistance is adjusted or ended.

The fact that we cannot immediately confirm eligibility does not mean an individual is ineligible for coverage or financial help. It just means that the information a consumer provided can’t be instantly validated by our data sources. Reasons this occurs can be as simple as a Social Security number typo or a government database that has first and last names switched. For many consumers, the issue is a change in employment or wages since they filed their last tax return. That’s why the law gives consumers time to provide more information, and that’s why the majority of “data-matching” issues are resolved because consumers successfully submitted documentation that substantiates what they told us on the application. Nonetheless, in 2015, coverage was terminated or APTCs were adjusted due to data matching issues for about 1.7 million consumers.

As with other Marketplace rules, CMS is committed to both making sure the process works better and limiting access to coverage and financial assistance to those individuals who are indeed eligible. We’ve already made significant improvements that we believe will help to reduce the share of consumers who lose coverage or financial assistance due to data matching issues this year.

To help consumers avoid data matching issues during the enrollment process:

  • We’ve made improvements to the online application that makes it clearer when a data matching issue is created and we encourage people to provide key information if they failed to do so initially, such as providing a Social Security number or an immigration document number to resolve the issue in real time.
  • We added functionality that helps make sure consumers do not generate a new data matching issue if they have previously resolved that issue with the Marketplace. This keeps consumers from having to summit the same documentation year after year.
  • Going forward, the 2017 payment notice allows CMS to establish more appropriate income verification thresholds next year for consumers.

And, to help consumers resolve data matching issues once they’ve been generated:

  • As a result of working with advocates and assisters, we have made improvements to our notice language to more clearly explain what documents a consumer should submit to resolve data matching issues. And we are developing a new resource guide designed to both prevent income data matching issues and improve resolution of generated income data matching issues.
  • Going forward, the FY 2017 budget proposes funding that would give CMS the ability to improve our outreach, including to consumers with data matching issues. The CMS team reaches out to consumers as many as 14 times to make sure consumers know what information they need to provide.

Because of these improvements, we’re starting to see promising signs, including a noticeable reduction in the rate of data matching issues, and consumers responding to our outreach efforts earlier and in larger numbers. While we won’t have final numbers for a couple of months, we are strongly encouraged by the progress we have made and hopeful that our progress will help consumers who need and are eligible for coverage stay covered all year.

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Keeping Consumers Covered

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