2018 Changes to Individual Market

The current administration has made changes to Obamacare; these changes will impact Hoosiers that purchase individual health insurance along with the rest of the country.

  1. 2018 open enrollment will be shorter to 45 days. Open enrollment is the time of year you can enroll, renew or make changes to your individual health insurance policy. For 2018, open enrollment will start on November 1st and end on December 15th.

For the most part, Indiana residents understand the open enrollment period because most have previous coverage. There is a small segment that are unaware of this time, most of them have been covered on an individual grandfathered policy or have not had experience in the individual markets. One of the problems with open enrollment, is the carriers and all their systems are strained by the heavy enrollment numbers. This can cause a lot of frustrations if a problem needs to be solved. Another problem is that many agents and brokers have left the individual market, which removes channels for consumers of obtaining quality information.

  1. Special enrollment periods (SEP) have additional requirements to enroll. This will impact the policies purchased on the marketplace. In the past, you could enroll into the plan and then provide the documentation showing life events. The market place gave up to 90 days to submit that information. Ultimately what happened is that people would game the system. They would state that they have a SEP, enroll in the plan, receive medical services and then drop the coverage. Usually the medical services were significant between $30,000-$100,000 worth of treatment and the carriers had to pay. This caused significant losses for the insurance carriers and led to higher premiums and the exit of many carriers in Indiana and the rest of the country.
  1. Carriers will be allowed to collect debt, from premiums from the prior 12 months, before one can enroll into a new plan.  This will cause a huge issue with Indiana residents. A very common technique to game the system is in the 4th quarter of the year, many people would not pay their last 2 months of premium. With the grace period being 90 days, if you did not have a claim you would save 2 months of premiums. If you did have a claim, you could go back and pay the premiums and have the claim covered. In 2016, this was a common practice. Now carriers will be able go after that back premium, which will end that gaming of the system. This could prevent families or individuals from getting coverage. If someone dropped coverage in the middle of the year, they may be on the hook for all of that back premium. There is little chance, Hoosiers or Americans will have that sum of money to pay back premium. What is not clear is the communications between different carriers. We would predicate, if you are a high claimant the carriers will find a way to make sure you are not gaming the system.
  1. Carriers will have more flexibility in plan offerings.  Currently under the Affordable care Act (ACA), health plans have to meet certain actuarially level of coverage. This will help lower premiums because it will shift more expense on to the insured. Which can be a good thing if you are healthy. If you have ongoing conditions, it’s important to spend time on electing a plan that is the best option for your needs.

These are not long term solutions to the individual health care crisis. This is an attempt however, to keep what carriers are left in the market. These steps should keep them in the market and should help with the skyrocketing premiums f0r 2018.

Anthony Nefouse
Indiana Health Insurance Company

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