Consumers urged to ‘stop, shop, enroll’ in health plans

Open enrollment, the period during which individuals can buy insurance plans through the online, state-based health insurance exchange, will run from Nov. 1 through Jan. 31, 2017. — Photo by Nelson Sigelman

As customers brace for changes to their health insurance coverage and bills due to changes in eligibility for some members, rising premiums, and a decline in subsidies, the Massachusetts Health Connector is preparing to soothe those “pain points” they expect could flare up during open enrollment.

Some people who get their insurance through the Connector might find themselves no longer eligible for their plan this year due to the start of annual redeterminations — a process that compiles the most recent state and federal data to update Connector customer eligibility.

And many Connector members will see “a material increase in their premiums” next year, the insurance clearinghouse said, due to rising premium costs for some carriers.

Premium costs for unsubsidized plans will increase by an average of 19 percent, the Connector reported last month. Neighborhood Health — which is the only plan that includes in its network the marquee Partners Healthcare hospitals Brigham and Women’s and Massachusetts General — will increase by 24.7 percent and Harvard Pilgrim Health Care will increase 47.1 percent.

Members could also see more expensive health insurance bills next year as a result of the Connector’s plan to lower the subsidies that mask major cost differences in subsidized ConnectorCare plans. That change means people below the federal poverty line — an income of $11,800 for individuals — who would have paid nothing no matter what plan they selected last year could pay as much as $165 per month if they select a more expensive plan this year.

“The impact this decision has on the most vulnerable members of the Commonwealth is apparent,” Health Care for All, a consumer advocacy group, wrote in a blog post last month referring to those below the poverty line. “In previous years, these members could choose any ConnectorCare plan and not pay a premium. Starting in 2017, they will pay anywhere from $0 to $165 in premiums, depending on their choice of plans.”

So with less than three weeks to go until open enrollment begins, officials at the Connector said Thursday they are gearing up to help customers navigate the changes.

“At its base, because of other factors, the population that goes through open enrollment this year will have a lot of things they need to pay attention to, and they may experience disruption,” Ashley Hague, the Connector’s deputy executive director of strategy and external affairs, told the Connector’s board Thursday. “There is a lot of work we need to do from an outreach and communications perspective to help our members get through this.”

Open enrollment, the period during which individuals can buy insurance plans through the online, state-based health insurance exchange, will run from Nov. 1 through Jan. 31, 2017. This year, because of the array of changes to plans and the possibility of increased costs for some, the Connector is stressing the importance of shopping around.

“This is the year to ‘stop, shop, enroll,’” Health Connector executive director Louis Gutierrez said Thursday, attributing the turn of phrase to a Connector employee. “Stop, take the time to make sure the application contains your most current income and other information. Shop, even if you like your current plan, because of changes in rates and subsidies; you’d be well-served by evaluating all plan options. And enroll, because the point of all this is to provide affordable health coverage.”

Because of the “pain points” cited by the Connector, the Connector is this year expecting a “significantly higher” volume of calls to its customer service centers, Connector chief operating officer Vicki Coates said.

The Connector will send specially tailored letters to members with changes in their eligibility to alert them to what they need to do to stay covered, and a separate mailer to members who are expected to see a significant increase in their premium.

For this year’s open enrollment, the Connector is also planning to keep its service centers open until 8 pm Monday through Thursday, and its walk-in help centers will be open to help customers on Saturdays.

Open enrollment has given the Connector and state government fits in previous years, including the disastrous 2013 rollout of a now abandoned website intended to be compliant with the Affordable Care Act (ACA). Last year’s ACA-compliant open enrollment went smoothly, officials said, and the Connector is keeping an eye on its system ahead of the next enrollment period.

“Our system is working, and will work for members and applicants before, during, and after open enrollment, but the reality is we are walking a narrow path,” Ms. Gutierrez said recently. “We have stayed on schedule, sometimes narrowly, but we continue to move forward, knowing our margin for error is slim.”

The Connector in February reported enrolling more than 36,000 new members during last year’s open enrollment, bringing the total number of members enrolled in plans for 2016 to 201,000.

First established through a 2006 law and now in compliance with the federal Affordable Care Act, the Connector was set up to allow those without access to insurance to receive coverage. The most recent estimate of the state’s uninsured population, according to the U.S. Census Department, is 2.8 percent.