Open Enrollment Sets Up a Challenging January 2018

Providers will be on the front lines come January, as the wheels are in motion for confusion and sticker shock during open enrollment this year. Most Americans will face at least a ripple of anxiety or new cost pressures as they grapple with year-end decisions and 2018 realities. Payers have scrambled to anticipate and minimize their risk amid the turmoil of 2017, and provider practices and organizations are where the rubber will meet the road next year.

Front-Desk Friction and Higher Costs
The happenings in Washington, D.C., have led some of the 20 million people enrolled in the Affordable Care Act exchange plans uncertain whether plans are available for 2018. Plans are available for 2018, and there is at least one plan available in every U.S. county. However, the open enrollment period for exchange plans has been shortened to Nov. 1 through Dec. 15, except where extensions have been made in a handful of states.* For most, this means less time to make decisions and a greater chance to miss the deadline.

Providers may face even more than the usual new year challenges. They might experience front-desk friction and confusion among exchange patients who haven’t proactively chosen a 2018 plan and have thus been auto-enrolled in one they don’t necessarily prefer. If a 2017 plan is discontinued in a given market (179 of 420 state rating areas are down to just one insurance carrier), its enrollees will be forced to change plans or lose coverage. Premiums and deductibles could rise dramatically since payers had to set their rates without a clear picture of 2018 costs.

Experts predict 6.5 percent growth in overall healthcare costs for next year. Providers and consumers are likely to absorb some of these costs. The 155 million Americans who receive health insurance through their employers may see higher premiums and deductibles, as well as narrower provider networks.

Patients Overconfident About Insurance Knowledge
Another source of front-desk friction could come as patients cope with more cost-sharing. Patients may not realize just how much they are responsible for until they seek care and that can mean unpleasant surprises at check-in. A 2016 consumer study shows that while respondents are very confident in their health insurance literacy, just 4 percent are able to correctly define the terms deductible, co-insurance, copay and out-of-pocket maximum. Healthcare administrative staff can probably explain these terms in their sleep, but may find themselves educating and re-educating patients. The risk of bad debt and hard feelings associated with this can and should be proactively managed.

Customer Service Part of the Care Equation
Another reason to be especially prepared for January 2018 comes from research on the most common complaints about providers. An analysis of 35,000 online provider reviews shows that 19 out of 20 reviewers with complaints vented about administrative and operational issues. Reviewers appeared to be satisfied with their clinical care, but were far more vocal about wait times, staff demeanor and billing issues.

Take Stock and Take Action
The unique challenges of 2018 will play out against the familiar backdrop of eligibility, health plan and benefit changes that take place every January, which are plenty to deal with in a normal year. There’s still time for providers and healthcare administrators to take stock of their situations and prepare.

To learn more about conquering open enrollment challenges in eligibility and claims, visit the Open Enrollment section of the ABILITY resource center.

*States with extended open enrollment periods are California, Colorado, Connecticut, Massachusetts, Minnesota, New York, Rhode Island, Washington, and the District of Columbia.