Coventry and Anthem: Does CSR Turn Similar Plans into Identical Plans?

[yorkriver1]

I have seen this a couple times with some silver plans. The carriers have, say, two plans close together in benefits.

The CSR turns them into identical copays/deductibles/MOOP, just different prices for the plans.

I am checking carefully tomorrow before advising, why not take the lower cost plan if the CSR renders the coverage identical?

Right now, at 87% CSR the Coventry $5 and $10 Copay Silver plans are quite a bit different in premium, but not benefits after CSR applied. Same copays/deductibles/MOOP/% of hospital, etc before MOOP reached. Hoping there are actual company provided SoB's adjusted for CSR levels. Not all carriers have them. *sigh* Don't want to rely on the estimate of benefits on HC.gov. May be right, but maybe not.

 

[dgoldenz]

Yes, I see this a lot with the 94% CSR plans.

 

[AllenChicago]

Hoping there are actual company provided SoB's adjusted for CSR levels. Not all carriers have them. *sigh* Don't want to rely on the estimate of benefits on HC.gov. May be right, but maybe not.

Our state's largest carrier produced CSR SOB's for 2014, but opted not to for 2015. Are they that expensive to produce? Maybe insurers are now trying to see how much of law they can stop complying with, and not get caught.

 

[yorkriver1]

Makes us more valuable as advisors, why we get paid the big bucks!

Thanks, I believe I can safely guide the prospect to take the lower cost plan, if the CSR adjusted copays, deductible (in this case zero) MOOP, etc. are the same. I did screen share with him and showed him the Kaiser subsidy calculator that explains CSR. The difference on Marketplace between their numbers for OOP's contrasted drastically with the carrier's SoB.

Yes, last year mostly Aetna in our market had the adjusted SoB's. Am calling Coventry this morning to see if they have them anywhere this year. Maybe not, because, I think the link to the accurate ones from Aetna was included on HC.gov last year.

So, do any carriers have the adjusted CSR SoB's? This is fun, as one carrier out our way is migrating insureds with 94% CSR to Platinum plans. Someone over there must be a teeny bit confused about why these folks have such low deductibles. I like Tater's response to some of these issues: tap tap tap tap

 

[RayNY]

Makes us more valuable as advisors, why we get paid the big bucks!

I just saved a client almost $3,000 a year by moving from platinum (sold by prior broker, who doesn't understand CSR apparently) to a silver CSR.

Same $0 deductible, same or lower cost share/copays/maxOOP, same network, same formulary. Essentially, the same plan at under half the cost.

I agree, this is why we're valuable.

 

[yorkriver1]

I am cleaning up a carrier error, which is identical to your client's situation, Ray. The carrier migrated the 94% clients on $0 deductible to Platinum plans on renewal, then sent big bills.

I am tempted to do my "you work for one carrier (I represent 15+), and you can't bother to learn all about the details to handle this business?" rant.....always to myself, of course.