CMS New Rules: It's A Whole New Ball Game

[Duaine]

Be sure to read all of this PDF. It's now allowed for a client to change plans "like to like" such as Silver Plan to Silver Plan by calling the insurance company.


Look at Bulletin #5 for issued plan changes.


Lots of good nuggets here:

 

[AllenChicago]

Thanks for finding and posting this document, Duaine. It looks like a lot of plan changes have to be made through the Marketplace call center. Hopefully this won't erase the "agent of record" for the account.

Also, how in the hell is every insured supposed to be made aware of what needs to be reported to the marketplace? Maybe the Marketplace will send this 14 page document to every insured via e-mail or snail-mail. It will confuse the daylights out of them, just like some parts of it are doing to me right now.

Some changes are to be done through the insurer..some through the marketplace...holy crappola. Lots more work (and expense) for insurers and even greater confusion for policyholders, going forward. With all the turmoil, snafu's, delays, extensions, glitches, IRS requirements, etc., consumers will BEG for cradle-to-grave Medicare. Just what Obama-Reid-Pelowsi want.
ac


BTW..the new rule that allows an insured to change from one plan to another within the same metal level is custom made for one of my clients. BCBS-IL is just sitting on his plan change request, because he's already paid the Jan and Feb premium. This new rule should get them moving on his request. In fact, I'll fax it to Policyholder services tomorrow to let them know that they have the green light from CMS to do his Silver-to-Silver change. Thanks again Duaine!

 

[cadylou]

My bet is that the changes made through the govt call center will lose the agent of record data . . . . .not to be cynical . . . .

 

[RayNY]

AC, are you sure that the silver>silver change is to a plan with a "better" network?

Remember, you have to meet ALL criterea, the 3rd of which is "Change is made in order to move to a plan with a more inclusive provider network... (...or a reason CMS approves)"

If they use the same network, that seems like a no-go.

 

[AllenChicago]

AC, are you sure that the silver>silver change is to a plan with a "better" network?

Remember, you have to meet ALL criterea, the 3rd of which is "Change is made in order to move to a plan with a more inclusive provider network... (...or a reason CMS approves)"

If they use the same network, that seems like a no-go.

Ray, he meets all the requirements. In his current Blue Cross Silver plan, there is 1 hospital within 10 miles of his home, which is 6 miles away. The Blue Cross Silver plan we're converting to has 6 in-network hospitals within 10 miles of his home, with the closest being 2 miles away.

The plan we're converting to is $654 per month, compared to the skimpy-network plan, which is $485 per month. He's willing to pay the additional premium for the peace-of-mind. The skimpy network plan was designed for people who live within a few miles of Chicago. It contains 95% of all Chicago hospitals and physicians, but drops off rapidly when you're 15 or more miles away from downtown. Blue Cross doesn't tell applicants this.... but that's another story, not for this thread.
ac

 

[Yagents]

So, I need some help with those of you with recent experience.
New client with eff date of 2/1/14
APTC = $150/mo
Gold Plan = $380 final reduced premium

2/3/14 - had a brain aneurysm, still in hospital. Hit 4k OOP already.
Won't be able to work, can't afford $380 premium.

He needs more tax credits to keep policy......
Can he get more APTC for March?
Must this be done by calling or online at HC.gov with new life change button?

 

[hamben]

Reading that document there is a section that allows for a authorized representative change. does anyone know if companies are accepting agent of record changes? Im not talking from agent to agent. im thinking more of the insured's who were dumb enough to do this themselves or with a navigator. Ill be happy to fix the messes if they can make me agent of record. Im sure they wont allow it but just wondering..

 

[AllenChicago]

So, I need some help with those of you with recent experience.
New client with eff date of 2/1/14
APTC = $150/mo
Gold Plan = $380 final reduced premium

2/3/14 - had a brain aneurysm, still in hospital. Hit 4k OOP already.
Won't be able to work, can't afford $380 premium.

He needs more tax credits to keep policy......
Can he get more APTC for March?
Must this be done by calling or online at HC.gov with new life change button?

Appenix "A" in the document that Duaine used to start this thread says that an expected 2014 income change is to be reported to the Marketplace. Logically, one should be able to hit the "Life Change" button, enter the new expected income, and receive a larger/smaller ATPC-Subsidy for the following month.

Since this is so new, I don't think anyone has any experience with it yet. You could call the Marketplace and see what they say. As of late, their level of competence has been on the increase.
ac

 

[taterpeeler]

Appenix "A" in the document that Duaine used to start this thread says that an expected 2014 income change is to be reported to the Marketplace. Logically, one should be able to hit the "Life Change" button, enter the new expected income, and receive a larger/smaller ATPC-Subsidy for the following month.

Since this is so new, I don't think anyone has any experience with it yet. You could call the Marketplace and see what they say. As of late, their level of competence has been on the increase.
ac

Well Allen, I do have the experience with it...

 

[AllenChicago]

Well Allen, I do have the experience with it...

Then by all means Tater, you're eminently qualified to respond to YAgents regarding his client. I'm sure he'll appreciate your advice and instruction.