News that health insurers are ending the policies of what might be millions of Americans has rattled consumers and added to the debate over the health care law. If you or a family member has been notified that your individual policy is being canceled at year’s end, you may be stunned and upset.
Health and Human Services Secretary Kathleen Sebelius said in testimony that the law generally didn’t require insurers to discontinue plans that were in effect at the time of the law’s enactment in March 2010. No one knows how many of the estimated 14 million people who buy their own insurance are getting such notices, but the numbers are substantial. Some insurers report discontinuing 20 percent of their individual business, while other insurers have notified up to 80 percent of policyholders that they’ll have to change plans.
Here’s a guide to help you understand the bigger picture, including why your premiums and benefits are likely to change next year and what you should consider as you shop for a new policy.
Why are these cancellations happening? The health care law targeted the so-called individual market because it didn’t work well for many people who don’t get coverage through employers, particularly those who were older or had health problems. The latter often were rejected for coverage, were charged more or had their conditions excluded from coverage. Some policies provided only the barest of coverage when someone did fall ill.
Starting Jan. 1, insurers no longer can reject people who are sick or charge them more than the healthy under the Affordable Care Act. They also must beef up policies to meet minimum standards and must add benefits such as prescription drug coverage, maternity care and mental health services.
If you got a cancellation notice, most likely your plan didn’t meet all the new standards. Some policies that fail to meet the law’s standards may still be sold if the insurer decides to continue them and if they’re “grandfathered,” meaning that you purchased one before March 2010 and neither you nor the insurer has made any substantial change since then. Adjusting an annual deductible, which many people do each year to keep premiums down, is a change that could end grandfathered status.
How are insurers picking the policies to discontinue? Some consumers fear they’re being targeted because they’re unhealthy or otherwise unprofitable for an insurance company. But insurers say they’re ending policies that don’t meet the law’s standards or weren’t grandfathered.
My insurer says that if I renew before the end of the year, I can keep my current plan. What does this mean? In some states, insurers are offering selected policyholders a chance to “early renew,” meaning they may continue their existing plans through next year, even if they don’t meet all the law’s standards. If you choose this option, your premium might still go up, but the cause would be medical inflation, rather than the need to add benefits because of the health law. Not all states allow early renewals.
Why are premiums changing? Under the old rules, insurers could decide whether to accept you, and how much to charge, based on answers to dozens of medical questions. Starting Jan. 1, insurers no longer can charge women more than men, or reject people who are sick or charge them more. They’re also adding new benefits.
As they drew up the rates for 2014, insurance firms had to make educated guesses about how many customers would stay, how many new ones they would attract, and what the health conditions of those new members might be. Actuaries say that it is possible that older buyers or those who had above-average health problems may find their premiums going down. Younger or healthier people, on the other hand, may find premiums going up, sometimes sharply. Under the new rules, consumers “are not paying based on their own health status, but an average health status,” said Robert Cosway, an actuary with the consulting firm Milliman.
I’m healthy. Why do I have to pay for people who are sick? Except for a fortunate few, everyone is likely to develop some kind of health problem or face an accident sometime in his or her life. Policy experts and regulators say insurance works best when it spreads the risk across a large group of people. Your house may not burn down this year, but you pay for insurance coverage just in case.
What should I do now that I’ve received a cancellation notice? Experts say people should scrutinize the terms of their soon-to-be-discontinued policies and compare them with what new policies offer. The monthly premium is just one factor in cost. Also note the deductible. Is it per person? What’s the maximum deductible if two or more family members fall ill in the same year? Finally, note the annual out-of-pocket cap, which is the maximum you’d pay in deductibles and co-payments for medical care during the year. An independent broker can also show you plans from various carriers.