It's Funny...

[FLM2]

Last year I almost completely ignored the Marketplace quotes and capability and did less than 5% of my apps On Exchange.

This year I am almost completely ignoring the Off Exchange plans and rates and quoting everyone Marketplace plans exclusively. In many cases I am going to submit Exchange apps without subsidy, primarily because United Healthcare is paying a much higher commission for Exchange apps using their Compass network than Off Exchange using Navigate (I use other carriers for my PPO clients because they have better networks.

Part of that, of course, is that Off Exchange rates haven't been released yet but a bigger reason is that there just seems to be more credibility when you send a client the Healthcare.gov link with a bunch of plans-they just seem more accepting of them and less interested in looking any further.

It also helps that more of the insurance companies are available On Exchange, at least in Florida, and WBEs like Health Sherpa make it feasible to process an Exchange app very quickly-most of my Exchange apps are over $600 premiums so paying 1/2 a months' commission to The Sherp isn't even an issue.

Just an interesting turn of events, IMO...

 

[houcoogster]

It is funny.....and very interesting! Who knows what kind of folks will turn out this year. What type of push back and what type of acceptance......it's anybody's guess. We have to be able to adjust on the fly.

 

[Ann H]

Twists and Turns! This landscape has shifted more than real estate on a California quake line.

I will be doing fewer Exchange apps this year. Our Benchmark (2nd Lowest Cost Silver Plan) was the lowest in the nation last year, and it's even lower this year. It was driven down by a local co-op that used an anorexic HMO network of 11 "community clinics" for PCP's, and the county hospital for the indigent. So, not only did subsidies go down, but clients have to pay extra to get a plan with a richer network.

In the Phoenix area, you have to have less than the following income to qualify for even $1 in subsidy:

Single:
Age 25 - $24,000
Age 35 - $27,000
Age 45 - $29,000
Age 55 - $39,000
Age 64 - $46,600

Even for a family of 4 with the parents age 35, you have to earn less than 285% of FPL before you even get $1 in APTC.

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We have to be able to adjust on the fly.

That is the KEY to survival in this business, Houcoogster! You nailed it.

 

[Yagents]

AZ Client getting subsidy emails me and says her income will be the same.

My answer, income premium stayed the same, but subsidy will go down $40 month.

So, because some company rolled out a cheap plan that nobody will buy, we must log back in (somehow), to raise her price by $40/mo, to avoid a clawback a year from now.

Since income didn't change, technically we don't have to report it.
Maybe she should just auto re-enroll, get same subsidy, keep same price, and be prepared with $480/mo clawback in a year from now.

Thoughts?

 

[kgmom219]

Punt.

Give the client the options. She already knows what a mess hc.gov is, so she will probably go with clawback. (Which time wise, is probably best anyway)

 

[RayNY]

So, because some company rolled out a cheap plan that nobody will buy, we must log back in (somehow), to raise her price by $40/mo, to avoid a clawback a year from now.

Thoughts?

It was my understanding that since the subsidy is changing based on an "exchange side" change (new reference silver) that the subsidy would automatically adjust at renewal to be appropriate with the same stated income. We do not have no notify the exchange about changes in their situation, only our client's. Client's situation hasn't changed in this scenario.

I might be wrong, I don't have a solid reference for this situation (but would love to see one if anyone has it!). I just can't see them blindly issuing APTC's that are impossible based on the data they have.

 

[Yagents]

Interesting thought Ray, but I haven't read that anywhere. It would make sense, but that's too much to expect.

As of now, I'm going to suggest to the client that we tackle it in Jan/Feb.

Since only 2-3k people signed up for Meritus in AZ, every single person in AZ who got tax credits may be affected in this way if income stayed same, and they want to keep same plan.

 

[houcoogster]

Y I wouldn't do anything on this case. You are fine the subsidy will be automatically calculated to reflect the new slcsp. As long as the client knows it will be $40 more starting in Jan. Sorry about you guys slcsp plight thats messed up.

 

[Ann H]

I agree. The IRS TD9590 mentions cases where the benchmark plan changes (like a family member moving to another rating area, etc.). In each case, after the change in circumstances is reported, it's up to the exchange to change the benchmark plan and adjust the premium. It is not up to the client to notify the exchange that they must do so.