Controversy Around Reporting Health Plan Changes

Looming frustration within the insurance industry from consumers, agents & brokers about the procedures and processes of making policy changes and updates for consumers to their health plans.

In the past, consumers would be taken through multiple hurdles to acquire policy changes for their federal or local marketplace insurance plans. A consumer would reach out for assistance through these designated channels and would be sent through a plethora of referral channels before finally receiving the answers they needed about making the appropriate changes to their policies.

As of March 2025, consumers may now request changes to their federal marketplace coverage policies directly through their accounts. This change also comes with the update of consumers now being able to report immediately when their Medicare coverage is scheduled to begin.

 With these changes, you would still need to be careful not to double coverages if that is not your intention. Why doesn’t the Federal Marketplace or State Marketplace simply prevent the doubling of coverage? The answer is simple yet can come across as complicated. Since the federal or state marketplaces do not possess the power to deny health insurance coverage to those deemed eligible, this creates a “loophole” for doubling coverage. Meaning, those eligible for coverage, if the consumer requests to have coverage that is more than sufficient, they maintain the right to double coverage in essence paying for multiple policies at once.

Doubling coverage can also lead to issues with taxation. If coverage is doubled, and you received premium tax credits (PTC), or advance premium tax credits (APTC), you could potentially owe money back to the IRS or your state’s treasury due to the fact that you may have received tax credits above what you were eligible for within your tax bracket. Read our latest JHN FINANCE Insurance blog post on how taxes impact health insurance.

Though these changes account for a big win for consumers, there is still much work to be done. As of right now, certain Special Enrollment Periods still must be reported directly through the appropriate state, federal, or county administrators such as the birth of a newborn, or adoptions. This is because the proration dates must be applied appropriately to the designated start date of the birth or adoption allowing 60 Days to complete enrollment into the health plan available. Similarly, Disaster Special Enrollment Periods are subject to those synonymous reporting requirements for plan changes.

Further work must be done about the deductibles the consumers paid prior to the request of policy update as it is currently considered a policy “change”. Therefore, previous copays, coinsurance, deductibles may not be applied to the new policy thereafter coverage changes are made. This has caused frustrations and heated discussions in the industry. But many agents and brokers are hopeful that changes will come in the future if they continue to be vocal on the behalf of the consumers.

Story Published & Released: Jacob Hollingsworth Network Corporation Publishing

Images are exclusive property of Jacob Hollingsworth Network Corporation©. JHN EXCLUSIVE© Jacob Hollingsworth Network Corporation Trademark rights are reserved.