Breaking News
October 21, 2018 - Report reveals growing impact of cannabis on young people
October 21, 2018 - NSF awards $5 million grant to help scientists magnify societal impact of research
October 21, 2018 - Fertility Rates Down for Each Urbanization Level 2007 to 2017
October 21, 2018 - Genetically engineered 3-D human muscle transplant in a murine model
October 21, 2018 - Moms’ tight work schedules may affect their children’s sleep
October 21, 2018 - AHA: No Direct Link Between Preeclampsia and Cognitive Impairment, Study Finds
October 21, 2018 - Weight loss success linked with active self-control regions of the brain
October 21, 2018 - Scripps researchers successfully test potential new smoking-cessation treatment in rodents
October 21, 2018 - More accurate and less stressful way to measure a baby’s heartbeat
October 21, 2018 - Researchers show better cardiorespiratory fitness leads to longer life
October 21, 2018 - Healthy candies for diabetic patients
October 21, 2018 - Environment impact of microplastics remains unclear
October 21, 2018 - Antibiotics for appendicitis? Surgery often not needed
October 21, 2018 - AHA and AMA recognize more than 800 medical practices, health systems for blood pressure control
October 21, 2018 - Scientists obtain clearest ever image of Ebola virus protein
October 21, 2018 - Study reveals connection between two proteins known to be hyperactive in cancer
October 21, 2018 - Gabapentin Beats Pregabalin for Chronic Sciatica
October 21, 2018 - Cosmetic surgeons offering incomplete information for breast augmentation customers
October 21, 2018 - Chronic sleep disruption in early adult life accelerates AD-related tau pathology
October 21, 2018 - Take 10 for Mindfulness – Drugs.com MedNews
October 21, 2018 - Length of breathing disruption in OSA may be better predictor of mortality risk
October 21, 2018 - ApoE4 gene linked with chronic inflammation increases risk for Alzheimer’s disease
October 21, 2018 - Mother-daughter conflict associated with suicide risk in abused adolescent girls
October 21, 2018 - Scientists molding bacteria into unnatural shapes
October 21, 2018 - High diet quality associated with lower risk of death in colorectal cancer patients
October 21, 2018 - Discharged mental health patients ‘at greater risk of dying’
October 21, 2018 - Research provides insight into neurobiology of aggression and bullying
October 21, 2018 - As billions in tax dollars flow to private Medicaid plans, Who’s minding the store?
October 21, 2018 - Neuroscientists identify brain region that appears to be related to food preference decisions
October 21, 2018 - Deaths related to air pollution in the U.S. decreased by 47% between 1990 and 2010
October 21, 2018 - Study shows correlation between spatial memory and the sense of smell
October 21, 2018 - Increased cardiorespiratory fitness associated with reduced long-term mortality
October 21, 2018 - IU researchers receive $1.55 million from NIH to improve chronic-disease management
October 21, 2018 - Income and wealth affect the mental health of Australians, study shows
October 21, 2018 - Patients with hypertension and psoriasis more often require cardiovascular interventions
October 20, 2018 - Leading hip-hop videos depict use of tobacco and marijuana products, study finds
October 20, 2018 - Dose Range of IV Ketamine for Adjunct Tx of Depression Tested
October 20, 2018 - Infants can distinguish between leaders and bullies, study finds
October 20, 2018 - Mad Cow disease found on Aberdeenshire farm
October 20, 2018 - Study identifies factors associated with prescription opioid misuse among students
October 20, 2018 - Scientists uncover key regulator of mTORC1 in cancer growth
October 20, 2018 - Pounds Regained After Weight-Loss Op Can Tell Your Doc a Lot
October 20, 2018 - Sending parents letters to fight childhood obesity doesn’t work
October 20, 2018 - Supervised aerobic exercise can support major depression treatment
October 20, 2018 - Mindfulness-based program effective for reducing stress in infertile women
October 20, 2018 - Molecule capable of halting and reverting neurodegeneration caused by Parkinson’s disease identified
October 20, 2018 - Midazolam-mediated alterations of PER2 expression may have functional consequences during myocardial ischemia
October 20, 2018 - Sweat bees are ideal for studying the genes underlying social behavior
October 20, 2018 - Weight loss success associated with brain areas involved in self-control
October 20, 2018 - KHN’s ‘What the Health?’ Republicans’ preexisting political problem
October 20, 2018 - Research provides a more complete picture of suffering caused by terrorist attacks
October 20, 2018 - Eradicating Helicobacter pylori infections may be a key treatment for Parkinson’s disease
October 20, 2018 - Breast Cancer as a Dynamic Disease
October 20, 2018 - University of Pittsburgh wins NSF grant for big data research to prevent complications from anesthesia
October 20, 2018 - Skin-to-skin contact may promote attachment between parents and preterm infants
October 20, 2018 - Recommendations Developed to Verify NGT Placement in Children
October 20, 2018 - Weight loss can be boosted fivefold thanks to novel mental imagery technique
October 20, 2018 - Children with autism are more likely to be overweight, obese
October 20, 2018 - Nurses making conscientious objections to ethically-relevant policies lack support
October 20, 2018 - Prion strain diversity may be greater than previously thought
October 20, 2018 - Antidepressant treatment may lead to improvements in sleep quality of patients with depression
October 20, 2018 - Study reports increased risk of death in children with inflammatory bowel disease
October 20, 2018 - Number of Autism Genes Now Tops 100
October 20, 2018 - Total diet replacement programmes are effective for treating obesity
October 20, 2018 - CLARIOstar used for fluorescence measurements on CSIRO’s purpose-built research vessel
October 20, 2018 - People with more copies of AMY1 gene digest starchy carbohydrates faster
October 20, 2018 - Case Comprehensive Cancer Center wins NIH grant to study health disparities
October 20, 2018 - Newly discovered compound shows potential for treating Parkinson’s disease
October 20, 2018 - High rate of non-adherence to hormonal therapy found among premenopausal early breast cancer patients
October 20, 2018 - Immunotherapy medicine found to be effective in treating uveitis
October 20, 2018 - The Pistoia Alliance Calls for Greater Collaboration to Realise Benefits of Innovation and Announces Winners of the 2018 President’s Startup Challenge
October 20, 2018 - Female internists consistently earn less than men
October 20, 2018 - Stanford team looks at dangers of teens’ vaping habits
October 20, 2018 - New approach to understanding cancers will accelerate development of better treatments
October 20, 2018 - LJI and UC San Diego awarded $ 4.5 million as part of NCI’s Cancer Moonshot initiative
October 20, 2018 - School-based HPV vaccination did not increase risky sexual behaviors among adolescent girls
October 20, 2018 - Eye discovery to pave way for more successful corneal transplants
October 20, 2018 - New analysis examines the importance of location in the opioid crisis
October 20, 2018 - Green filters increase reading speed for children with dyslexia
October 19, 2018 - Bariatric Sx Cuts Macrovascular Complications in Obesity, T2DM
Churning, confusion and disruption — The dark side of marketplace coverage

