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October 06, 2015 at 02:48 AM
One of the problems with predicting what will happen to the commercial major medical coverage market during the third open enrollment period, for 2016 coverage, is that health insurers still aren’t completely sure how they did in 2014, let alone how they’ll do in 2015.
See also: Feds: PPACA risk program may pay just 13% of 2014 claims
The open enrollment period for individual coverage for the coming year is set to start Nov. 1 and run until Jan. 31.
That calendar affects all individual coverage sold inside or outside the Patient Protection and Affordable Care Act (PPACA) exchange system.
The PPACA Small Business Health Options Program (SHOP) exchange has a different kind of calendar system. Issuers in the non-exchange group market can set their own rules but may benefit from any buzz, or ail from any blahs, prevalent in the individual market.
See also: PPACA World 2016: Dates, risks, flops
Many exchanges have started to show what their 2016 plan menus will look like through a window shopping mode.
Commercial market issuers, marketers and exchange technology vendors are revving their engines.
“We’re really excited about this open enrollment season,” Mike Baker, general manager for commercial products at hCentive, an exchange technology company, said in a telephone interview.
Some companies have thought hard about the problems insurers and insurance exchanges may face and are counting on those problems to create opportunities.
Managers of Healthcare Inc., the owner of the HealthCare.com lead-generation website, is an example of a company hoping tight budgets give marketers an incentive to economize.
“We deliver consumers when they’re shopping,” Jeff Smedsrud, the chief executive officer (CEO) of Healthcare, said during a visit to New York.
But players in the market are still so uncertain about how the market really works that they continue to struggle to find ways to describe the market.
For a look at five of the wildcards, read on.
1. The three R’s
PPACA calls for the U.S. Department of Health and Human Services (HHS) to buffer health insurers against risk using three major new “three R’s” risk-management program: a temporary reinsurance program, paid for with a broad assessment on health insurers; a temporary risk corridors program, which is supposed to shift money to eligible carriers with poor operating results from carriers with good operating results; and a risk-adjustment program, which is supposed to shift money to carriers with relatively low-risk enrollees from carriers with high-risk enrollees.
See also: S&P sees PPACA risk corridors program funding gap
HHS had trouble even getting the data it needed to calculate the transfers for 2014, and it already says the risk corridors program is likely to have less than 13 percent of the cash it needs to make good on obligations to the insurers that had good operating results in 2014.
The result is that insurers are still not really sure how much their major medical operations earned in 2014.
2. Prices
Health insurance price analysts have struggled to comb through rate filings to come up with 2016 rate forecasts, and to know which numbers to present in what format.
Should analysts look at how much rates for the same plan will change between 2015 and 2016? Should they look solely at silver plans or find some way to deal with bronze, gold and platinum plans? Is they are anything they can do to reflect changes in the enrollees’ out-of-pocket spending maximums? Should they assume enrollees will change plans to get lower prices?
Baker sees prices rising 30 percent to 40 percent in 2016 in the markets he cares about.
The ultimate outcome of the three R’s cash transfer calculations could have unexpected effects on coverage menus and prices, on and off the exchange, but market watchers are cautious about trying to discuss the subject.
