ACA Provision Allows Some Covered Calif. Enrollees To Switch Plans
Under a provision of the Affordable Care Act, Covered California enrollees can switch plans outside of the exchange's open enrollment period if they were given misleading information from insurers, the Contra Costa Times reports.
Details of Provision
Individuals can obtain health coverage through the insurance exchange during open enrollment periods or after a "qualifying life event," such as moving or getting married or divorced.
However, the "qualifying life event" provision also allows individuals to enroll in coverage or switch plans if they:
- Experience misconduct by insurers; or
- Receive misinformation or incorrect plan data from insurers.
According to the Contra Costa Times, the provision is especially relevant in California, where thousands of state residents have complained that they felt "duped" by insurers over inaccurate lists of physicians and providers on the health plans' websites.
This week, Consumer Watchdog filed a lawsuit against Anthem Blue Cross for allegedly misinforming consumers about the providers included in its exchange plans' networks (Seipel, Contra Costa Times, 7/10). As a result of the alleged misinformation, the lawsuit states that many members received thousands of dollars in unexpected medical bills and were unable to see their preferred physician (California Healthline, 7/9).
The state has been "quietly" implementing the ACA's "qualifying life event" provision and allowing consumers to switch plans over the past several months, according to the Contra Costa Times.
Covered California Response
Covered California spokesperson Dana Howard said the exchange will consider "each and every complaint," but added, "It's not a guarantee just because you had some issues with your plan" you will be able to switch.
Howard said that the exchange has not tracked how many such switches have been made so far but that the exchange has not been overwhelmed with requests from consumers to switch plans (Contra Costa Times, 7/10).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.