Churning, confusion and disruption — The dark side of marketplace coverage

image_pdfDownload PDFimage_print

Every fall, after she has spent months figuring out her insurance plan’s deductibles, doctor networks, list of covered drugs and other fine print, she receives notice that the policy will be canceled as of Dec. 31. Because her job doesn’t come with insurance, “it’s agonizing going through all the plans and trying to compare,” said Weston, 55, who has diabetes and a history of melanoma. “Every year it’s the same scenario: ‘We’re not going to renew your policy.'”

Under the market-based system set up by the ACA, individuals are encouraged to “shop around” each year to find insurance that better suits medical needs and income. In fact — like Weston, a trade association executive in Sulphur, Okla. — they are often forced to do so when plans drop out of the local market or eliminate preferred hospitals and doctors from the network.

The ACA increased the number of Americans with health insurance by 20 million and cut the uninsured rate to about 9 percent.

But the task of finding new insurance annually often undermines the continuity of care for people with ongoing medical needs or chronic conditions. That challenge is immeasurably harder this year as policies change under the Trump administration, spurring unstable networks and turmoil in many state and local markets.

“There’s quite a number of people who are either temporarily uninsured or they move into different plans” each year, said Marianne Udow-Phillips, head of the Center for Healthcare Research & Transformation at the University of Michigan. “And I’m guessing this year that will be much greater, given all the changes that are happening in the marketplace plans.”

Fewer than half of those buying individual coverage in 2014 kept the same plan the following year, according to a Michigan survey done by Udow-Phillips and colleagues. Nearly a third of marketplace enrollees for 2017 were new customers, meaning they had other kinds of coverage before or were uninsured. For the 2018 enrollment season that began on Nov. 1 and ends Dec. 15 in most states, millions of consumers will find themselves switching coverage.

