Can I change to another Carrier now that I may be losing my providers with Community Health Options?

Community_Health_Options_Logo_RGB_HighRezSomeone who is enrolled on a Community Health Options (CHO) plan through the individual market may switch to a new plan during the course of the year if they experience a Special Enrollment Period (SEP), otherwise they must wait until Open-Enrollment 2017 (November 1, 2016 to January 31, 2017) to select a new plan for 2017. On the other hand, there is more flexibility in the group market if a group administrator decides the plan is no longer working for their group. We can work with groups on a case-by-case basis if they decide they need to make a move.

CHO is a co-op, it operates under different rules than a traditional insurance company and is directly accountable to The Center for Medicare and Medicaid services (CMS). If CMS determines that CHO’s financial stress is a clear and a present danger to existing policyholders they would allow all of the members of CHO a special enrollment period (SEP) to find other coverage. This has happened with some of the other co-ops that failed or, were on the verge of failing in other parts of the country. At that time, CMS would notify all affected members of their eligibility to move to another carrier. Fortunately, CHO has not reached this point as of yet. The recent newspaper article printed in the Union Leader pointed out the fact that CHO is being monitored with heightened supervision by both CMS and the Maine Department of Insurance due to the losses they sustained last year and projected losses they expect for this year.

Behind the scenes, CHO is telling brokers, including myself, that they are working through their problems and have a plan to get back to financial health. For example, they have raised their group rates substantially and have discontinued writing individual business as of December 15th, 2015. They have also changed their network in New Hampshire, and are no longer allowing members to utilize the First Health Network as an in network provider;  unless, they are outside the states of Maine and New Hampshire. In Maine & New Hampshire, members must utilize doctors that are directly contracted with CHO in order to be considered in-network. Lastly, they have implemented some administrative cost-cutting measures. They believe that all of these steps together will steer the company back on track to be sustainable and competitive in the long term.

In conclusion, take comfort in the fact that two regulators are monitoring this situation; the State of Maine Department of Insurance and CMS. They are requiring CHO to report their financials on an ongoing basis, and continue to closely monitor them from a financial standpoint. If CHO should fail its financial obligations to consumers, then it’s reasonable to expect CMS to protect all of the affected members, as they have done historically with the 12 co-ops that have already gone out of business over the last two years.