ACA Government Co-Ops: Is This Experiment Working In Your State?

[scagnt83]

Doctors in my area of SC are saying that the SC Consumers Choice Co-Op is already around 10-12 months behind on paying claims as it is. So I would guess in SC it will be 2 years minimum to wind it down totally. I have a few friends who are on it until year end. They say that they have yet to receive benefit statements from services performed 5 and 6 months ago.

I helped a couple of them decide on alternative options (3 or 4 Aetna plans and about 15 from BCBS). They both went with BCBS plans. One is actually saving money and the other is only paying $10 more per month for a better plan vs the co-op. I charged my normal individual exchange based health insurance consulting fee... a 6 pack of IPA

 

[somarco]

Tyler, once they don't have new claims coming in they should be able to clear out the backlog fairly quickly. Providers generally have 6 months after incurred date to submit or else forfeit any right to collect from carrier or patient.

Even in situations where the business is winding down it is unusual for volume of any kind to go beyond 6 months following COB.

 

[HealthRisk]

Tyler, once they don't have new claims coming in they should be able to clear out the backlog fairly quickly. Providers generally have 6 months after incurred date to submit or else forfeit any right to collect from carrier or patient.

Even in situations where the business is winding down it is unusual for volume of any kind to go beyond 6 months following COB.

I am guessing the issue with SC isn't a claim processing backlog but cash flow.

 

[somarco]

I am guessing the issue with SC isn't a claim processing backlog but cash flow.

Obama has a phone and a pen. He can write checks when there is no money in the bank.

Co-ops are his creation.

 

[HealthRisk]

Obama has a phone and a pen. He can write checks when there is no money in the bank.

Co-ops are his creation.

Co-ops are his creation. But appropriation bills are not. He can wish all he wants but Congress shut the funding off. Hence, a number of co-ops have fixed capital and ever increasing costs.

 

[AllenChicago]

Is it permissible for a Health Insurance Company to remove it's plans from Healthcare.gov in the middle of Open Enrollment, simply because some pre-defined 2016 Enrollment Goal has been reached?

The Land of Lincoln Health insurance Co-op did this yesterday. (They stopped selling off-exchange earlier in December.)

By allowing LOLH to pull it's plans from the Marketplace in the middle of O.E., HHS has opened a door that enables other health insurers to follow suit.

-ac

 

[russelltw]

Not sure about co-ops, but thought I read if a carrier pulls out of marketplace, they cannot come back in for 5 years. Carriers might welcome that kind of break from aca claims.

 

[TN_agent]

AC,

It is permissable. The TN co-op did that in 2015.

The same co-op that is now kaput.

They are not technically withdrawing from the marketplace, just closing to new enrollment.

And watch out with that. If they lose subsidy for not reconciling or not getting docs in or whatever the marketplace will not let them back on the same plan even after fixing that, they will have to go with a new carrier. Had that happen to a couple last year.

 

[HealthRisk]

AC,

It is permissable. The TN co-op did that in 2015.

The same co-op that is now kaput.

They are not technically withdrawing from the marketplace, just closing to new enrollment.

And watch out with that. If they lose subsidy for not reconciling or not getting docs in or whatever the marketplace will not let them back on the same plan even after fixing that, they will have to go with a new carrier. Had that happen to a couple last year.

I had heard when TN did this, it resulted in a new second lowest cost silver plan and changed the subsidy amounts. Was this true?

 

[TN_agent]

I had heard when TN did this, it resulted in a new second lowest cost silver plan and changed the subsidy amounts. Was this true?

Yes. People who waited until late to enroll were able to get plans with other carriers for cheaper than if they had enrolled in the fall.