The imperative to shop for insurance affects mostly those who buy insurance for themselves, such as small-business owners and those who are self-employed.

Enrollment for 2018 through online ACA marketplaces has been particularly complicated, due to big premium increases for some plans, the mistaken belief that the health law was fully or partially repealed and the administration’s decision to terminate $7 billion in subsidies.

Many of plans that people relied on for 2017 are being canceled, the result of insurers exiting the marketplaces or redesigning coverage to try to keep premiums down.

Aetna and Humana stopped selling individual marketplace plans for 2018 after losing money on the products. UnitedHealthcare has sharply pulled back. Hundreds of counties have only one marketplace insurer next year, although competition is higher in metro areas.

The average number of carriers selling individual marketplace plans in each state has fallen from five in 2014 to 3.5 next year.

“I wouldn’t call it ideal. It’s what we have,” said Sabrina Corlette, who studies insurance for Georgetown University’s Health Policy Institute. “Ultimately, the consumers have to read the fine print and probably expect that things are going to change from year to year.”

Such instability impedes what was supposed to be the ACA’s other big goal besides coverage expansion. Former President Barack Obama talked of fixing a “broken system” that neglects preventive care, orders billions of dollars in unneeded procedures and shuffles patients among doctors who don’t talk to each other.

The idea was to push insurers to help diabetics improve diets, keep patients on their blood-pressure medication, prevent asthma flare-ups and otherwise improve care and control costs.

Investing in prevention upfront, the thinking went, would pay off for carriers over time as members needed less emergency and inpatient care.

That equation fails when people find themselves with a new policy or a new insurance company each year — or more often.

Insurance churn “is a long-standing problem in the U.S. health care system,” said Benjamin Sommers, a physician and health economist at Harvard’s Chan School of Public Health.

“But there’s a concern that with the ACA you’ve added a whole new layer.” Insurance turnover is especially frequent among lower-income families and those with irregular work.

Unemployed people might be eligible for a plan under Medicaid, which the ACA expanded to most low-income adults in most states. But getting a job and a salary might make them ineligible for Medicaid, bumping them up to a subsidized marketplace plan and a coverage change.

Medicaid, which often comes with its own confusing menu of managed-care plans, generally covers those with the lowest incomes. Subsidized marketplace plans are for medium-income households.

In a 2015 survey by Sommers and colleagues, about a fourth of low-income adults reported they changed coverage during the previous 12 months. That was lower than expected but still problematic, Sommers said.

More than half the switchers had coverage gaps between policies, causing many to report skipped medications and poorer health. Even plan changers with no coverage gap were more likely to swap doctors, to have trouble booking appointments and to seek treatment in the emergency room.

Even though laws in some states allow patients in active treatment to keep doctors from one plan to the next, that’s not a recipe for stable medical relationships or long-term treatment strategies.

“Coming up with the right balance and right approach to a patient’s condition takes time,” said Sommers. “If you wind up with a new set of doctors and new coverage every year, it’s going to make that much harder.”

Cyndee Weston has navigated the shifting ground better than many. For years she has had the same insurer — BlueCross BlueShield of Oklahoma — which has dominated that state’s market for individual plans and is the only marketplace player for 2018.

But even though the carrier is the same and the health law requires insurers to take all comers, canceled plans each year force her to learn a new coverage design, file new paperwork with doctors and worry her primary physician will be dropped from the network.

One year BlueCross “automatically enrolled us into a bronze plan which we didn’t want, so we chose another gold plan,”  Weston said.

Even when insurers stay in a particular market, they often redesign plans from year to year, changing drug coverage or raising out-of-pocket costs to keep premiums as low as possible, Corlette said. As in Weston’s case, that often requires canceling the old plan and having subscribers switch.

“Each year, we assess our plan offerings and make any necessary adjustments to best meet our members’ anticipated health care needs,” BlueCross Oklahoma spokeswoman Melissa Clark said via email.

After Weston’s primary physician left the plan’s network this year, she’s had trouble finding a new one, although the insurer said its physician list has not changed significantly.

“I take some medications, and I worry that if I go to a new doctor they’ll change my medication or it won’t be covered,” she said.

A few weeks ago, she got a new notice from BlueCross saying her current plan is canceled as of Dec. 31. So she’s shopping again.


Kaiser Health NewsThis article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Tagged with:

About author

Related Articles