UnitedHealth Group (UNH) CEO Stephen Hemsley's announcement on Tuesday -- saying the insurance company would leave all but a handful of state health care exchanges by 2017 -- sparked plenty of the usual debate about the viability of the Affordable Care Act and whether insurers can make money in the exchanges. But for the 795,000 patients who pay for UnitedHealth coverage through an exchange, the most pressing question is, "What do I do now?"
If you're a UnitedHealth customer, the news is important, but no need to panic, said Cynthia Cox, associate director of health reform and private insurance at the Henry J. Kaiser Family Foundation. "For better or worse, exchange consumers have become very savvy shoppers, and this incident is no exception."
First reason to relax: Your coverage for 2016 will continue throughout the year. And unlike some other recent announcements of ACA provider closings, the UnitedHealth news comes well before the open-enrollment period for 2017, which begins Nov. 1. This gives customers time to compare plans.
A possible silver lining? Because UnitedHealth isn't usually the provider offering the lowest-priced plan in a given area, consumers who need to switch may find themselves moving to less-expensive coverage.
UnitedHealth, the nation's largest insurer, focuses mainly on group health insurance offered through employers. After a slow start with the exchanges in 2014, UnitedHealth now has an ACA presence in 34 states, according to an analysis by the Kaiser Family Foundation. Despite the relatively wide reach, a combination of higher risks and higher claims than expected has led to a $650 million loss in UnitedHealth's exchange business.
Overall, however, first-quarter results for UnitedHealth, also announced on Tuesday, beat Wall Street's expectations, thanks to strong performance from the insurer's consulting and technology unit.
The bottom line for consumers, however, is they'll have to hunt for new coverage. As open enrollment approaches later this year, here's what to keep in mind.
Don't necessarily go with the automatic fix.
Because UnitedHealth is making the announcement now, states have time to move people at the start of next year to a similar plan within each exchange, likely with similar coverage and similar pricing. This process is often referred to as mapping.
This can work just fine, but it's important to be sure. Many times your doctors won't be included in the network of the new plan, or the coverage may be slightly different in an area of treatment that may be important to you. Instead of automatically opting for the switch, better to start from scratch and check out every option in your exchange, advises Cox.
Be aware of the competitive landscape in your area.
Thanks to the UnitedHealth pullout, your options may be more limited now, depending on where you live. According to a Kaiser study, if UnitedHealth exited all states, 11 percent of exchange enrollees would be faced with only one insurer choice compared to 2 percent currently.
Cox noted, however, that it's still early -- just days after the announcement. The possibility of other carriers coming in to fill the UnitedHealth void is real and could help keep competition lively. What's more, she said, the vast majority of exchanges still offer three or more choices, the amount experts say is enough to engender healthy competition. The important thing is to stay plugged into your exchange so you know when new providers arrive and what they're offering.
Watch out for subsidy changes.
Two types of subsidies are available for exchange customers. The first, if you qualify based on income, helps cover your premium costs no matter which plan you choose -- platinum, gold, silver or bronze. The second, designed for lower-income people, helps subsidize out-of-pocket health care costs. But you may receive this only if you choose a silver plan (the one that comes with high out-of-pocket costs).
How much subsidy you receive depends on something called the "benchmark" premium, which is based on the second-lowest-cost silver plan in your exchange. The pullout of UnitedHealth silver plans may affect this benchmark and, thus, your premium. "You could get less money or more money," said Cox, "so you've got to keep an eye on it."