What Do I Do If My Health Plan Is Being Cancelled?

If your health plan is being cancelled, here's what you need to know
Got a cancellation notice from your health insurer? Try to enroll in a new plan by December 15, but you can still get coverage after that. Westend61/Getty Images

Hundreds of thousands of people across the country are currently enrolled in health plans that aren't eligible for renewal into 2017. This includes people whose carriers are switching to new plan designs for 2017, as well as people whose health insurance carriers are exiting the exchange entirely (or the whole individual health insurance market) at the end of 2016.

If you're among them, here's what you need to do.

My Plan is ending. What do I do now?

If your plan is ending, rest assured that you'll still have coverage options for 2017. Prior to 2014 in most states, if a carrier pulled out of the market, there was no provision to allow their insureds to pick from any other plan on the market without medical underwriting. But that's changed now that the ACA forbids medical underwriting. During open enrollment, you have your choice of any plan available in your area.

Since general open enrollment is currently going on, your best option will be to select a new plan and finalize your enrollment by the regular enrollment deadline in your state. In all but three states, the deadline is December 15 to get a January 1 effective date.

New for 2017: The exchange can pick a new plan for you

In previous years—even after the ACA had been implemented—there was no provision to allow the exchange to automatically pick a new plan for people whose carriers were exiting the exchange altogether.

But that has changed for 2017. New rules allow the exchange to switch you to a plan from a different carrier if your carrier is exiting the exchange. This was implemented in an effort to prevent people from losing their coverage altogether if they forgot to return to the exchange to select a new plan.

State-run exchanges aren't all on board with this process yet, and even the federally-run exchange (Healthcare.gov) might not be able to make it work in all cases. The regulations specifically said that the FFE (federally-facilitated exchange) "will endeavor to" make this happen for 2017, following a protocol that attempts to pick the plan that's most similar to what you already had.

You'll receive ample notification from the exchange and your health insurer in terms of what to expect for 2017. If your carrier is leaving the exchange or your plan is being discontinued, you'll be notified if the exchange is planning to map you to a new plan. You'll also be notified if that's NOT the case, and informed that your coverage will terminate at the end of December unless you actively pick a new plan. So pay close attention to the notifications you receive from your health insurer and the exchange.

It's important to understand that even if the exchange has said they will map you to a new plan when your current plan ends, you still have the option to go back to your exchange account and pick your own new plan for 2017.

You can do that anytime until the end of January, but if you make your plan selection after December 15, your new coverage won't be effective until February or March, and the plan the exchange picked for you would instead be effective starting January 1 until whenever your own selection takes effect.

What if I miss the December 15 deadline and the exchange isn't mapping me to a new plan?

If your plan is ending on December 31 (and not being automatically replaced with a new plan) and you miss the December 15 enrollment deadline for picking a new plan, it's still possible to get a January 1 effective date, but the process may be complicated. Because your plan is ending, you qualify for a special enrollment period. But the fact that the special enrollment period is concurrent with the general open enrollment period means that the technology involved might not function correctly. The enrollment systems are set up for general open enrollment right now, rather than special enrollment periods. And while most special enrollment periods follow the same deadlines and effective dates as general open enrollment, that's not the case for special enrollment periods that are triggered by loss of other coverage

When loss of coverage triggers the special enrollment period, the new plan is effective the first of the month following the month when you enroll. So a person whose plan is ending December 31 could technically apply on December 31 and have coverage effective January 1. But this could be a complicated process, and should definitely not be something you plan to do. Again - the best course of action is to enroll in a new plan by December 15. But if your plan is ending and you miss that deadline, here's what to do:

  • Contact a broker, the exchange in your state, or the carrier you're using if you're enrolling off-exchange. You will need assistance with this process, and you'll want a paper trail in case there are glitches.
  • Make sure your enrollment is completed using a special enrollment period and NOT the general open enrollment period (which would push your effective date to February 1 if you enroll in the second half of December).
  • Be aware that you may need to complete a paper application, as some carriers may not have the technological capabilities to allow for an online special enrollment to occur during the general open enrollment period.
  • Be prepared for delays. If you enroll on December 31, you are obviously not going to have your new plan and ID cards by January 1. Your coverage will eventually be finalized and back-dated to January 1, but if you need care in January, you may have to pay for it up-front and seek reimbursement from your health insurance carrier.

Clearly, the best course of action is to enroll using the general open enrollment parameters, and finish by December 15. But if something comes up that prevents that, you'll still be able to get coverage for January 1, albeit with a few more hoops to jump through.

What if I have coverage outside the exchange?

If your carrier is exiting the market altogether, there's no provision for anyone to map you to a new plan outside the exchange.

If your carrier is simply discontinuing your plan but replacing it with new options, they will likely offer to switch you to a new plan, without you having to do anything. But again, your best bet is to actively select your own new plan for 2017, even if your carrier is offering to pick one for you.

The same open enrollment schedule is followed outside the exchange; plan selections for 2017 must be completed by January 31, and enrollment will not be available after that unless you have a qualifying event.

Sources:

Department of Health and Human Services. Patient Protection and Affordable Care Act, Notice of Benefit and Payment Parameters for 2017.

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